| ICD-9-CM: |
| 490 - | Bronchitis, Not Specified as Acute or Chronic |
| 491 - | Bronchitis, Chronic |
| 491.0 - | Chronic Bronchitis, Simple |
| 491.1 - | Chronic Bronchitis, Mucopurulent |
| 491.2 - | Chronic Bronchitis, Obstructive |
| 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 |
| 506.4 - | Chronic Respiratory Conditions due to Fumes and Vapors |
| Chronic bronchitis is a long-term respiratory illness related to inflammation within the air passages to the lungs (bronchi) and to abnormal enlargement of mucus-producing glands in the larger lung airways (bronchioles). It is usually accompanied by an increase in the size of the air sacs (alveoli) beyond the bronchioles (pulmonary emphysema). A simple cold may easily progress to acute bronchitis or pneumonia in these patients.
In individuals with chronic bronchitis, the enlarged glands produce excessive amounts of mucus that triggers coughing. Chronic bronchitis is officially diagnosed when it persists for at least 3 months of the year for 2 consecutive years.
In addition to the basic diagnosis of chronic bronchitis, some doctors further subdivide this illness into more specific subtypes. If the cough produces thin and clear mucus, then the condition is called simple chronic bronchitis, but if the mucus is thick and discolored, it becomes chronic mucopurulent (mucus with pus present) bronchitis. If an individual develops significant airway obstruction in addition to the chronic cough, the condition is termed chronic bronchitis with obstruction. If episodes of asthmatic symptoms (wheezing and shortness of breath) occur, it is called chronic asthmatic bronchitis. Chronic bronchitis is one form of chronic obstructive pulmonary disease (COPD).
Bronchitis is nearly always self-limited in the otherwise healthy individual, although it frequently results in absenteeism from work.
Factors that may increase an individual's risk of getting chronic bronchitis include a history of frequent upper respiratory illnesses, infections, or allergies; pneumonia during childhood; and having an identical twin with chronic bronchitis.Risk: Risk factors for chronic bronchitis include tobacco smoking or, in nonsmokers, exposure to second-hand smoke; air pollution; and working where exposure to airborne organic dusts or toxic gases occurs. Such exposure is especially prevalent in cotton mills and plastic manufacturing plants. Among smokers, the severity of the disease relates to the amount and duration of smoking. Incidence and Prevalence: In the US, COPD affects 14.2 million people; of them, 12.5 million have chronic bronchitis and 1.7 million have emphysema (Sharma).
Since the mid-1990s, the prevalence of COPD in women has increased by 30% (Sharma). |
Source: Medical Disability Advisor
| 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. Frequent respiratory infections may be revealed, as well as fatigue, headaches, and ankle, feet, and leg swelling. 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). Listening to the chest 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. It 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 chest x-ray may be normal unless the individual also has pneumonia, emphysema, or severe chronic bronchitis. A complete blood count (CBC) may also be performed, as well as a chest CT scan. |
Source: Medical Disability Advisor
| 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 blow) 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 episode of bronchitis when sputum normally white in color changes to yellow or green. 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
| Early diagnosis and treatment of chronic bronchitis, along with smoking cessation, significantly improves the chances of a good outcome.
Individuals with chronic obstructive bronchitis usually become permanently disabled at some point, even with treatment and smoking cessation. 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. Smokers with chronic bronchitis who kick the habit can slow the progression of lung deterioration, even if they have severe symptoms. |
Source: Medical Disability Advisor
| The most common complication of chronic bronchitis is an episode of acute bronchitis, pneumonia, or emphysema. Chronic bronchitis compromises the defense mechanisms of the lung so infections that develop may be frequent or severe enough to require 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. The lung tissue behind the obstruction will then collapse (atelectasis). |
Source: Medical Disability Advisor
| 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 hazard in the workplace. |
Source: Medical Disability Advisor
| 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 a persistent cough for at least 3 months a year for 2 years?
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Was lung condition evaluated through spirometry, pulse oximetry, lung volume and arterial blood gas measurements?
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Were conditions with similar symptoms ruled out?
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Does bronchitis have an asthmatic component?
Regarding treatment:
- Were bronchial irritants removed from the environment?
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Has individual quit smoking cigarettes? If unable to quit on his or her own, would individual benefit from enrollment in a community stop-smoking program?
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Does individual participate in a home respiratory care program?
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If individual has an asthmatic component to chronic bronchitis, were steroids used effectively to break the cycle of airway reactivity?
Regarding prognosis:
- Does individual have an underlying lung or cardiopulmonary disease that may affect recovery?
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Have any complications occurred as a result of the bronchitis?
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Is individual a smoker or former smoker?
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Is individual exposed to second-hand smoke? What can be done to limit or eliminate exposure?
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Has individual had any occupational exposure to airborne organic dusts or toxic gases? What can be done to prevent further exposure?
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Does individual live where smog is a problem?
|
Source: Medical Disability Advisor
| Sharma, Sat. "Chronic Bronchitis." eMedicine. Eds. Laurie Robin Grier, et al. 2 Sep. 2004. Medscape. 30 Sep. 2004 <http://emedicine.com/med/topic367.htm>. |
Source: Medical Disability Advisor
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