Chronic bronchitis is an inflammation of the bronchial tubes characterized by mucus production and breathing difficulties, impacting approximately 3.49% of adults over 35 in India. It can be acute or chronic, with acute cases often following viral infections and chronic cases resulting from long-term irritants like smoking and air pollution. Management includes rest, hydration, medications such as antibiotics and bronchodilators, and addressing complications like pneumonia and COPD.

2. Introduction
It is a condition where the lining of bronchial
tubes become inflamed or infected. It have
reduce ability to breath in air & oxygen into the
lungs, they have also heavy mucus forming in the
airways.
Incidence
The recent 'Indian Study of Asthma, Respiratory
Symptoms and Chronic Bronchitis' study of
85,105 men and 84,470 women from 12 urban
and 11 rural sites reported the incidence of
chronic bronchitis to be 3.49% (4.29% in males
and 2.7% in females) in adults > 35 years.

4. Normal mechanism of inflammation
Infection enter into the body
Chemical release from WBC are released into the
blood or affected tissue to protect your body from
foreign substances
This release of chemicals increases the blood flow to
the area of injury or infection
may result in redness and warmth
Some of the chemicals cause a leak of fluid into the
tissues, resulting in swelling
This protective process may stimulate nerves and
cause pain

5. Definition
It is an inflammation and swelling of the
bronchial tubes (bronchi), the air passage
between the lungs.
Anatomy of Bronchi
Trachea divide it form two primary bronchi
Right bronchus – this is wider, shorter &
more vertical then the left bronchus. It is
approximately 2.5 cm long. After entering
into the right lung it divide into three
branches, one to each lobe. Each branches it
subdivided into numerous smaller branches.

6. Left bronchus – 5 cm long, & narrower then
the right. After entering into the lung it divide into
the two branches , one to each lobe, each branch
then subdivide into the numerous smaller branches.
Structure – it lined with ciliated columnar
epithelium. The bronchi progressively subdivide into
the bronchioles, terminal bronchioles, respiratory
bronchioles, alveolar duct & finally alveoli.
In trachea & bronchi cartilages, ciliated epithelium,
goblet cells is present, at the bronchiolar level
there is no cartilage it replace with smooth muscle,
ciliated replaced with non-ciliated epithelium &
goblet cell disappear.

8. Types
1. Acute – it is a shorter illness that commonly
follow a cold or viral infection such as flu.
It consist of a cough with mucus, chest
discomfort, throat soreness, fever,
shortness of breath. It is usually a last a
few days or weeks (1-3 week).
2. Chronic – it is a serious ongoing illness, it is
a persistent, mucus producing cough that
last longer then three month. The person is
having severe breathing difficulties & it may
get worsen. It occurs with emphysema and
it may become COPD.

11. Etiology
1. Acute – It is caused by virus, the same
virus that cause cold & flu. It can be
caused by bacterial infection & exposure to
substance that irritate the lungs such as
tobacco smoke, dust, fumes, vapours & air
pollution.
2. Chronic – it is caused by repeated irritation
& damage of the lungs & airway tissue.
Smoking is most common cause with other
causes including long term exposure to air
pollution, dust & fumes from the
environment & repeated episodes of acute
bronchitis.

12. Etiology
• Etiologic agent – bacteria, virus
• Predisposing factor (contribute to the
problem)– smoking, long term illness,
immune deficiency and immobilization.
• Precipitating factor (trigger the
problem)– hospitalization, environment,
smoking and malnutrition.

14. Clinical manifestation
Sign & symptoms for both acute and chronic bronchitis.
• Persistent cough
• Production of mucus which can be clear, white,
yellowish gray or green in color, rarely it may be
streaked with blood.
• Crackles and Wheezing sound
• Low fever, chills, Headache
• Chest tightening
• Sore throat, dyspnoea
• Blocked nose & sinuses

16. Diagnostic evaluation
• History
• Physical examination
• Chest x-ray
• Sputum– for gram stain, culture and
sensitivity test may be obtained to
determine presence of bacterial infection.
• Pulmonary function test by using spirometer
– to determine peak expiratory flow
(person's maximum speed of expiration)
• ABG Level

17. Management
People with bronchitis are instruct to rest, drink
fluid, breath warm & moist air, & take OTC
cough suppressant & pain relieve in order to
manage symptoms & ease breathing.
Many case of acute condition may go away without
any specific treatment, but there is a no cure
for chronic condition.
To keep bronchitis symptoms under control &
relieve symptoms, doctor may prescribe –
Antibiotics – Azithromycin, for 7-10 days
Antitussive – Codeine for suppressing the cough

18. Bronchodilators – To dilate the bronchi
• Beta2-adrenergic agonist agents – Salbutamol,
Terbutaline
• Anticholinergic agents – Ipratropium bromide
• Methylxanthines – Theophylline
Mucolytics - e.g. Acetylcysteine to thin the secretions.
Corticosteroids – Dexamethasone, Methylprednisolone to
relieve the inflammation
Antipyretics - for fever
Other - Oxygen therapy, Pulmonary rehabilitation program,
chest physiotherapy, nutritional therapy

19. Additional behaviour remedies include –
• Removing the source of irritants from the
lungs
• Using a humidifier – loosen mucus
• Exercise
• Breathing exercise – pursed lip breathing

20. Complication
• Pneumonia
• Asthma
• COPD

21. 1. Nursing diagnosis – ineffective airway clearance
related to thick mucus discharge as evidence by
presence of rhonchi, cough and tachypnea.
Nursing goal – Improve airway clearance
Intervention - Place the patient laterally and
recumbent to help maintain an open airway and drain
the secretion.
• Provide oxygen to decrease her laboured breathing.
• Observe the oxygen therapy delivery system every
hourly.
• To clear the thick mucus, use humidifier and
suctioning.
• Use cough medicine.

22. 2. Nursing diagnosis – Impaired respiratory
functioning related to ineffective breathing pattern
as evidence by increased respiratory rate.
Goal – To improve the respiratory functioning
Intervention - Always stay with patient to reduce
the anxiety.
• To give instruction regarding the pursed lip &
diaphragmatic breathing to assist with slowing
respiratory rate.
• To provide water to drink help in loosen the secretion
& lessen the dryness in mucus membrane.
• To provide oxygen therapy.
• To provide suctioning help in removing the secretion.

23. 3. Nursing diagnosis – acute pain related to
inflammation, cough as evidence by report of
discomfort and facial expression.
Goal – To relieve the pain
Intervention
• Administer acetaminophen medication.
• Monitor vital sign for respiratory suppression
associated with pain medication.
• To apply pillow to chest while coughing.
• Help the patient increase level of comfort in hospital
bed by elevating the head of the bed, to help assist
in less painful breathing.

24. Research study
Smoking Cessation and Lung Function in Mild-to-
Moderate Chronic Obstructive Pulmonary Disease
It was conducted at 10 North American medical centres, we
studied 3,926 smokers with mild-to-moderate airway
obstruction randomized to one of two smoking cessation
groups. We measured lung function annually for 5 yr.
Participants who stopped smoking experienced an
improvement in FEV1 (forced expiratory volume) in the
year after quitting. The subsequent rate of decline in FEV1
among sustained quitters was half the rate among
continuing smokers, 31 ± 48 versus 62 ± 55 ml (mean ± SD),
comparable to that of never-smokers. Smokers with
airflow obstruction benefit from quitting despite previous
heavy smoking.