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Chronic Bronchitis

Chronic bronchitis is a condition characterized by excessive tracheobronchial mucus production and cough that are present for at least three months of the year for two consecutive years. Chronic bronchitis may develop as an independent disease entity, or it may be present as a co-morbidity in diseases such as chronic obstructive pulmonary disease and asthma.

Chronic bronchitis is associated with pathological enlargement of the mucus-producing glands found in the submucosa of the large airways. The etiology of this enlargement is not fully understood, although environmental, genetic, and inflammatory processes have all been implicated.

Airway clearance indications associated with chronic bronchitis include:

• Mucus hypersecretion: In the normal lung, ciliated cells line the epithelium from the bronchioles to the trachea. A thin mucus blanket covers the cilia, which beat in a coordinated fashion, propelling mucus toward the pharynx. This mucociliary escalator serves as the primary defense mechanism for the lung, trapping inhaled particles, transporting them out of the lung, and maintaining a sterile environment. Mucus hypersecretion overwhelms the mucociliary apparatus and results in secretion retention.

• Impaired mucociliary apparatus: If the mucociliary escalator is impaired, inhaled particles and bacteria are not adequately cleared from the lung. The resulting irritation can lead to additional secretion production initiating a vicious cycle of mucus obstruction, recurrent pulmonary infection, bacterial colonization, and progressive pulmonary compromise.

Aggressive bronchial hygiene, including daily Airway Clearance Therapy, is an essential component in the management of patients with pulmonary complications from chronic bronchitis. Conscientious attention to daily secretion clearance may prevent or minimize the pulmonary complications associated with this disorder.

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Sources

1. Honig EG, Ingram RH: Chronic Bronchitis, Emphysema, and Airways Obstruction. In: Fauci AS, Braunwald E, Isselbacher KJ, et al. Harrison's Principles of Internal Medicine. 14^th edition. New York, NY: McGraw-Hill Book Co; 1998: 1451-1453.