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Chronic Bronchitis Treatment

Discussion in 'Off-Topic' started by Jeanh, Sep 9, 2015.

  1. Treating bronchitis
    Most cases of bronchitis do not require treatment from a GP, and the symptoms can be easily managed at home.

    There is no cure for chronic bronchitis, but healthy living will help. In particular, you should Please or Register to view links, if you smoke.

    Managing symptoms at home
    If you have bronchitis:

    • get plenty of rest
    • drink lots of fluids – this helps prevent Please or Register to view links and thins the mucus in your lungs, making it easier to cough up
    • treat headaches, fever, and aches and pains with Please or Register to view linksor Please or Register to view links – although ibuprofen is not recommended if you have Please or Register to view links
    There is little evidence that cough medicines work – Please or Register to view links. The Medicines and Healthcare Products Regulatory Agency (MHRA) has recommended that over-the-counter cough medicines should not be given to children under the age of six.

    As an alternative to an over-the-counter cough medicine, try making your own mixture of honey and lemon, which can help soothe a Please or Register to view links and ease your Please or Register to view links.

    Stop smoking
    If you smoke, you should stop immediately. Smoking aggravates bronchitis and increases your risk of developing a long-term (chronic) condition.

    Please or Register to view links while you have bronchitis can also be the perfect opportunity to quit altogether.

    Although treatment from a GP is rarely necessary, there may be times when you should see one – read more about Please or Register to view links.

    Your GP will not routinely prescribe Please or Register to view links, as bronchitis is nearly always caused by a virus. Antibiotics have no effect on viruses, and prescribing them when they are unnecessary can, over time, make bacteria more resistant to antibiotic treatment. Read more about Please or Register to view links.

    Your GP will only prescribe antibiotics if you have an increased risk of developing complications, such as Please or Register to view links. Antibiotics may be recommended for:

    • premature babies
    • elderly people over the age of 80
    • people with a history of heart, lung, kidney or liver disease
    • people with a weakened immune system, which could be the result of an underlying condition or a side effect of a treatment such as steroid medication
    • people with Please or Register to view links
    If you are prescribed antibiotics for bronchitis, it is likely to be a five-day course of amoxicillin, oxytetracycline or doxycycline.

    Possible side effects of these medicines include nausea, vomiting and diarrhoea, but they are uncommon.

    Chronic bronchitis
    Chronic bronchitis is treated in the same way as chronic obstructive pulmonary disease (COPD).

    For example:

    • a type of medication called mucolytics can be used to make mucus easier to cough up
    • an exercise programme known as pulmonary rehabilitation can help you cope better with your symptoms
    Stopping smoking is also very important if you have been diagnosed with chronic bronchitis or COPD.

    Read more about the Please or Register to view links.
  2. Bronchitis is a condition in which the bronchial tubes are inflamed. These tubes carry air to the lungs. When the tubes become inflamed or infected, they produce a lot of mucus, which is a slimy substance made by the bronchial tubes. The main symptom of bronchitis is persistent coughing – the body's attempt to Please or Register to view links. Forceful coughing can be painful, and excess mucus can make it difficult to breathe. Other bronchitis symptoms include a low-grade fever, shortness of breath and wheezing.

    There are two types of bronchitis: acute (short term) and chronic (long term). In both types, irritated membranes swell and grow thicker. This swelling shuts off the tiny airways in the lungs. Acute bronchitis is often the result of infections or exposure to irritants. cïgârêttê smoking is the main cause of chronic bronchitis, which is sometimes called a "smoker's cough."

    [See: Please or Register to view links]

    A single acute episode is not a cause for concern. However, repeated episodes may lead to chronic bronchitis. A person with chronic bronchitis has scarred lungs, and this scarring cannot be reversed. Lung damage makes it difficult to breath and increases the risk for infections. Elderly and those with weakened Please or Register to view links have the greatest risk for developing bronchitis.

    Signs and Symptoms of Acute Bronchitis

    • Approximately 90 percent of cases are caused by the same viruses that cause the common cold and the flu. The main symptom is a persistent cough, which often makes it difficult to sleep.

    • Lung irritants can also cause acute bronchitis. Common lung irritants include tôbâccô smoke, air pollution, dust and fumes.

    • Most cases improve within 10 days, but coughing may linger for several weeks.

