Chronic Bronchitis is a disease that is diagnosed on the basis of the symptoms: a daily, productive cough for at least 3 consecutive months for 2 years in a row. Most frequently it is the result of tobacco smoke exposure. While our textbooks identify Chronic Bronchitis and Emphysema as distinct disorders, most patients have a combination of both, with very few patients that fit only in one disorder.

CHANGES IN VITAL SIGNS

Vital sign changes are most frequently related to hypoxemia for which the body tries to compensate by increasing cardiac output / perfusion, thus heart rate and blood pressure are usually increased. Respiratory rate, when stable, may show a slow rate with a prolonged expiratory phase, or will increase as a result of hypoxemia, and hypercapnia when in acute failure.

CHANGES IN PHYSICAL APPEARANCE

Obstructive disorders result in the patient being unable to exhale and thus traps air in the distal regions of the lung, so even though they are hyperaerated, they are extremely underventilated! If you take in a deep breath, only exhale a third of the volume, and then try to breath in and out at that level you will get a little idea of how uncomfortable it is to try to breath like that! Therefore chronic bronchitis patients have to work hard to try and get air out past obstruction, while struggling to get a little bit of fresh air in, resulting in signs of increased work of breathing. This would include the fixation of the shoulder girdle by resting their arms on a bed side table, or bracing on the bed-rails - creating a tripod that stabilizes the shoulders and allows the sternocleidomastoid muscles to lift the upper rib cage in an attempt to bring air into lungs that are over distended. Then, when they exhale they will purse-lip breathe - blow out through pursed lips - which helps generate a positive back pressure in the airways that stents the airway open and allows more air to be exhaled before their collapse. Pursed-lip breathing prolongs the expiratory phase.

Air-trapping keeps the chest cage in an expanded condition and results in the barrel-chest appearance.

Signs of right-heart failure are most common in end-stage COPD patients.

CHANGES IN COUGH AND SPUTUM PRODUCTION

Secretion retention is a result of destruction of the normal muco-ciliary escalator. Cough therefore is the primary defense mechanism that a COPD patient has to clear secretions from their lungs. Morning productive coughing (frequently experienced by smokers before they are ever diagnosed with a chronic lung disease) is a result of the lack of normal airway clearance combined with positional changes that cause the secretions to move and trigger the cough reflex. This loss of the normal protective mechanism also predisposes the patient to lung infections as the mucus in the airways has all the ideal nutrients for bacterial growth. Sputum will become thicker, more yellow or green as a result of infection.