Chronic Bronchitis

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Chronic bronchitis causes increased airflow resistance in large airways.

Chronic bronchitis is a functional disorder, defined clinically as 'cough productive of sputum on most days for 3 months of the year for at least 2 successive years'.

Airways obstruction in chronic bronchitis is due to luminal narrowing and mucus plugging.
This leads to alveolar hypoventilation, hypoxaemia and hypercapnia (type II respiratory failure).
Individuals with chronic bronchitis and type II respiratory failure are typically cyanosed, but do not usually have distressing dyspnoea.
Hypoxic pulmonary vasoconstriction may cause secondary pulmonary hypertension and, with time, lead to right-heart failure (cor pulmonale).

In chronic bronchitis the main abnormality is secretion of abnormal amounts of mucus, causing plugging of the airway lumen.
Hypersecretion is associated with hypertrophy and hyperplasia of bronchial mucus-secreting glands.
This can be appreciated by the Reid index, the ratio of gland wall thickness in the bronchus, which is increased in cases of chronic bronchitis.
Inflammation in chronic bronchitis is typically not present, although individuals with excessive mucus production frequently develop coincidental respiratory tract infections, leading to secondary inflammation.
Squamous metaplasia is common in patients who have persistent or recurrent superimposed infections.

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