    • Acute bronchitis is contagious.

    Signs and Symptoms of Chronic Bronchitis

    • Chronic bronchitis doesn't appear suddenly. It usually begins with a simple cough. Over time, symptoms worsen until the person has difficulty breathing.

    • Airways are constantly inflamed and irritated.

    • Excess mucus is produced constantly. A person may cough up more than an ounce of mucus each day.

    • The cough is often worse in the morning and in damp, cold weather. Persistent coughing makes it difficult to sleep.

    • Left untreated, chronic bronchitis can be life-threatening.

    • Chronic bronchitis is not contagious.

    How Is bronchitis treated?

    The main treatment goal is to relieve symptoms. Along with standard treatment, some patients use natural and home remedies. Certain foods seem to reduce symptoms. These include honey, lemon, ginger, bay leaf and almonds. Patients should discuss natural remedies with their doctor before using them.

    [See: Please or Register to view links.]

    Treatment for acute bronchitis includes rest and fluids. Aspirin or a similar agent is used to treat fever. A humidifier or steam can also help. Your doctor may prescribe medications to open your airways and reduce wheezing and inflammation. A cough syrup may also be prescribed. Antibiotics are not used to treat acute bronchitis, since they don't work against viruses. If your doctor thinks you have a bacterial infection, he or she may order an X-ray and other tests. Antibiotics are used to treat bacterial infections.

    Treatment for chronic bronchitis is to eliminate sources of irritation. Because the lungs have been damaged, chronic bronchitis never completely goes away, and flare-ups may occur. Medications are generally needed. These include inhaled agents that open your airways. Steroids are used to reduce inflammation, and in severe cases, oxygen therapy may be needed. Oxygen is supplied in a metal cylinder and flows through a tube and into the nose. Pulmonary rehabilitation may also be prescribed. Rehabilitation teaches patients to breathe more easily.

    Can I do anything to lessen my symptoms?

    Chronic bronchitis can be prevented by not smoking. Patients should avoid secondhand smoke and other lung irritants. People with shortness of breath should breathe using the technique of pursed-lip breathing. Pursed-lip breathing helps reduce shortness of breath. These are the five steps for pursed-lip breathing:

    1. Relax the muscles in your neck and shoulders. Sit in a comfortable chair with your feet on the floor.

    2. Breathe in (inhale) slowly through your nose for two counts.

    3. Feel your belly get larger as you breathe in.

    4. Pucker your lips as if you were going to whistle or blow out a candle.

    5. Breathe out (exhale) slowly through your lips for four or more counts.

    Be sure to exhale normally. Do not force air out. Do not hold your breath when you are doing pursed-lip breathing. Repeat these steps until your breathing improves.

    Recommendations For People With Bronchitis

    Quit smoking. Medications are available to help you quit smoking.

    Many cases of acute bronchitis result from having a Please or Register to view links. It's important to get a yearly flu vaccine. You should also be vaccinated against pneumonia.

    Do not take over-the-counter cough suppressants without your doctor's permission.

    If your doctor prescribed an inhaler, ask your pharmacist to demonstrate how it's used.

    Contact your doctor if your cough worsens. Call your doctor immediately if you cough up blood or rust-colored or green phlegm.

    Call 911 if you experience severe chest pain and/or are gasping for air.

    Avoid lung irritants. Wear a mask when you are working with strong fumes like paint.

    If possible, stay indoors when air pollution is rated high.

    Use a humidifier. Warm, moist air helps Please or Register to view links. It also loosens mucus in your airways.

    Drink plenty of fluids. Lung secretions will be thinners and easier to clear.

    Don't brush off persistent coughing as harmless smoker's cough. Delaying treatment can result in serious lung problems and even death.

    Wash your hands frequently to lower your risk of infection.

    Eat a healthy diet and be as physically active as you can.
  3. What is the treatment for chronic bronchitis?
    Reader Stories
    For the majority of cases, the initial treatment is simple to prescribe but frequently ignored or rejected by the patient – stop smoking cïgârêttês and avoid second-hand tôbâccô smoke. People should be encouraged in every way to cease smoking, as continuation will only cause further lung damage. Similarly, blocking or removing other underlying causes of repeated bronchial irritation (for example, exposure to chemical fumes) is a treatment goal. Half of patients with chronic bronchitis who smoke will no longer cough after 1 month of Please or Register to view links.

