CHRONIC BRONCHITIS

Definition
Chronic bronchitis is defined as excessive sputum production and cough of at least 3 months in duration
occurring 2 years in a row. Is a type of COPD, in which there is inflammation and irritation of the bronchial
tubes. These tubes are the airway that carries air to and from the air sacs in the lungs.

Etiology/Risk factors
Modifiable
● Smoking - This is the main risk factor. Up to 75% of people who have chronic bronchitis smoke or used
to smoke.
● Long-term exposure to other lung irritants - such as secondhand smoke, air pollution, and chemical
fumes and dust from the environment or workplace.
● Exposure to cold and damp environments

Non-Modifiable
● Genetics - This includes alpha-1 antitrypsin deficiency, which is a genetic condition. Also, smokers who
get chronic bronchitis are more likely to get it if they have a family history of COPD.
● Age - Most people who have chronic bronchitis are at least 40 years old when their symptoms begin.

Epidemiology
● Men>women between the ages of 45-65 years old

Airways

● SINUSES are hollow spaces in the bones of your head above and below your eyes that are connected
to your nose by small openings. Sinuses help regulate the temperature and humidity of inhaled air.
● The NOSE is the preferred entrance for outside air into the respiratory system. The hairs lining the
nose's wall are part of the air-cleaning system.
● Air also enters through the MOUTH, especially for those who have a mouth-breathing habit, whose
nasal passages may be temporarily blocked by a cold, or during heavy exercise.
● The THROAT collects incoming air from your nose and mouth then passes it down to the windpipe
(trachea).
● The WINDPIPE (trachea) is the passage leading from your throat to your lungs.
● The windpipe divides into the two main BRONCHIAL TUBES, one for each lung, which divides again
into each lobe of your lungs. These, in turn, split further into bronchioles.

Pathophysiology
During an episode of acute bronchitis, the cells of the bronchial-lining tissue are irritated and the mucous
membrane becomes hyperemic and edematous, diminishing bronchial mucociliary function. Consequently, the
air passages become clogged by debris and irritation increases. In response, copious secretion of mucus
develops, which causes the characteristic cough of bronchitis.

Chronic bronchitis is associated with excessive tracheobronchial mucus production sufficient to cause cough
with expectoration for 3 or more months a year for at least 2 consecutive years. The alveolar epithelium is both
the target and the initiator of inflammation in chronic bronchitis.
Clinical Manifestations
The clinical presentation can be an increased exacerbation rate, accelerated decline in lung function, worse
health-related quality of life and an increase in mortality.

● Wheezing, particularly breathing out

● Breathlessness when resting or active
● Tight chest
● Cough
● Producing more mucus or phlegm than usual

These symptoms would be persistent for at least 3 months a year for 2 consecutive years to be considered
Chronic Bronchitis.

Diagnostic and Imaging Tests:

● Blood test: This is to see if your symptoms could be due to anemia, or to see if the symptoms
are due to the genetic marker alpha-1-antitrypsin deficiency.
● A chest x-ray in the elderly and when physical findings suggest pneumonia is important.
● A culture of the sputum when a bacterial infection is suspected is indicated.
● The additional investigations which are a helpful measurement of oxygen saturation, and
pulmonary function tests (eg. Spirometry).

Differential Diagnosis:

Disease Findings

Congestive Heart Failure Features with orthopnea, paroxysmal

nocturnal dyspnea, fine crackles on
auscultation, and chest x ray findings of
cardiac enlargement and pulmonary
congestion (Kerley B lines, and pleural
effusion)

Bronchiectasis Presents copious purulent sputum,

coarse crackles, clubbing and CT
findings suggestive of bronchiectasis

Asthma Presents with cough, dyspnea and

wheezing and typically is a chronic
condition which has started from
childhood
Bronchiolitis obliterans Has history of collagen vascular
disease, usually young patient without a
history of smoking and CT scan shows
finding of mosaic attenuation and no
evidence of emphysema

Pneumonia Presents with acute fever, cough and

shortness of breath, although
pulmonary infiltrate on chest X-ray is an
imaging finding

Course and Prognosis

Chronic bronchitis is a progressive condition, meaning it gradually worsens over time. There is no
cure, but the prognosis can be significantly improved through managing the condition via medication
and lifestyle changes. However, in cases where an individual continues to smoke, where there is a
considerable drop in lung function or where complications occur, the prognosis is generally poor, with
patients typically given a life expectancy of five years or under.

Medical Treatment

The chosen treatment route will depend on the severity of the condition.

● Bronchodilator: A medicinal substance breathed in through an inhaler which helps open up the
bronchial tubes and aids breathing.
● Theophylline: Particularly useful for treating shortness of breath, this oral medication relaxes
the muscles in the airways in order to help with breathing. Usually, this is only used under
direct medical supervision, in a clinical setting.
● Steroids: Corticosteroids help bring many of the condition’s symptoms under control,
specifically by reducing both mucus production and the inflammation of the bronchial tubes.

OT Theoretical Foundations (Models and FORs):

Rehabilitative frames of reference - This FOR focuses on compensating for the skills that
can not be remediated anymore. This FOR will be used to be able to use alternative
interventions, task modification techniques, work simplification techniques for the patient
to still be able to perform IADL independently and prevent him from exerting too much
energy despite his condition.

Biomechanical frames of reference - This FOR will be used as the patient still has the
ability to perform smooth, isolated movements that can help to improve the patients
ROM, strength and endurance with the use of purposeful activities.

Cognitive Behavioral frames of reference - as patients who experienced this kind of

condition, most of them would feel unsatisfied with their life, and performance in their
ADLs, with this FOR influencing their mind to affect their behavior for the client to be
motivated to do the activities to improve function in ADLs and their quality of life. This
FOR can be used in conjunction with an occupation-focused conceptual model such as
Model of Human Occupation, to enhance a detailed understanding of clients’ occupational
performance and occupational identity needs.