Chronic Bronchitis Chronic Bronchitis is a form of Chronic Obstructive Pulmonary Disease (COPD). The other form is called Emphysema (see that section). Chronic Bronchitis is defined as a cough productive of mucous for 3 months (or more) of the year, for two years in a row (without another disease present that could cause the same symptoms). Most patients with COPD do not strictly have either Emphysema or chronic Bronchitis, but often have features of both. Additionally, chronic Bronchitis can be complicated by right Heart Failure (cor pulmonale). The reason this occurs is that the lungs are damaged, and the right side of the heart has to work much harder to pump blood through the lungs. Productive cough (as described above) Shortness of breath Cigarette smoking Air pollution Occupational exposures (e.g., noxious gas) Chronic allergies Possible genetic factors Examination: Jugular venous distention may be present Lung exam may be abnormal, showing rhonchi and wheezes Heart exam may reveal early diastolic gallop and holosystolic murmur in tricuspid area Skin color may be bluish (cyanotic) May have leg swelling (edema) Sputum cultures usually grow Streptococcus pneumoniae, Haemophilus influenzae, or Moxarella catarrhalis Arterial blood gas shows decreased pO2 and increased pCO2 Complete blood count may reveal increased red blood cells and hemoglobin/hematocrit (the reason is that the body tries to compensate for lower oxygen levels by increasing the number of red blood cells) Chest X-Ray may be normal or show "tramline" shadows and increased bronchovascular markings. The cardiac silhouette (right side) may enlarge. Quit Smoking using an effective method (e.g., Zyban, Nicotine patches, etc.) Supplement oxygen if p02 is less than 55 (normally, it is about 90) Supplement oxygen if p02 is less than or equal to 60 and cor pulmonale (right Heart Failure) is present Proper diet and a specially designed exercise (usually walking) programs may help symptoms. Bronchopulmonary drainage techniques (e.g., posterior percussion and drainage) as needed Pneumonia vaccine (Pneumovax) should be given approximately every seven years. Yearly influenza vaccine Consider Haemiphilus vaccine in those not immunized Phlebotomy for erythrocytosis usually only if hematocrit is greater than 55, and the patient is symptomatic (e.g., headaches). Other causes of erthrocytosis may involve phlebotomy at much lower levels (e.g., hemochromatosis) Lung transplant may be considered in severe cases Emphysema Cor pulmonale Bronchiectasis