Chronic bronchitis: Difference between revisions

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==Treatment==
==Treatment==
[[Chronic bronchitis medical therapy|Medical therapy]] | [[Chronic bronchitis surgery|Surgical options]] | [[Chronic bronchitis primary prevention|Primary prevention]]  | [[Chronic bronchitis secondary prevention|Secondary prevention]] | [[Chronic bronchitis cost-effectiveness of therapy|Financial costs]] | [[Chronic bronchitis future or investigational therapies|Future therapies]]
[[Chronic bronchitis medical therapy|Medical therapy]] | [[Chronic bronchitis surgery|Surgical options]] | [[Chronic bronchitis primary prevention|Primary prevention]]  | [[Chronic bronchitis secondary prevention|Secondary prevention]] | [[Chronic bronchitis cost-effectiveness of therapy|Financial costs]] | [[Chronic bronchitis future or investigational therapies|Future therapies]]
==Diagnosis==
A [[physical examination]] will often reveal decreased intensity of breath sounds, wheeze ([[rales]]) and prolonged [[Exhalation|expiration]].  Most doctors rely on the presence of a persistent dry or wet cough as evidence of bronchitis.
A variety of tests may be performed in patients presenting with cough and shortness of breath:
* Pulmonary Function Tests (PFT) (or [[spirometry]]) must be performed in all patients presenting with chronic cough. An [[FEV1]]/[[FVC]] ratio below 0.7 that is not fully reversible after bronchodilator therapy indicates the presence of [[COPD]], that requires more aggressive therapy and carries a more severe prognosis than simple chronic bronchitis.
* A [[chest X-ray]] that reveals hyperinflation; collapse and consolidation of lung areas would support a diagnosis of [[pneumonia]]. Some conditions that predispose to bronchitis may be indicated by chest radiography.
* A sputum sample showing [[neutrophil granulocyte]]s (inflammatory white blood cells) and [[microbiological culture|culture]] showing that has pathogenic microorganisms such as [[Streptococcus|Streptococcus spp.]]
* A [[blood test]] would indicate inflammation (as indicated by a raised [[white blood cell]] count and elevated [[C-reactive protein]]).
*Neutrophils infiltrate the lung tissue, aided by damage to the airways caused by irritation.
*Damage caused by irritation of the airways leads to inflammation and leads to neutrophils being present
*Mucosal hypersecretion is promoted by a substance released by neutrophils
*Further obstruction to the airways is caused by more goblet cells in the small airways. This is typical of chronic bronchitis
*Although infection is not the reason or cause of chronic bronchitis it is seen to aid in sustaining the bronchitis.'''''


==Treatment==
==Treatment==

Revision as of 19:54, 27 January 2012

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

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History and Symptoms | Physical Examination | Staging | Laboratory tests | Electrocardiogram | X Rays | CT | MRI Echocardiography or Ultrasound | Other images | Alternative diagnostics

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Treatment

Antibiotics

For acute exacerbations of chronic bronchitis, if antibiotics are used a meta-analysis found that "amoxicillin/clavulanic acid, macrolides, second-generation or third-generation cephalosporins, and quinolones" may be more effective.[1]

Bronchodilators

For acute exacerbations of chronic bronchitis, a clinical practice guideline by the American College of Physicians found that bronchodilators may help.[2]

Corticosteroids

For acute exacerbations of chronic bronchitis, a clinical practice guideline by the American College of Physicians found that corticosteroids may help.[2]

Smoking cessation

References

  1. Dimopoulos G, Siempos II, Korbila IP, Manta KG, Falagas ME (2007). "Comparison of first-line with second-line antibiotics for acute exacerbations of chronic bronchitis: a metaanalysis of randomized controlled trials to Joe Fo Sho". Chest. 132 (2): 447–55. doi:10.1378/chest.07-0149. PMID 17573508.
  2. 2.0 2.1 Bach PB, Brown C, Gelfand SE, McCrory DC (2001). "Management of acute exacerbations of chronic obstructive pulmonary disease: a summary and appraisal of published evidence". Ann. Intern. Med. 134 (7): 600–20. PMID 11281745.

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