    Two major classes of medications are used to treat chronic bronchitis, bronchodilators and steroids.

    • Bronchodilators (for example, Please or Register to view links [Ventolin, Proventil, Please or Register to view links, Please or Register to view links, ProAir], metaproterenol [ Please or Register to view links], formoterol [ Please or Register to view links], Please or Register to view links [ Please or Register to view links]) work by relaxing the smooth muscles that encircle the bronchi, which allows the inner airways to expand. Anticholinergic Please or Register to view links also can act as bronchodilators, including tiotropium (Spiriva) andipratropium ( Please or Register to view links).
    • Steroids (for example, Please or Register to view links, Please or Register to view links [ Please or Register to view links, Please or Register to view links]) reduce the inflammatory reaction and thus decrease the bronchial swelling and secretions that in turn allows better airflow because of reduced airway obstruction. Often inhaled steroids are administered since they have fewer side effects than systemic (oral) steroids. Examples include Please or Register to view links (Pulmicort), fluticasone (Flovent), beclomethasone ( Please or Register to view links), and Please or Register to view links (Asmanex). Combination therapy with both steroids and bronchodilators is often utilized. These include fluticasone/salmeterol (Advair), budesonide/formoterol (Symbicort), and mometasone/formoterol (Dulera).
    • PDE4 inhibitors are a class of anti-inflammatory agents for exacerbations of COPD. They are primarily for exacerbations that involve excessive bronchitis and mucus production. There is currently only one agent available called roflumilast (Daliresp), a pill taken once per day.
    Occasionally, antibiotics are used to treat chronic bronchitis exacerbations caused by bacterial infections. Broad spectrum antibiotics are often the choice. Examples include:

    Of course, if a culture is obtained, directed therapy at the specific offending organism is always best.

    Pulmonary rehabilitation is another treatment method that combines education and graded physical Please or Register to view links. The education portion often includes smoking cessation techniques and the relationship of tôbâccô use to symptoms. Breathing techniques can be very helpful in overcoming the Please or Register to view links and discomfort of exacerbations. When chronic bronchitis is severe, airflow and blood flow may not move appropriately through the lungs. It is crucial for lung function that airflow and blood flow to the lung are precisely matched. When they are not, drops in oxygen and increases in carbon dioxide can result with profound negative consequences.

    Supplemental oxygen therapy may be an integral part of treatment. Often it is required with activity and Please or Register to view links. Patients with severe disease may benefit from purchasing a small finger oximeter for monitoring blood oxygen levels at rest and with activity.

    Certain "home remedies" may ease the symptoms of chronic bronchitis. Please or Register to view links air often aggravates coughing and dyspnea, so avoiding cold air or wearing a cold-air mask (such as a ski mask or face scarf) may help when in cold environments. Dry air also aggravates coughing so warm, humidified air may help by reducing coughing and also may allow mucus to flow more freely, which may result in better clearing of the bronchial airways and less blockage by viscous mucus. One of the lessons of pulmonary rehabilitation is to instruct patients on the proper path for air to follow. This involves breathing in through the nose so that the air is moistened, cleansed, and warmed by the function of the upper airways (sinuses). Air is than expelled through the mouth and in some cases with pursed lips to help optimize the lung's function.

    Over-the-counter (OTC) cough suppressants such as dextromethorphan (for example, Pertussin, Vicks 44 or Please or Register to view links) may be helpful in reducing cough symptoms. OTC preparations with Please or Register to view links (for example, Please or Register to view links or Please or Register to view links) may make patients feel more comfortable but there is no scientific evidence that it helps mucus to become less viscous.

    Alternative treatments have been suggested by some individuals with little or no evidence of any benefit; and some may even be harmful (for example, herbal teas, high doses of Please or Register to view links, South African geranium herb, eucalyptus oil inhalation therapy, and many others); it is advisable to check with the health care professional before using any of these remedies or products. Please or Register to view links
  4. Chronic bronchitis is a clinical diagnosis characterized by a cough productive of sputum for over three months' duration during two consecutive years and the presence of airflow obstruction. Pulmonary function testing aids in the diagnosis of chronic bronchitis by documenting the extent of reversibility of airflow obstruction. A better understanding of the role of inflammatory mediators in chronic bronchitis has led to greater emphasis on management of airway inflammation and relief of bronchospasm. Inhaled ipratropium bromide and sympathomimetic agents are the current mainstays of management. While theophylline has long been an important therapy, its use is limited by a narrow therapeutic range and interaction with other agents. Oral steroid therapy should be reserved for use in patients with demonstrated improvement in airflow not achievable with inhaled agents. Antibiotics play a role in acute exacerbations but have been shown to lead to only modest airflow improvement. Strengthening of the respiratory muscles, smoking cessation, supplemental oxygen, hydration and nutritional support also play key roles in long-term management of chronic bronchitis.

