Chronic bronchitis is defined as a persistent cough with sputum production for at least 3 months in two consecutive years. The most common cause is cigarette smoking. Clinical features include persistent cough, sputum production, wheezing, and breathlessness. In later stages, patients develop hypercapnia, hypoxemia, and mild cyanosis known as "blue boaters." Assessment of a patient with chronic bronchitis involves collecting demographic information, medical history, subjective reports of symptoms like cough and breathlessness, and objective measures including reduced lung function, increased pCO2, and chest x-ray abnormalities in later stages.

1. CHRONIC BRONCHITIS
BY BHAVIN CHAUHAN

2. Chronic bronchitis
Chronic bronchitis is defined as
persistent cough with sputum
production for at least 3 months in at
least 2 consecutive years.

3. 

4. Etiology
 Cigarette smoking – Most common cause
 Air pollutants
 Toxic industrial inhalants
 Respiratory tract infection

5. Clinical features
 Persistent cough with sputum production
 Fever
 Wheezing and tightness of chest
 Breathlessness-late in onset
 Blue boaters-distinctive clinical pattern seen in chronic
bronchitis; Low pao2,high paco2 ,right heart failure

6. Clinical features
 Usually affect middle – aged men
who are heavy smokers
 Early symptoms – Persistent
productive cough for many years,
fever
Later stage
 Dyspnea on exertion
 Blue boaters : Pts. Develop
Hypercapnia, hypoxemia and
mild cyanosis.

7. Leading causes of death in COPD
 Respiratory failure
 Lung cancer
 Cardiovascular disease

8. PT assessment
 [A] General assessment
 demographic data:
 Name-
 Age-
 Gender-
 BMI-
 Occupation-
 Provisional diagnosis-chronic bronchitis

9. .
 Chief complaints:he/she feels difficulty in breathing,early
morning cough since many years.
 History:
 1.h/o present illness:
 2.h/o past medical or surgical conditions
 3.h/o family:
 .4.personal habits: smoking
 5.h/o environmental:ask about their residence and type of
workplace

10. [C] subjective assessment
1.breathlessness
o Progressive exertional dyspnea
o Duration:
o Severity (assessed by NYHA scale)
o Pattern: orthopnea
o Precipitating factors: on exertion,exposure with pollutants
o Relieving factors:rest,bronchodilators

11.  2.Cough-present
o Type: chronic productive cough
o Frequency: It is intermittent in initial stage,and becomes
continuous progressively.
o Duration: morning
o Severity: increased by infections, fog,worst in winter season.

12.  3.Sputum:-present
o Color-white(without infection)
o Smell-
o Quantity-
o Grade-mucoid(without infection),
if infection present -mucopurulent sputum

13.  4.hemoptysis:-may be present
 5.wheeze: present during expiration.
Wheeze-More during morning and in winter
 6.chest pain: absent
 Other symptoms: fever in acute exacerbation,
Fatigue, peripheral edema

14. [D]objective assessment
 On observation:
1.General observation:-
o Level of consciousness-alert
o General health and body built:-obese in blue boaters.
o cyanosis-present
o Peripheral cyanosis
2.observation of chest:
o Shape-barrel shaped chest
o Breathing pattern-abnormal apical breathing
o Use of accessory muscles-present

15.  3.JVP-increased
4.Extremities:
clubbing-absent
Edema-Peripheral
 On palpation:-
 chest expansion-Reduced thoracic movt.
 Paradoxical indrawing develops.
 Vocal fremitus-heard
 Position of trachea-midline
 On percussion:hyperresonance

16.  On examination:-
 Vitals:- RR decreased in exacerbation
 Chest expansion:-
 Auscultation (heart sounds):-S1 and S2 present
 Breath sound: Vesicular sound with Prolonged expiration; rhonchi
may be heard
 ROM :-shoulder joint reduced, thoracic spine reduced
 Exercise tolerance -Reduced

17.  Investigations
 PFT:-reduced FEV1/FVC
 ABG:-paco2 increased,pao2 decreased
 Chest x ray:-no characteristic abnormality in early
stages
 ECG-show features of right atrial and ventricular
hypertrophy; Tall p waves.

18. X-ray findings:Cor pulmonale

20. Impairments
Impairments:-
1.Structural impairments:-Obstruction of airways peripheral
cyanosis,Weight loss and cor pulmonale in later stages
2. Functional impairments:-increased work of breathing,decreased
endurance,Patient easily get tired (Fatigue),

21. Thank you