chronic bronchitis, a very common, debilitating pulmonary disease, characterized by greatly increased production of mucus by the glands of the trachea and bronchi and resulting in a cough with expectoration for at least 3 months of the year for more than 2 consecutive years. ▪ OBSERVATIONS: The condition has a strong association with smoking. Productive cough and chronic inflammation, often with wheezing or rhonchi, are universal features, followed by progressive dyspnea on exertion, repeated purulent respiratory infections, airway narrowing and obstruction, and often respiratory failure. Cor pulmonale with right ventricular heart failure is a common result. In some patients secondary polycythemia results from chronic hypoxemia. Prolonged expiratory phase, prominent cough, cyanosis, and acute attacks of respiratory distress with rapid, labored respirations may result. Common laboratory findings include elevated hematocrit, with or without respiratory acidosis; abnormal liver function caused by right-sided heart failure and hepatic congestion; pathogenic bacteria in the sputum; abnormal pulmonary function test results; and often chest x-ray signs of increased bronchial markings. ▪ INTERVENTIONS: Patients with chronic bronchitis should be immunized against influenza and pneumococcal infections. Broad-spectrum antibiotics are usually prescribed during acute exacerbations of symptoms. Bronchodilators, such as albuterol, and sympathomimetic drugs, such as terbutaline and metaproterenol, are prescribed to prevent worsening of the condition. Adrenergics and anticholinergics, like albuterol and Atrovent, are used to maintain lung function. Heart failure is managed with appropriate medication. ▪ PATIENT CARE CONSIDERATIONS: The patient should be encouraged to discontinue smoking and to avoid exposure to toxic inhalants, such as hair sprays, aerosol insecticides, and occupational irritants and poisons. The use of low-flow oxygen in the home requires patient/family education and monitoring. Exercise, especially walking, is often indicated.
