Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Bronchitis, Chronic


Related Terms

  • Chronic Obstructive Pulmonary Disease
  • Non-obstructive Bronchitis
  • Purulent Bronchitis

Differential Diagnosis

Specialists

  • Pulmonologist

Comorbid Conditions

Factors Influencing Duration

Disability is influenced by the severity of the disease, presence of complications, the individual's age, exposure to irritating substances, continued smoking, underlying medical conditions, episodes of acute illness, and compliance with the prescribed treatment.

Chronic bronchitis symptoms worsen when atmospheric concentrations of sulfur dioxide and other air pollutants (smog) increase. These symptoms are intensified when individuals also smoke. Any superimposed acute respiratory illness and exposure to colds and influenza, either at home or in public, can increase the period of disability. Surgery or any other physical stress can worsen symptoms.

Medical Codes

ICD-9-CM:
491.0 - Chronic Bronchitis, Simple
491.1 - Chronic Bronchitis, Mucopurulent
491.20 - Chronic Bronchitis, Obstructive, without Mention of Acute Exacerbation
491.21 - Chronic Bronchitis, Obstructive, with Acute Exacerbation
491.8 - Bronchitis, Chronic, Other
491.9 - Bronchitis, Chronic, Unspecified

Overview

Chronic bronchitis is a long-term respiratory illness characterized by mucus-producing cough most days of the month that persists for at least 3 months of the year for 2 consecutive years in the absence of another cause of chronic productive cough such as tuberculosis, lung cancer, bronchiectasis, cystic fibrosis, or chronic congestive heart failure (Akinbami). Chronic bronchitis is characterized by inflammation of the air passage walls in the lungs (bronchi) and abnormal enlargement of mucus glands in the larger lung airways (bronchioles). The enlarged glands produce excessive amounts of mucus that triggers coughing and sputum expectoration. Chronic bronchitis is one component of chronic obstructive pulmonary disease (COPD), a collection of conditions characterized by progressive difficulty exhaling air from the lungs and an abnormal inflammatory response to inhaled noxious irritants. Chronic bronchitis can be triggered by bacterial or viral infection, smoking tobacco, or exposure to airborne irritants. In individuals who smoke or who are regularly exposed to irritants, chronic bronchitis is often accompanied by an increase in the size of the air sacs (alveoli) at the ends of the bronchioles (pulmonary emphysema), resulting in shortness of breath (dyspnea) on exertion. A simple cold may easily progress to acute bronchitis or pneumonia in these patients, or an acute bronchitis may develop into chronic bronchitis. Please refer to Acute Bronchitis for additional information.


In addition to the basic diagnosis of chronic bronchitis, some doctors further subdivide this illness into more specific subtypes. If the cough produces thin, clear mucus, then the condition is called simple chronic bronchitis, but if the mucus is thick and yellow or green (containing pus), it becomes chronic mucopurulent bronchitis. If an individual develops significant airway obstruction in addition to the chronic cough, the condition is termed chronic bronchitis with obstruction. In asthmatic individuals, the presence of chronic bronchitis symptoms as a complication of frequent asthma attacks and bronchitis episodes is called chronic asthmatic bronchitis.

Incidence and Prevalence: In the United States, chronic bronchitis affected about 4.2% of the population in 2011 (Schiller). Chronic bronchitis is most prevalent in individuals older than age 45 (Schiller). Females are affected by acute and chronic bronchitis more than males (Schiller).

Acute and chronic bronchitis are common worldwide and are among the most frequent reasons individuals seek medical care in countries that have collected data.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Risk factors for chronic bronchitis include tobacco smoking or, in nonsmokers, breathing second-hand smoke. Air pollution and exposure to irritants such as airborne organic dusts or toxic gases are also risk factors. Such exposure is especially prevalent in cotton mills and plastic manufacturing plants. Among smokers, the severity of the disease corresponds to the amount and duration of smoking. Individuals over age 45 (Schiller; Forey) and those with a history of frequent upper respiratory illnesses, infections, or allergies are at greater risk of developing chronic bronchitis.

Source: Medical Disability Advisor



Diagnosis

History: The individual may report a cough producing sputum that may or may not contain some blood. An occupational history is important in determining if specific irritants play a role. Symptoms may include shortness of breath on exertion, wheezing, chest discomfort, fatigue, and headaches. A history of acute bronchitis or frequent respiratory infections may be revealed.

Physical exam: The individual's respiratory rate and chest expansion may appear normal in early simple bronchitis. The individual with chronic obstructive bronchitis may have a variable respiratory rate, labored respirations, and a bluish color to the skin (cyanosis), and may be overweight. Listening to the chest (auscultation) likely reveals coarse sounds (rhonchi) that clear with coughing and possibly wheezing or other abnormal breath sounds (rales).

Tests: The type and severity of chronic bronchitis is determined by pulmonary function testing (PFT), which may include simple airflow (spirometry), blood oxygen saturation (pulse oximetry), lung volume, and arterial blood gas measurements. The testing can be done both before and after administering a bronchodilator to determine if any of the airway obstruction is reversible. A complete blood count (CBC) may be performed. A culture of sputum may be done to rule out the presence of specific causative bacteria, although negative results are typical in chronic bronchitis. A chest x-ray may be normal unless the individual also has pneumonia, emphysema, or more severe chronic bronchitis in which thickening of the mucous membrane has caused significant narrowing of the airways. A chest computed tomography (CT) scan may also be performed.

