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Chronic Bronchitis

Updated : January 25, 2024





Background

Chronic bronchitis is a condition of an obstructive pulmonary disease characterized by a productive cough lasting more than three months and occurring within two years.

Patients often appear with a prolonged productive cough, lethargy, and excessive coughing, often accompanied by symptoms such as abdominal or chest pain.

Epidemiology

According to studies, 3-7% of healthy individuals in the overall population have chronic bronchitis. It is established that, compared to healthy subjects, subjects under 50 with chronic bronchitis are at more significant mortality and morbidity risk.

Chronic bronchitis is more common with advancing age, smoking tobacco, occupationally exposure to chemicals, and higher socioeconomic background.

Anatomy

Pathophysiology

Goblet cells produce and secrete excessive amounts of mucus, which is the primary cause of chronic bronchitis. When exposed to harmful or infectious stimuli, the epithelial cells in the airway release inflammatory mediators such as interleukin 8, colony-stimulating factor, and other pro-inflammatory cytokines.

Additionally, there is a decline in the secretion of regulatory substances, including neutral endopeptidase and angiotensin-converting enzymes. In chronic bronchitis, the alveolar epithelium is both a target and a source of inflammation. The bronchial mucosal membrane is often hyperemic and edematous, with decreased bronchial mucociliary function during an acute exacerbation.

Luminal blockage to smaller airways obstructs airflow. The discomfort is aggravated further when debris blocks the airways. The excessive mucus secretion in chronic bronchitis causes the characteristic bronchitis cough.

Etiology

Exposure to tobacco smoke from active smoking or passive inhalation is the primary causative agent. Smog, industrial pollutants, and hazardous chemicals are a few respiratory system irritants that can induce chronic bronchitis when inhaled. Although bacterial and viral infections typically result in acute bronchitis, chronic bronchitis can also be brought on by persistent infection exposure.

Influenza types A and B are the most common viruses that cause the disease, and Mycoplasma pneumonia Staphylococcus, and Streptococcus, are the most common bacteria.

People with a history of respiratory conditions such as asthma, cystic fibrosis, or bronchiectasis are more likely to develop chronic bronchitis. Chronic bronchitis is more likely to develop in individuals exposed to airborne contaminants such as ammonia, sulfur dioxide, or dust. Although less common, chronic gastroesophageal reflux is a well-studied cause of bronchitis.

Genetics

Prognostic Factors

It is well established possessing chronic bronchitis can aggravate airflow restriction and impair pulmonary function. Extensive epidemiological studies have demonstrated a link between decreased FEV1 and persistent mucus hypersecretion. Compared to the population without symptoms, patients had a threefold higher risk of getting new COPD.

Mortality rates increase with chronic bronchitis. Serum IL8 and CRP levels were more significant in chronic bronchitis patients, indicating that a systemic inflammatory response might enhance the risk of heart disease and other comorbidities. Lower quality of life is also a result of chronic bronchitis.

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

 

epinephrine 

MD:

1 - 1

mcg/m²

Capsules

Aerosol

3 times a day

1 - 1

minutes

CM



Dose Adjustments

AD

cefpodoxime 

200

mg

Orally 

every 12 hrs

10

days


Note: It is indicated for Acute Bronchitis & Acute Exacerbation of Chronic Bronchitis



amoxicillin 

Mild/moderate/severe:

875

mg

every 12 hrs or 500mg every 8hrs



moxifloxacin 

chronic exacerbation
:


400mg orally/intravenous every day for five days



gemifloxacin 

320mg orally every day for five days



cefixime 

Indicated for Acute Exacerbations of Chronic Bronchitis:

