Overall incidence of chronic bronchitis is increasing in the community. Long-term side effects negatively affect quality of life of patients. This poster presentation attempts to provide more details on chronic bronchitis. Extensive details on the pathophysiology, signs & symptoms, nursing implications are provided to help the reader understand the disease process, management and prevention strategies of chronic bronchitis

Chotalia, Dhwani

English

Otterbein University

Otterbein University Digital Commons @ Otterbein Nursing Student Class Projects (Formerly MSN) Student Research & Creative Work Summer 7-27-2016 Chronic Bronchitis Dhwani Chotalia Dhwani.chotalia, dhwani.chotalia@otterbein.edu Follow this and additional works at: https://digitalcommons.otterbein.edu/stu_msn  Part of the Nursing Commons Recommended Citation Chotalia, Dhwani, "Chronic Bronchitis" (2016). Nursing Student Class Projects (Formerly MSN). 167. https://digitalcommons.otterbein.edu/stu_msn/167 This Project is brought to you for free and open access by the Student Research & Creative Work at Digital Commons @ Otterbein. It has been accepted for inclusion in Nursing Student Class Projects (Formerly MSN) by an authorized administrator of Digital Commons @ Otterbein. For more information, please contact digitalcommons07@otterbein.edu. Chronic	  BronchitisDhwani	  Chotalia,	  RN,	  BSNIntroductionDifficulty	  breathing,	  increased	  coughing	  with	  mucus	  production,	  and	  supplemental	  oxygen	  use	  are	  all	  symptoms	  that	  people	  who	  suffer	  with	  chronic	  bronchitis,	  deal	  with	  on	  a	  daily	  basis.	  Chronic	  bronchitis	  which	  is	  often	  used	  under	  the	  umbrella	  term	  chronic	  obstructive	  pulmonary	  disease	  (COPD),	  is	  describe	  as	  an	  inflammatory	  disease	  of	  the	  mucous	  membranes	  of	  the	  bronchi	  (Higginson,	  2010).	  According	  to	  the	  Centers	  for	  Disease	  Control	  and	   Prevention	  (CDC),	  8.7	  million	  Americans	  were	  diagnosed	  and	  664	  deaths	  secondary	  to	  bronchial	  complications	  in	  year	  2014	  (2016).	  Women	  are	  almost	  twice	  as	  likely	  to	  be	  diagnosed	  with	  chronic	  bronchitis	  as	  men	  (Pelkonen,Notkola,	  Laatikainen,	  &	  Koskela,	  2014).	  In	  2011,	  3.3	  million	  men	  were	  diagnosed	  with	  chronic	  bronchitis	  compared	  to	  6.8	  million	  women	  (CDC,	  2016).	  Bronchitis	  is	  one	  of	  the	  most	  prevalent	  seen	  chronic	  disorders	  in	  primary	  care	  outpatient	  setting.	  Given	  current	  statistics,	  the	  prevalence	  of	  chronic	  bronchitis	  is	  so	  high,	  hence	  why	  this	  topic	  was	  chosen.Pathophysiology	  ReferencesOtterbein	  University,	  Westerville,	  OhioSignificance	  of	  PathophysiologySigns	  and	  SymptomsConclusionImplications	  for	  Nursing• A	  form	  of	  chronic	  obstructive	  pulmonary	  disease	  (COPD),	  bronchitis	  may	  be	  classified	  as	  acute	  or	  chronic.	  Chronic	  bronchitis	  is	  characterized	  by	  over	  production	  of	  mucous	  in	  the	  bronchi	  accompanied	  by	  a	  recurrent	  cough	  last	  for	  three	  months	  of	  the	  year	  and	  occur	  for	  at	  least	  twice	  consecutive	  years	  (Corhay,	  Vincken,	  Schlesser,	  Bossuyt,	  &	  Imschoot,	  2013).