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v
Progressive dis.
v
Dx is made on clinical
history.
Definition
q
Persisted cough with
sputum, for at least 3 consecutive months, ≥ 2 successive yrs.
q
Providing other causes
of productive cough (e.g. bronchiectasis & untreated chronic
asthma) have been excluded.
Etiology
o
Cigarette smoking, dust, smoke.
o
N.B. Infection is
aggravating factor (not a cause!).
Pathology
Clinical features
o
Productive cough.
o
Wheeze, breathlessness,
tightness before excessive bronchial secretions are cleared by
coughing.
o
Sputum: scanty, mucoid,
tenacious + blood (?).
o
Inspirational & expirational rhonchi.
investigations
o
CXR.
o
Pulmonary Functions
Tests:
o
↓
FEV1 ,
↓ PEF.
o
↑ TLC.
o
Gas transfer:
(Normal)
o
ABG measurement:
§
Permanent
PaCO2.
§
↓ PaO2.
"In sever cases", this could lead to generalized
alveolar under-ventilation".
Complications:
1.
Resp. Failure I & II.
2.
Cor pulmonale (= Pulm.
HTN à
RVF)
3.
2º Polycythemia.
management
1.
↓
Bronchial irritation.
2.
Rx
of Resp. infection:
Most
infections are caused by strep. pneumoniae / H. influenzae.
3.
Bronchodilators:
·
They’re <<
effective in chronic bronchitis than in bronchial asthma.
·
β2-adrenoceptor
agonist (salbutamol / terbutaline)
·
Anti-cholinergic
bronchodilator (ipratropium bromide)
4.
Symptomatic
measures:
·
Warm bedroom à
for unproductive nocturnal cough.
·
Hot drink / inhalation
of steam à
liquefy sputum & make it easier to cough up.
written
by:
Khalid Bin Yaroof. FMHS, UAE University.
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