400

mg/day

Orally 

Single dose or divided every 12hr



ciprofloxacin 

In the case of mild/moderate infections: 500 mg orally every 12 hours or 400 mg intravenously every 12 hours for 7-14 days
In the case of severe/complicated infections: 750 mg orally every 12 hours or 400 mg intravenously every 8 hours for 7-14 days
Limitations for usage: Reserve the fluoroquinolones for patients who are voided of available treatment options for chronic bronchitis



tetracycline 

A dose of 500 mg orally every 12 hours or 250 mg orally every 6 hours is indicated in chronic bronchitis infection



red clover 

Indicated for Cancer, skin sores, asthma, bronchitis :


4 mg of flower tops orally three times a day
Or
4 gm of flower tops in 150 ml of water;1 cup of tea orally three times a day
Or
1.5-3 ml of liquid extract orally three times a day;1:1 in 25% alcohol
1-2 ml of tincture orally three times a day;1:10 in 45% alcohol



red clover 

Indicated for Cancer, skin sores, asthma, bronchitis :


4 mg of flower tops orally three times a day
Or
4 gm of flower tops in 150 ml of water;1 cup of tea orally three times a day
Or
1.5-3 ml of liquid extract orally three times a day;1:1 in 25% alcohol
1-2 ml of tincture orally three times a day;1:10 in 45% alcohol



cefditoren 

Exacerbation of chronic bronchitis by acute bacteria Take 400 mg orally after every 12 hours up to 10 days



procaterol 

Inhaled a dose of 20 mcg up to 4 times daily



grepafloxacin 


Indicated for Chronic bronchitis
400 mg to 600 mg orally one time a day for nearly 10 days
Community-acquired pneumonia
600 mg orally one time a day for nearly 10 days
Uncomplicated gonorrhea
400 mg orally one time
Cervicitis or Nongonococcal urethritis
400 mg orally one time a day for nearly 7 days



loracarbef 

For one week, take 400 mg two times a day by oral route



lomefloxacin 

Take 400 mg by oral route one time daily for ten days duration



ethylephedrine 

5 ml of this drug every 3 to 5 hours is recommended, which should be at most 30 ml daily
This drug is used for treating bronchial congestion and bronchospasm, which are associated with acute and chronic bronchitis



cefodizime 

Administer 1 to 2 g once or twice a day intramuscularly or intravenous infusion.
Maximum dose-4 g/day.

Renal impairment
CrCl 10 to 30ml/min-Administer 1 to 2 g every day.
CrCl<10ml/min- Administer 0.5 to 1 g every day.



dirithromycin 

500 mg is given orally once every day for one week



ephedra sinica root 

Take a dose of 32 mg orally daily



flurithromycin 

375

mg

Tablets

Orally 

twice a day

2

weeks



Dose Adjustments

Off-label

amoxicillin and clavulanate potassium 

500 mg orally 3 times a day or 875 mg orally 2 times daily 7-10 days



sulfametopyrazine 

It is mostly recommended for respiratory tract infections, chronic bronchitis, and urinary tract infections
The usual recommended single dose per week only once is 2 g via oral administration



Dose Adjustments

Reduction in dosage is needed depending upon the condition

 

amoxicillin 

Mild/moderate/severe :

45 mg/kg daily divided in doses for every 12hrs or 40 mg/kg per day in divided doses for every 8hrs
Community-acquired pneumonia (Off-label use)
<3 months: Safety and effectiveness have not been established
Age: ≥3 months
immediate release (IR):
Empirical treatment:
90 mg/kg/day orally, divided 2 times a day 10 days
maximum daily dose should not exceed 4,000 mg
Group A Streptococcus:
50-75 mg/kg/day orally, divided 2 times a day 10 days
maximum daily dose should not exceed 4,000 mg
H. influenza:
75-100 mg/kg/day orally, divided 3 times a day 10 days
maximum daily dose should not exceed 4,000 mg
S. pneumoniae:
90 mg/kg/day orally, divided 2 times a day 10 days or 45 mg/kg/day divided 2 times a day 10 days
maximum daily dose should not exceed 4,000 mg



dirithromycin 

above 12 years: 500 mg is given orally once every day for one week



 

Media Gallary

References

https://www.ncbi.nlm.nih.gov/books/NBK482437/

Chronic Bronchitis

Updated : January 25, 2024




Chronic bronchitis is a condition of an obstructive pulmonary disease characterized by a productive cough lasting more than three months and occurring within two years.