• According	  to	  Kim	  &	  Criner (2013),	  mucous	  metaplasia	  is	  the	  pathological	  foundation	  of	  chronic	  bronchitis.	  “it	  is	  a	  process	  in	  which	  mucus	  is	  overproduced	  in	  response	  to	  	  inflammatory	  response	  caused	  by,	  overproduction	  and	  hypersecretion	  by	  goblet	  cells	  and	  decreased	  elimination	  of	  mucus”	  (pg.	  229).• Mucus	  overproduction	  is	  caused	  by,	  “cigarette	  smoke	  exposure,	  acute	  or	  chronic	  viral	  infection,	  bacterial	  infection	  or	  inflammatory	  cell	  activation	  of	  mucin	  gene	  transcription	  via	  activation	  of	  the	  epidermal	  growth	  factor	  receptor,	  leading	  to	  overproduction	  of	  mucus	  and	  hypersecretion	  from	  increased	  degranulation	  of	  neutrophil-­‐mediated	  elastase.	  Due	  to	  mucous	  hypersecretion,	  patients	  have	  difficulty	  in	  clearing	  secretions	  because	  of	  poor	  ciliary	  function,	  distal	  airway	  occlusion,	  and	  ineffective	  cough	  secondary	  to	  respiratory	  muscle	  weakness	  and	  reduced	  peak	  expiratory	  flow”	  (Kim	  &	  Criner,	  2013,	  pg.	  229).• ImMucous metaplasia	  causes	  airflow	  obstruction	  by	  several	  mechanisms	  such	  as,	  “Increased	  mucous	  hypersecretion	  causes	  luminal	  occlusion,	  epithelial	  layer	  thickening	  encroaches	  on	  the	  airway	  lumen,	  and	  increased	  mucus	  alters	  airway	  surface	  tension.”	  (Kim	  &	  Criner,	  2013,	  pg.	  230)• Over	  time	  patient	  experiences	  abnormal	  ventilation	  perfusion	  ratios,	  hypoxemia,	  hypoventilation,	  and	  right	  sided	  heart	  failure	  (Martin	  &	  Harrison,	  2015)Over	  ten	  million	  Americans	  reported	  a	  physician	  diagnosis	  of	  chronic	  bronchitis	  in	  2011	  with	  almost	  70%	  of	  cases	  occurring	  in	  those	  over	  45	  years	  old	  (CDC,	  2016).	  Overall	  incidence	  of	  chronic	  bronchitis	  is	  increasing	  in	  the	  community.	  Long-­‐term	  sideeffects	  negatively	  affect	  quality	  of	  life	  of	  patients.	  Without	  early	  detection	  and	  effective	  management	  of	  the	  disease,	  patient	  can	  have	  many	  other	  secondary	  complications.Since	  the	  disease	  is	  on	  the	  rise,	  there	  are	  many	  research	  studies	  and	  clinical	  trials	  are	  ongoing	  to	  improve	  patient’s	  quality	  of	  life.	  The	  RejuvenAir system	  cryospray treatment	  is	  a	  new	  therapy	  currently	  in	  clinical	  trial	  for	  challenging	  symptoms.	  It	  is	  anticipated	  that	  this	  new	  treatment	  will	  be	  beneficial	  and	  improve	  patient’s	  breathing	  by	  freezing	  and	  filling	  off	  the	  top	  layer	  of	  cells	  in	  the	  damaged	  airway,	  enabling	  the	  regrowth	  of	  healthy	  cells	  (Sarli,	  2016).	  With	  current	  and	  upcoming	  research	  findings,	  hopefully	  there	  will	  be	  better	  interventions	  to	  manage	  chronic	  bronchitis	  effectively,	  prevent	  further	  progress	  and	  secondary	  complications.