    Chronic bronchitis is one of the principal manifestations of chronic obstructive pulmonary disease (COPD), the fourth leading cause of death in the United States. About 10 million Americans are affected by some degree of COPD; it causes 40,000 deaths annually. Please or Register to view links

    Chronic bronchitis is a clinical diagnosis characterized by a cough productive of sputum for over three months' duration during two consecutive years and airflow obstruction. These requisites exclude more transient causes of cough associated with sputum production, such as acute bronchitis. The airflow obstruction in chronic bronchitis is caused by excessive tracheobronchial mucus production and is distinct from the anatomic findings of distal air space distention and alveolar septa destruction, which define emphysema. Please or Register to view links

    cïgârêttê smoking is the most important risk factor for the development of chronic bronchitis. Over 90 percent of patients with chronic bronchitis have a smoking history, although only 15 percent of all cïgârêttê smokers are ultimately diagnosed with some form of obstructive airway disease. Please or Register to view links Studies have demonstrated persistent markers of active airway inflammation in bronchial biopsy specimens from symptomatic ex-smokers, even after they had been smoke-free for 13 years. Please or Register to view links

    The overall 10-year mortality rate following the diagnosis of chronic bronchitis is 50 percent, Please or Register to view links with respiratory failure following an acute exacerbation being the most frequent terminal event. Such acute exacerbations are often precipitated by bacterial infection, manifested by purulent sputum, fever and a worsening of the symptoms of poor ventilation. Other known precipitants include viral upper respiratory infections, seasonal changes in the weather, medications and exposure to irritant inhalants.

    Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis are the three leading bacterial pathogens isolated from the lower bronchi of patients with chronic bronchitis, in contrast to the causative organisms of acute bronchitis, which include Mycoplasma pneumoniae and Chlamydia trachomatis. However, studies of acutely symptomatic patients with COPD have failed to reveal definite organisms in over 50 percent of patients. Please or Register to view links Nonbacterial pathogens (such as viruses) and Chlamydia and Mycoplasma species are also, rarely, isolated in patients with chronic bronchitis, although their role in either causing symptoms directly or triggering the characteristic inflammatory response is poorly understood.

    One speculative explanation of the interaction between infection and chronic bronchitis is that low-intensity colonization of the lower respiratory tract by infectious agents can set up an inflammatory reaction that itself triggers subsequent acute exacerbations. Please or Register to view links Documentation supporting this concept comes from studies in which patients with chronic bronchitis were found to have circulating bacteria-specific IgE that triggered release of histamine following exposure to the same bacteria cultured from their lower respiratory tracts. Please or Register to view links, Please or Register to view links Additional mechanisms, such as neurogenic inflammation, may then develop, and the symptomatic flare-up of chronic bronchitis may continue by means of sustained inflammatory mediators. Please or Register to view links, Please or Register to view links These and similar studies are the reason for greater therapeutic emphasis on reducing airway inflammation in chronic bronchitis.

    Diagnostic Testing
    Documentation of airflow obstruction by pulmonary function testing is critical for the diagnosis of chronic bronchitis and provides valuable therapeutic information about the patient's responsiveness to inhaled bronchodilator therapy. A measured forced expiratory volume in one second (FEV1) of less than 70 percent of the total forced vital capacity (FVC)—the FEV1/FVC ratio—defines obstructive airway disease. An FEV1/FVC ratio of less than 50 percent indicates end-stage obstructive airway disease.

    In most adults beyond the mid-life years, age-related physiologic changes in the elasticity of the lungs cause a 30 mL per year decline in the FEV1, so that progressive rates of decline in the FEV1 that exceed this amount represent true disease progression. Airflow obstruction in the presence of chronic sputum production confirms the clinical diagnosis of chronic bronchitis.