Patients often appear with a prolonged productive cough, lethargy, and excessive coughing, often accompanied by symptoms such as abdominal or chest pain.

According to studies, 3-7% of healthy individuals in the overall population have chronic bronchitis. It is established that, compared to healthy subjects, subjects under 50 with chronic bronchitis are at more significant mortality and morbidity risk.

Chronic bronchitis is more common with advancing age, smoking tobacco, occupationally exposure to chemicals, and higher socioeconomic background.

Goblet cells produce and secrete excessive amounts of mucus, which is the primary cause of chronic bronchitis. When exposed to harmful or infectious stimuli, the epithelial cells in the airway release inflammatory mediators such as interleukin 8, colony-stimulating factor, and other pro-inflammatory cytokines.

Additionally, there is a decline in the secretion of regulatory substances, including neutral endopeptidase and angiotensin-converting enzymes. In chronic bronchitis, the alveolar epithelium is both a target and a source of inflammation. The bronchial mucosal membrane is often hyperemic and edematous, with decreased bronchial mucociliary function during an acute exacerbation.

Luminal blockage to smaller airways obstructs airflow. The discomfort is aggravated further when debris blocks the airways. The excessive mucus secretion in chronic bronchitis causes the characteristic bronchitis cough.

Exposure to tobacco smoke from active smoking or passive inhalation is the primary causative agent. Smog, industrial pollutants, and hazardous chemicals are a few respiratory system irritants that can induce chronic bronchitis when inhaled. Although bacterial and viral infections typically result in acute bronchitis, chronic bronchitis can also be brought on by persistent infection exposure.

Influenza types A and B are the most common viruses that cause the disease, and Mycoplasma pneumonia Staphylococcus, and Streptococcus, are the most common bacteria.

People with a history of respiratory conditions such as asthma, cystic fibrosis, or bronchiectasis are more likely to develop chronic bronchitis. Chronic bronchitis is more likely to develop in individuals exposed to airborne contaminants such as ammonia, sulfur dioxide, or dust. Although less common, chronic gastroesophageal reflux is a well-studied cause of bronchitis.

It is well established possessing chronic bronchitis can aggravate airflow restriction and impair pulmonary function. Extensive epidemiological studies have demonstrated a link between decreased FEV1 and persistent mucus hypersecretion. Compared to the population without symptoms, patients had a threefold higher risk of getting new COPD.

Mortality rates increase with chronic bronchitis. Serum IL8 and CRP levels were more significant in chronic bronchitis patients, indicating that a systemic inflammatory response might enhance the risk of heart disease and other comorbidities. Lower quality of life is also a result of chronic bronchitis.

epinephrine 

MD:

1 - 1

mcg/m²

Capsules

Aerosol

3 times a day

1 - 1

minutes

CM



Dose Adjustments

AD

cefpodoxime 

200

mg

Orally 

every 12 hrs

10

days


Note: It is indicated for Acute Bronchitis & Acute Exacerbation of Chronic Bronchitis



amoxicillin 

Mild/moderate/severe:

875

mg

every 12 hrs or 500mg every 8hrs



moxifloxacin 

chronic exacerbation
:


400mg orally/intravenous every day for five days



gemifloxacin 

320mg orally every day for five days



cefixime 

Indicated for Acute Exacerbations of Chronic Bronchitis:

