Bronchitis is an obstructive pulmonary disease characterized by a chronic cough and excessive mucus production, often caused by smoking and environmental pollutants. Key clinical manifestations include a persistent productive cough, dyspnea, and potential respiratory failure, with diagnostic evaluations involving history collection, physical exams, and pulmonary function tests. Management focuses on symptom relief through antibiotics, bronchodilators, and rehabilitation programs aimed at improving patient outcomes and quality of life.

1. BRONCHITIS
SHILPASREE SAHA,
Assistant Professor, JVWU

2. Introduction
• Bronchitis is an obstructive pulmonary disease , characterized by chronic
cough and excessive production of mucus and is present for most days of
at least 3 months of the year for 2 or more consecutive years.1 Varying
degrees of fixed obstruction of airway are reported in many patients with
chronic bronchitis.2

3. • Chronic airway irritation
Impaired mucocilliary clearance
Increase airway resistance & produce limitation of
expiratory flow.
In exacerbation, aggrevation of V/Q mismatch &
↑work of breathing
In severe case, it can lead to ventilatory failure , cor
pulmonale or both.

5. Clinical manifestations
• Insidious onset of smoker’s cough and progress to chronic productive
cough.
• Mucoid brownish colored sputum.
• Exertional dyspnea, respiratory distress.
• Cold, foggy weather increases respiratory symptoms.
• Prolonged expiratory time.
• ↑RR, and use of accessory muscles.
• Blue bloaters
• Edema in extremities and distention of neck vein.

6. • Wheezing or crackles on auscultation.
• Intercostal retraction.
• PFT: ↓VC, FEV1, MVV, diffusing capacity and ↑FRC, RV
• In advace case, hypoxemia, hypercapnia, respiratory acidosis.
• Polycythemia
• ↑ pulmonary artery pressure and right ventricular hypertrophy.

7. Causes
1. Smokers
2. People who are exposed to smoke
3. People with weakened immune systems
4. The elderly and infants
5. People who are exposed to air pollution

8. Diagnostics evaluation
• History collection
• Physical examination
• Chest x- rays
• Sputum cultures
• Pulmonary function test
• Bronchoscopy

9. Principles of management
• Hospitalization required during exacerbation and treated with IV fluids,
antibiotics, bronchodialators and low flow oxygen. Diuretics and digitalis
are often given to treat RHF. Physiotherapeutic treatment are based on
symptoms of patients and severity of condition.

10. Treatment
• Antibiotics - These are effective for bacterial infections, but not
for viral infections. They may also prevent secondary infections.
• Bronchodilators - these open the bronchial tubes and clear out
mucus.
• Mucolytics - these thin or loosen mucus in the airways, making it
easier to cough up sputum.

11. • Anti-inflammatory medicines and glucocorticoid steroids - these
are for more persistent symptoms.
• Pulmonary rehabilitation program - this includes work with a
respiratory therapist to help breathing

12. Goal of physiotherapeutic management
• The goal should involve:
Education about the prevention and management of condition.
Reduction of dyspnea.
Removal of secretion.
Improve exercise tolerance
Increase thoracic mobility and lung volume.

13. Physiotherapeutic treatment
Airway clearance techniques are coordinated with breathing control and
cough maneuvers.
During recovery , exercise with supplemental oxygen.
Patients with chronic bronchitis can be treated with Comprehensive
pulmonary rehabilitation program.

14. Relaxation
• Jacobson’s progressive relaxation technique.
• Biofeedback.
• Yoga.
• Breathing exercises.
• Chest mobilization.

15. Breathing exercises
• Diaphragmatic breathing exercise
• Pursed lip breathing exercise

16. Airway clearance technique
• Percussion
• Vibration
• Bronchial/postural drainage
• Active cycle of breathing technique
• Autogenic drainage
• Oscillatory positive expiratory pressure device

17. 1. Watchie J. Cardiovascular and Pulmonary Physical Therapy – a clinical manual. 2nd ed. 2010.
77–78 p.
2. A. Bellone et al., “Chest Physical Therapy in Patients With Acute Exacerbation of Chronic
Bronchitis : Effectiveness of Three Methods,” Arch Phys Med Rehabil, 2000. 81, May, 558–560,
3. Frownfelter D et al, Principles and practice of cardiopulmonary physical therapy , 3rd edition,
1996, pp-476-477
References

18. THANK YOU