    Evidence of obstructive airflow changes on pulmonary function tests in patients without the characteristic symptom of sputum production is often accompanied by radiographic findings consistent with emphysema. Younger patients with emphysematous obstructive pulmonary findings, especially those without a smoking history, should be evaluated for alpha1 antitrypsin deficiency. The median survival for patients with an FEV1 of less than 1 L is four years. Please or Register to view links

    Hypoxemia is a common finding on arterial blood gas sampling in patients with advanced chronic bronchitis and ventilatory failure secondary to bronchospasm and inflammation. Concomitant hypercapnia is associated with worsening ventilatory gas exchange as the illness progresses. Blood tests may reveal mild polycythemia secondary to the hypoxia.

    Radiographic findings correlate poorly with symptoms in most patients with chronic bronchitis. Common, but nonspecific, findings include hyperinflation, bullae, blebs, diaphragmatic flattening and peribronchial markings.

    Electrocardiographic findings can sometimes include supraventricular rhythm disturbances, such as multifocal atrial tachycardia, atrial fibrillation or atrial flutter with “P” pulmonale. Findings on airway biopsy include goblet cell hyperplasia, mucosal and submucosal inflammation, and increased smooth muscle at the level of the small non-cartilaginous airways. Please or Register to view links These changes can be quantitated pathologically as the Reid index.

    The role of sputum cultures remains limited in nonhospitalized patients who present with acute exacerbation of chronic bronchitis, since cultures of expectorated samples do not reflect the organism(s) present at distal bronchial levels. Gram stain of sputum is often suggested as a means of directing initial antibiotic therapy. But because of the likelihood of multiple organisms, the role of Gram stain in acute decision-making is de-emphasized. Please or Register to view links For expectorated sputum samples to be considered valid, conventional wisdom is that there should be fewer than 10 squamous cells and more than 25 white blood cells per high-power microscopic field.

    Patients with a history of chronic bronchitis and the onset of new symptoms while hospitalized may have acquired a nosocomial infection. For these patients and for others in whom atypical organisms are suspected as the cause of an exacerbation, “protected-tip” cultures of samples obtained from the airway level that appears the most inflamed on bronchoscopy offer the best chance of identifying causative infectious agents.

    Please or Register to view links provides an overview of the management of chronic bronchitis. Please or Register to view links

    Please or Register to view links

    Educating the patient and family caregivers about the progressive nature of chronic bronchitis and its potential impact on future lifestyle and function is another important aspect for the primary care physician to oversee. Realistic goal setting and advance directives focused on terminal management issues (e.g., ventilatory support, hospitalization), as well as day-to-day medication management and oxygen compliance, should be addressed early in the illness. A multidisciplinary approach, using nurses, respiratory therapists and others to teach the patient about the disease (e.g., inhaler utilization, pulmonary rehabilitation), is encouraged.

    Pharmacologic Measures
    Please or Register to view links summarizes the current stepwise approach for the pharmacologic management of chronic bronchitis. Please or Register to view links

    Please or Register to view links In addition to evidence of symptomatic benefit, airway response can be objectively determined by spirometry. The anticholinergic aerosol agent ipratropium produces greater bronchodilation and has a slower onset of action than sympathomimetic drugs, although the effects last longer with ipratropium than with sympathomimetic agents. Sympathomimetic agents such as albuterol (Proventil, Ventolin) provide more rapid bronchodilation but have a shorter duration of action than ipratropium, except for the long-acting agent salmeterol (Serevent). However, salmeterol should only be used as maintenance therapy, not as a rescue bronchodilator. Oral sympathomimetic agents are rarely tolerated in the dosages required for sustained, adequate relief of bronchospasm, and these agents can worsen concomitant cardiovascular disease.

    The combination of ipratropium and a sympathomimetic agent, initially administered by a metered-dose inhaler, two puffs of each agent every six hours, allows adequate, sustained relief of bronchospasm while minimizing the adrenergic side effects associated with higher dosages of the beta agonists alone.

    The future development of additional inhaled anticholinergic or anti-inflammatory agents may broaden management options. In addition, the potential applications of the new leukotriene receptor antagonists currently approved for asthma therapy, such as zafirlukast (Accolate), or leukotriene inhibitors (5-lipoxygenase blockers), such as zileuton (Zyflo), may offer new strategies for the management of chronic bronchitis.