400

mg/day

Orally 

Single dose or divided every 12hr



ciprofloxacin 

In the case of mild/moderate infections: 500 mg orally every 12 hours or 400 mg intravenously every 12 hours for 7-14 days
In the case of severe/complicated infections: 750 mg orally every 12 hours or 400 mg intravenously every 8 hours for 7-14 days
Limitations for usage: Reserve the fluoroquinolones for patients who are voided of available treatment options for chronic bronchitis



tetracycline 

A dose of 500 mg orally every 12 hours or 250 mg orally every 6 hours is indicated in chronic bronchitis infection



red clover 

Indicated for Cancer, skin sores, asthma, bronchitis :


4 mg of flower tops orally three times a day
Or
4 gm of flower tops in 150 ml of water;1 cup of tea orally three times a day
Or
1.5-3 ml of liquid extract orally three times a day;1:1 in 25% alcohol
1-2 ml of tincture orally three times a day;1:10 in 45% alcohol



red clover 

Indicated for Cancer, skin sores, asthma, bronchitis :


4 mg of flower tops orally three times a day
Or
4 gm of flower tops in 150 ml of water;1 cup of tea orally three times a day
Or
1.5-3 ml of liquid extract orally three times a day;1:1 in 25% alcohol
1-2 ml of tincture orally three times a day;1:10 in 45% alcohol



cefditoren 

Exacerbation of chronic bronchitis by acute bacteria Take 400 mg orally after every 12 hours up to 10 days



procaterol 

Inhaled a dose of 20 mcg up to 4 times daily



grepafloxacin 


Indicated for Chronic bronchitis
400 mg to 600 mg orally one time a day for nearly 10 days
Community-acquired pneumonia
600 mg orally one time a day for nearly 10 days
Uncomplicated gonorrhea
400 mg orally one time
Cervicitis or Nongonococcal urethritis
400 mg orally one time a day for nearly 7 days



loracarbef 

For one week, take 400 mg two times a day by oral route



lomefloxacin 

Take 400 mg by oral route one time daily for ten days duration



ethylephedrine 

5 ml of this drug every 3 to 5 hours is recommended, which should be at most 30 ml daily
This drug is used for treating bronchial congestion and bronchospasm, which are associated with acute and chronic bronchitis



cefodizime 

Administer 1 to 2 g once or twice a day intramuscularly or intravenous infusion.
Maximum dose-4 g/day.

Renal impairment
CrCl 10 to 30ml/min-Administer 1 to 2 g every day.
CrCl<10ml/min- Administer 0.5 to 1 g every day.



dirithromycin 

500 mg is given orally once every day for one week



ephedra sinica root 

Take a dose of 32 mg orally daily



flurithromycin 

375

mg

Tablets

Orally 

twice a day

2

weeks



Dose Adjustments

Off-label

amoxicillin and clavulanate potassium 

500 mg orally 3 times a day or 875 mg orally 2 times daily 7-10 days



sulfametopyrazine 

It is mostly recommended for respiratory tract infections, chronic bronchitis, and urinary tract infections
The usual recommended single dose per week only once is 2 g via oral administration



Dose Adjustments

Reduction in dosage is needed depending upon the condition

amoxicillin 

Mild/moderate/severe :

45 mg/kg daily divided in doses for every 12hrs or 40 mg/kg per day in divided doses for every 8hrs
Community-acquired pneumonia (Off-label use)
<3 months: Safety and effectiveness have not been established
Age: ≥3 months
immediate release (IR):
Empirical treatment:
90 mg/kg/day orally, divided 2 times a day 10 days
maximum daily dose should not exceed 4,000 mg
Group A Streptococcus:
50-75 mg/kg/day orally, divided 2 times a day 10 days
maximum daily dose should not exceed 4,000 mg
H. influenza:
75-100 mg/kg/day orally, divided 3 times a day 10 days
maximum daily dose should not exceed 4,000 mg
S. pneumoniae:
90 mg/kg/day orally, divided 2 times a day 10 days or 45 mg/kg/day divided 2 times a day 10 days
maximum daily dose should not exceed 4,000 mg



dirithromycin 

above 12 years: 500 mg is given orally once every day for one week