Introduction
Chronic bronchitis is defined clinically as cough with sputum expectoration for at least 3 months during a period of 2 consecutive years. Chronic bronchitis is associated with hypertrophy of the mucus-producing glands found in the mucosa of large cartilaginous airways
Respiratory viruses are the most common causes of acute bronchitis. The most common viruses include influenza A and B, parainfluenza, respiratory syncytial virus, and coronavirus.
Chronic bronchitis can be categorized as
1) simple chronic bronchitis : Mucoid sputum production
2) chronic mucopurulent bronchitis : Persistent or recurrent purulent sputum production in the absence of localized suppurative disease, such as bronchiectasis
3) chronic bronchitis with obstruction : must be distinguished from chronic infective asthma.
Patients who have chronic bronchitis with obstruction present with a long history of productive cough and a late onset of wheezing, whereas patients who have asthma with chronic obstruction have a long history of wheezing with a late onset of productive cough.
Frequency
United States: 4% of the population
International: One of the top 5 reasons for seeking medical care www.emedicine.com
Top 5 diseases that cause death <HIV< LRI < Cerebrovascular Disease <IHD.
Signs and Symptoms
chronic obstructive pulmonary disease (COPD) in which the air passages in the lungs -- the bronchi -- are repeatedly inflamed, leading to scarring of the bronchi walls. As a result, excessive amounts of sticky mucus are produced and fill the bronchial tubes, which become thickened, impeding normal airflow through the lungs. Other symptoms like : Breathlessness ,Breathlessness on exertion, Cyanosis Mild fever ,Mild chest pain.
Diagnosis :
• Pulmonary Function Testing (PFT)
• High Resolution Computed Tomography (HRCT)
• Chest X-Ray.
• Sputum Examination
Treatment:
The goal of therapy for chronic bronchitis is to provide:
1) Relief of symptoms : Bronchodilator Medications, Steroids (SA)….
2) Prevent complications : Antibiotics, Vaccines….
3) Slow the progression of the disease: Pulmonary Rehabilitation….
Quitting smoking is also essential.
short-acting agonists or anticholinergic bronchodilators should be administered during the acute exacerbation.
In acute bronchitis, treatment with beta2-agonist bronchodilators may be useful in patients who have associated wheezing with cough and underlying lung disease.
In patients with acute exacerbations of chronic bronchitis, the use of antibiotics is recommended: macrolides, quinolones, and amoxicillin/clavulanate
A short course of antibiotics (5 d) is as effective as the traditional longer treatments (>5 d) in these patients.

Dirty chest. Because of recurrent infection with scarring, the bronchovascular structures have irregular contours. This is the only sign of bronchitis in chest x-ray