1. SHAHD ALALI
CHRONIC BRONCHITIS

2. • It is characterized by a chronic productive cough
lasting at least 3 months over a minimum of 2 years.
• Common among smokers
• Most have both emphysema & chronic bronchitis
• Early stages of the disease:
• Productive cough
• Mucoid sputum

3. ETIOLOGY
• Smoking
• Air pollutants
• Sulfur dioxide
• Nitrogen dioxide
• Cystic fibrosis
• Coexistent emphysema
• Experimental evidence: Increase transcription of
mucin gene

4. PATHOGENESIS
• Charactirized by hypertrophy of bronchial mucinous
glands thus hypersecretion of mucus
• Increased thickness of mucus glands (Reid index
increases to >50%)
• Casing inflammation (CD8+, lymphocytes….
• In contrast with asthma there are no eosinophils
• Microbial infection often is present

6. MORPHOLOGY
• Large airways gross specimens:
• Hyperemic
• Swollen by edema fluid
• Covered by a layer of mucinous secretion
• Increase of goblet cells
• Histological examination of trachea & bronchi:
• Enlargement of mucus-secreting glands
• Inflammatory cells (mononuclear / mixed with
neutrophils)

7. • Chronic bronchiolitis:
• Goblet cell metaplasia
• Mucous plugging
• Inflammation
• Fibrosis

10. CLINICAL FEATURES
• Prominent cough & production of sputum
• Cyanosis “Blue bloaters”
• Increase risk of infection
• Tend to be stocky or obese
• Wheezing
• Hypoxemia
• Dyspnea

11. PULMONARY FUNCTION TEST
• Less increased TLC & RV than emphysema
• Chronic respiratory acidosis

12. COMPLICATIONS
• Respiratory failure
• Cor pulmonale