    While both ipratropium and beta-agonist agents are available in solutions for nebulized aerosol administration, the use of a small, hand-held metered-dose inhaler greatly simplifies administration and allows greater mobility than is possible with bulky nebulizer units that require electricity to operate. Optimal use of a metered-dose inhaler for administration of these agents, as well as steroid preparations, requires considerable patient education and training.

    The use of an inhaler with a spacing device held between the patient's lips reduces the need for the patient to tightly coordinate inhalation and activation of the inhaler. Proper training and consistent use of a spacing device greatly increase drug effectiveness and reduce the amount of wasted medication. Adaptive devices, often available through occupational therapists, may permit easier administration by patients with impaired hand function.

    Theophylline has long been a mainstay of therapy for chronic bronchitis, although a narrow therapeutic range and relatively common medication interactions limit its use. Its actions include improved collateral ventilation, improved respiratory muscle contractile function and improved mucociliary clearance. A long-acting theophylline preparation, taken in the evening, is especially useful in patients whose symptoms worsen at night and in whom more frequent inhaler use would further disrupt sleep.

    An increased dosage of theophylline is required in patients who continue to smoke and in patients receiving hepatically cleared medications such as rifampin (Rifadin), phenytoin (Dilantin) and other drugs. A dosage reduction is necessary in patients with hepatic failure or congestive heart failure, and in patients receiving macrolide antibiotics, quinolone antibiotics, allopurinol (Zyloprim), oral contraceptives, histamine H2-receptor blocking agents and other drugs. Monitoring serum theophylline levels following dosage adjustment is important for maintenance of a therapeutic drug level.

    Steroids can be delivered by inhalation using a metered-dose inhaler (as is more commonly used in asthma management) or by systemic therapy with oral or parenteral preparations. While therapy with short bursts of high-dose parenteral steroids is a mainstay of hospital management of acute exacerbations, rapid dosage reduction to the lowest oral dosage possible for long-term management is necessary to minimize long-term side effects.

    Long-term oral steroid therapy in chronic bronchitis should be reserved for use in patients with documented symptomatic improvement in airflow that was not achievable with inhaled preparations. Potential risks of therapy include steroid myopathy, which can worsen ventilatory muscle strength, and steroid-induced osteoporotic vertebral compression fractures. Therefore, the benefits of prolonged systemic steroid therapy should be carefully documented.

    Antibiotic Therapy
    Antibiotics are probably helpful only in acute exacerbations of chronic bronchitis. The role of antibiotic therapy in the routine management of chronic bronchitis is poorly defined. A meta-analysis of studies of antibiotic therapy for chronic bronchitis, conducted during the past 40 years, identified only six acceptable controlled trials in which any documented improvement in peak expiratory respiratory flow occurred with antibiotic use compared with placebo. Please or Register to view links While the mean airflow improvement was quite modest, patients with more severe symptoms seemed to benefit the most.

    Common current clinical practice is to promptly use antibiotics empirically in patients who demonstrate a fever or a change in sputum character. Such therapy should be directed against streptococcal species, Haemophilus species and Moraxella catarrhalis. Local resistance patterns in these organisms to ampicillin and other first-line antibiotics, such as tetracyclines (including doxycycline), trimethoprim-sulfamethoxazole (Bactrim, Septra, etc.) and the second-generation macrolides, guide initial therapy. All of these agents generally have good activity against these lower respiratory pathogens and penetrate well into bronchial tissues.

    Broader antibiotic coverage is required when acute exacerbations develop in the hospital setting. Such patients may be candidates for bronchoscopic protected-tip culture techniques.

    A role for antibiotic prophylaxis in patients having four or more repeated acute exacerbations per year has been suggested, although the effectiveness of this approach in preventing hospitalizations or morbidity has not yet been documented. Please or Register to view links A more defined role exists for yearly influenza immunizations, since post-influenza bacterial infections are a significant cause of exacerbations of chronic bronchitis. All patients with chronic bronchitis should receive the polyvalent pneumococcal vaccine at least once. Re-vaccination with the pneumococcal vaccine should be considered after seven years in patients with renal impairment. Unfortunately, the currently available Haemophilus b conjugate vaccine (Acthib, Comvax, Hibtiter) is not expected to be helpful in patients with chronic bronchitis, since most strains of Haemophilus isolated from the lower respiratory tracts of symptomatic patients are non-typable. Please or Register to view links

    Adjunctive Measures
    Correcting the hypoxia associated with chronic bronchitis is an important part of improving both survival and quality of life. Please or Register to view links summarizes indications for chronic oxygen therapy. While oxygen must be used for at least 18 hours daily to produce any reduction in mortality, use during sleep can improve the quality of sleep and decrease the frequency of nocturnal arrhythmias.

