Chronic Bronchitis Clinical Manifesitation

The hallmark of chronic bronchitis is chronic cough and sputum production. Productive cough may be present on most of the days, at least for many years. The disease is commonly seen in old men and women with an onset related to winter and
is caused by cold. At early stage, cough is productive and often occurs in the morning.This may be the only symptoms and may gradually become serious and symptoms such as dyspnea on exertion may develop.

As the disease progresses, the course of the illness is usually marked by recurrent episodes of acute respiratory failure resulting from infectious exacerbations of the bronchitis. Clinically, the manifestations are increased cough, change in sputum from clear and mucoid to purulent, fever, "dyspnea and varying degrees of respiratory distress. The course of the disease is one of gradual increase in frequency and severity of episodes of acute infection and respiratory failure, eventually resulting in intubation and the need for almost constant ventilatory assistance. Death usually occursduring an episode of respiratory failure.

The physical findings vary with the stage in which the patient is examined.
During relatively quiescent period, the only findings may be increased anteroposterior diameter of the chest, hyperresonance to percussion, prolonged expiratory phase,scattered diffuse coarse or moderate rhonchi and tales and wheezing. Later the patient may manifest the signs and symptoms of pulmonary hypertension and right ventricular failure, i.e. increased second heart sound, pedal edema, hepatomegaly and ascites.

If examined during an acute attack, the patient is found in respiratory distress as evidenced by tachypnea and use of accessory muscles for respiration. Cough is often prominent and cyanosis during acute attack is not uncommon.

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