Chronic Bronchitis and COPD

Chronic Bronchitis
Chronic bronchitis: a clinical diagnosis
requiring patients to have a chronic cough
productive of sputum for at least 3 months a
year for at least 2 consecutive years in the
absence of other diseases
However, only a minority of patients with
chronic bronchitis develop clinically significant
airway obstruction
 Chronic Bronchitis
There is a strong familial association of COPD due
to chronic bronchitis, but the underlying genetics
are unknown

Note: Abnormalities of cytokines and pro-

inflammatory mediators are believed to play
an important etiologic role

In patients with established chronic bronchitis,

viral or bacterial infections are a common cause
of acute exacerbations
 Chronic Bronchitis and COPD
The hallmark and earliest feature of chronic
bronchitis is hypersecretion of mucus in the large
airways, and it is associated with hypertrophy of
the submucosal glands in the trachea and bronchi
As chronic bronchitis persists, there is also a
marked increase in goblet cells of small airways -
- small bronchi and bronchioles--leading to
excessive mucus production that contributes to
airway obstruction
 Chronic Bronchitis and COPD
This accompanying alterations in the small
airways of the lung (small bronchi and
bronchioles, <2 to 3 mm in diameter) can
result in physiologically important and early
manifestations of chronic airway obstruction
Chronic Bronchitis and COPD
 Effects on Lung Capacities

Note: Chronic bronchitis have no or little effect on spirometry

 Effects on Lung Capacities

Tests of overall lung mechanics such as the FEV1 and

airways resistance are usually abnormal in patients with
COPD when dyspnea develops
Residual volume, FRC, and TLC, in some cases, is increased
Moreover, ventilation-perfusion ratio (V/Q) mismatching is
the most important cause of impaired pulmonary gas
exchange in COPD
Decreased pO2
Normal Values: 75 -100 mmHg
With chronic Bronchitis: 4560 mm Hg
Increased pCO2
Normal values: 3545 mm Hg
With chronic bronchitis: 50-60 mmHg