    View/Print Table

    TABLE 1

    Indications for Supplemental Oxygen in Patients with COPD
    Recommended indications

    PaO2 ≤55 mm Hg or SaO2 ≤89% at rest

    PaO2 ≤55 mm Hg or SaO2 ≤89% with exercise

    PaO2 ≤55 mm Hg or SaO2 ≤89% during sleep

    Evidence of pulmonary hypertension or cor pulmonale, mental or psychologic impairment, or polycythemia and a PaO2 of 56 to 59 mm Hg or an SaO2 ≤90% at any time

    Medicare criteria for reimbursable oxygen supplementation

    PaO2 ≤55 mm Hg or SaO2 ≤88%

    PaO2 of 56 to 59 mm Hg or SaO2 ≤89% if [there is] evidence of cor pulmonale (“P“pulmonale, polycythemia or congestive heart failure)

    COPD = chronic obstructive pulmonary disease; PaO2 = partial pressure of arterial oxygen; SaO2 = arterial oxygen saturation.

    Reprinted with permission from Ferguson GT, Cherniack RM. Management of chronic obstructive pulmonary disease. N Engl J Med 1993;328:1017–22.

    Oxygen can be provided in a variety of forms, including economic oxygen concentrators for patients who require only low flow rates. Because the monthly expense of oxygen therapy is substantial, selected patients may benefit from oxygen-conserving devices, which are triggered by respiration to deliver a fixed dose of oxygen only during inhalation.

    Expectorant mucolytic therapy is generally regarded as unhelpful in most patients with chronic bronchitis. Cough suppressants and sedatives should be avoided as routine measures. Increased mobilization of secretions may be accomplished through adequate systemic hydration and the use of effective cough methods and postural drainage. One effective method of coughing up retained secretions is to lean forward and “huff” repeatedly; the huffing is interspersed with relaxed breaths. Forceful paroxysms of coughing are to be discouraged. Opiates may increase exercise tolerance, although they are not considered standard treatment in most patients.

    Surgical approaches for the treatment of chronic bronchitis are limited to use in those rare patients with coexisting bullous emphysema, in whom a bullectomy may allow greater respiratory expansion, or in those patients who might tolerate reduction pneumoplasty, in which bilateral resection of 20 to 30 percent of the lung volume is performed. Lung transplantation remains an expensive ($300,000 the first year) and extraordinary consideration for only highly selected patients with emphysema and very limited functional status despite exhaustive medical management. Patients being considered for lung transplantation should have an established social support network to cope with the emotional and functional stresses of this surgery.

    Optimizing Functional Capacity
    Pulmonary rehabilitative efforts for patients with chronic bronchitis can improve airway function and allow greater mobility. In addition to exercise conditioning of the respiratory and associated muscles, nutrition and hydration support and psychologic and vocational services are necessary.

    Common strategies for attaining respiratory muscle conditioning include graded aerobic exercise such as walking or bicycling over progressively longer durations three times a week, with oxygen supplementation as needed. Instruction regarding pursed-lip breathing—taking deep breaths and breathing out slowly through pursed lips—can help patients reduce the exhausting rapid respiratory rate that many develop. Training the inspiratory muscles to inhale against progressively larger resistance loads can improve exercise tolerance, especially when this conditioning technique is accompanied by abdominal breathing exercises to relieve thoracic respiratory muscle fatigue. The increased respiratory muscle work associated with these pulmonary rehabilitative efforts often requires enhanced nutritional support. Improved hydration through greater fluid intake and provision of airway humidity can also facilitate sputum mobilization, more so than pharmacologic expectorants or mucolytic agents.
  5. walang sumagot nung tumawag ako sa 911 :facepalm:
  6. gggrrr..baket 911

    @parpol antibiotics

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    eto pa
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