Source: Medical Disability Advisor



Treatment

There is no cure for chronic bronchitis. Treatment is aimed at relieving symptoms and preventing complications. The first objective is to eliminate the bronchial irritants that have caused the disease, including occupational or environmental exposures to dusts and fumes. Discontinuing cigarette smoking is necessary; the importance of doing so cannot be overemphasized. To facilitate the removal of thick mucus from airways and prevent the pooling of secretions that leads to infections, the individual can regularly use a humidifier and perform deep-breathing and effective coughing exercises. Postural drainage and percussion (striking the back with short, sharp blows) may be used occasionally to enhance removal of mucus.

Individuals with an asthmatic component to their chronic bronchitis are given bronchodilators. If the asthmatic component is severe, steroids may be used to break the cycle of airway reactivity. Antibiotics are given during an acute exacerbation of chronic bronchitis when sputum, normally white in color, changes to yellow or green and a bacterial cause is suspected. Individuals with long-standing chronic obstructive bronchitis and low oxygen saturation, either at rest or during exercise, may benefit from supplemental oxygen therapy.

Immunization against pneumococcal pneumonia and influenza is recommended for individuals with chronic bronchitis because of the increased risk of complications and prolonged recovery time if acute respiratory diseases develop.

Source: Medical Disability Advisor



Prognosis

Early diagnosis and treatment of chronic bronchitis, along with smoking cessation, significantly improve the chances of a good outcome. The progressive limitation in respiration characteristic of COPD conditions is partially reversible in the chronic bronchitis component with reduction or cessation of smoking or removal of causative irritants, as well as an effective treatment regimen.

Individuals with chronic obstructive bronchitis usually become permanently disabled at some point, even with treatment and smoking cessation. Smokers with chronic bronchitis who stop smoking can slow the progression of lung deterioration, even if they have severe symptoms. The frequency of complications, including shortness of breath, declining lung function, and airflow obstruction, gradually worsens. Ultimately, individuals who are severely incapacitated may need a lung transplant.

Source: Medical Disability Advisor



Complications

The most common complication of chronic bronchitis is an episode of acute bronchitis and pneumonia. Chronic bronchitis compromises the defense mechanisms of the lungs, so infections that develop may be frequent or severe enough to cause obstruction of the airways and to compromise breathing, requiring hospitalization. The most debilitating complications are right heart failure (cor pulmonale), cardiac arrhythmia, and respiratory failure. An acute infection usually precedes an episode of respiratory failure.

Sometimes bronchial secretions collect in the lungs and thicken. If the individual cannot cough up these thick secretions, they may totally obstruct the flow of air into a part of the lung.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Reduction of airway irritants in the environment and/or the use of respiratory protective masks can help decrease time lost from work. Avoiding very cold or hot air temperatures can also help. Individuals with long-standing chronic bronchitis may have reduced capacity for physical work, and any such duties may need to be temporarily or permanently restricted. Individuals who require supplemental oxygen at work may present a safety hazard in the workplace.

For more information on risk, capacity, and tolerance, refer to "Work Ability and Return to Work," pages 302, 305-306.

Source: Medical Disability Advisor



Maximum Medical Improvement

60 days.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual meet the chronic bronchitis criteria of having had a persistent cough for at least 3 months a year for 2 consecutive years?
  • Was lung condition evaluated through spirometry, pulse oximetry, lung volume, and arterial blood gas measurements?
  • Were conditions with similar symptoms ruled out?
  • Does bronchitis have an asthmatic component?
  • Has pulmonary emphysema been noted?
  • Does individual have shortness of breath on exertion?

Regarding treatment:

  • Were bronchial irritants removed from the work and home environments?
  • If the individual is a smoker, has he or she quit smoking cigarettes? If unable to quit on his or her own, would individual benefit from enrollment in a smoking cessation program?
  • Does individual participate in a home respiratory care program?
  • If individual has an asthmatic component to chronic bronchitis, is a bronchodilator part of regular treatment? Were steroids used effectively to break the cycle of airway reactivity?
  • Is oxygen therapy part of current treatment?
  • Has the individual participated in a pulmonary rehabilitation exercise program?

Regarding prognosis:

  • Does individual have an underlying lung or cardiopulmonary disease that may affect recovery?
  • Does individual have diabetes or other underlying medical condition?
  • Is individual overweight or obese?
  • Have any complications occurred as a result of bronchitis?
  • Has individual received influenza vaccine and avoided exposure to colds and flu?
  • Is individual a smoker or former smoker?
  • Is individual exposed to second-hand smoke? What can be done to limit or eliminate exposure?
  • Has individual had any occupational exposure to airborne organic dusts or toxic gases? What can be done to prevent further exposure?
  • Does individual live where smog is a problem?

Source: Medical Disability Advisor



References

Cited

Akinbami, L. J. , and X. Liu. Chronic Obstructive Pulmonary Disease Among Adults Aged 18 and Over in the United States, 1998–2009. NCHS Data Brief 63. National Center for Health Statistics, 2011.

Fayyaz, Jazeela, et al. "Bronchitis." eMedicine. Eds. Zab Mosenifar, et al. 28 Mar. 2014. Medscape. 6 May 2014 <http://emedicine.medscape.com/article/297108-overview>.

Forey, B. A. , A. J. Thornton, and P. N. Lee. "Systematic Review with Meta-Analysis of the Epidemiological Evidence Relating Smoking to COPD, Chronic Bronchitis and Emphysema." BMC Pulmonary Medicine 11 36 (2011): None-None.

Schiller, J. S. , J. W. Lucas, and J. A. Peregoy. "Summary Health Statistics for US Adults: National Health Interview Survey, 2011." Vital Health Statistics 10 256 (2012): None-None.

Talmage, J. B. , J. M. Melhorn, and M. H. Hyman, eds. Work Ability and Return to Work, AMA Guides to the Evaluation of. Second ed. Chicago: AMA Press, 2011.

Source: Medical Disability Advisor






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