• As	  a	  healthcare	  provider,	  a	  complete	  history	  must	  be	  obtained,	  including	  information	  on	  exposure	  to	  toxic	  substances	  and	  smoking	  (Higginson,2010).• Symptoms	  of	  chronic	  bronchitis	  include	  the	  following:• Cougha• Increased	  production	  of	  mucus• Dyspnea• Wheezing	  • Fatigue• Fever	  and	  chills• Chest	  discomfort	  • Sings	  of	  global	  hypoxemia	  (Higginson,2010;	  Iyer &	  Kaiser,	  2013)Treatment	  for	  chronic	  bronchitis	  includes	  combination	  approach	  such	  as:• Smoking	  cessation	  and	  avoiding	  second	  hand	  smoke	  (Corhay et	  al,	  2013)• Mucolytic	  therapy	  is	  prescribed	  to	  improve	  their	  symptoms	  related	  to	  sputum	  production	  (Martin	  &	  Harrison,	  2015,	  pg.	  1107).• An	  antibiotic	  treatment	  recommended	  if	  there	  is	  change	  in	  sputum	  quantity	  or	  quality	  (Corhay et	  al,	  2013)• Studies	  indicate	  that	  “five-­‐day	  therapy	  antibiotic	  regimens	  with	  telithromycin 800mg	  once	  daily,	  amoxicillion-­‐clavulanate 2000/125	  mg	  twice	  daily,	  clarithromycin	  ER	  1000	  mg	  once	  daily	  or	  various	  cephalosporins,	  macrolides	  and	  fluoroquinolones	  are	  as	  effective	  as	  7-­‐10	  days	  in	  treating	  patients	  with	  chronic	  bronchitis	  exacerbation”(Bashlian,	  Sun,	  Dorsen,	  2012,	  pg.	  538).• Long-­‐term	  use	  of	  low	  dose	  azithromycin	  has	  shown	  to	  improve	  quality	  of	  life	  and	  decrease	  frequency	  of	  exacerbations	  (Martin	  &	  Harrison,	  2015).• Inhaled	  bronchodilator	  therapy	  and	  corticosteroid	  treatment	  (Kaufman,	  2010)• Oxygen	  to	  treat	  hypoxia	  (Higginson,	  2010)Bashlian,	  R.	  A.,	  Sun,	  C.	  J.,	  &	  Dorsen,	  C.	  G.	  (2012).	  Short-­‐ vs	  long-­‐course	  antibiotics	  for	  acute	  exacerbations	  of	  chronic	  bronchitis.	  Journal	  for	  Nurse	  Practitioners, 8(7),	  534-­‐539	  6p.	  doi:	  10.1016/j.nurpra.2012.01.001Centers	  for	  Disease	  Control	  and	  Prevention.	  (2016,	  April	  27).	  Chronic	  Obstructive	  Pulmonary	  Disease	  (COPD)	  includes:	  chronic	  bronchitis	  and	  emphysema. Retrieved	  May	  29,	  2016	  from	  http://www.cdc.gov/nchs/fastats/copd.htmCorhay,	  J.	  L.,	  Vincken,	  W.,	  Schlesser,	  M.,	  Bossuyt,	  P.,	  &	  Imschoot,	  J.	  (2013).	  Chronic	  bronchitis	  in	  COPD	  patients	  is	  associated	  with	  increased	  risk	  of	  exacerbations:	  A	  cross-­‐sectional	  multicentre study. International	  Journal	  of	  Clinical	  Practice, 67(12),	  1294-­‐1301.	  doi:http://dx.doi.org.ezproxy.otterbein.edu/10.1111/ijcp.12248Forey,	  B.	  A.,	  Thornton,	  A.	  J.,	  &	  Lee,	  P.	  N.	  (2011).	  Systematic	  review	  with	  meta-­‐analysis	  of	  the	  epidemiological	  evidence	  relating	  smoking	  to	  COPD,	  chronic	  bronchitis	  and	  emphysema. BMC	  Pulmonary	  Medicine, 11(1),	  36-­‐36	  1p.	  Doi:	  10.1186/1471-­‐2466-­‐11-­‐36Higginson,	  R.	  (2010).	  COPD:	  pathophysiology	  and	  treatment.	  Nurse	  Prescribing,	  8(3),	  102-­‐110	  9p.	  Iyer,	  V.	  N.,	  &	  Lim,	  K.	  G.	  (2013).	  Chronic	  cough:	  an	  update.Mayo	  Clinic	  Proceedings, 88(10),	  1115-­‐1126	  12p.	  doi:	  10.1016/j.mayocp.2013.08.007Kaufman,	  G.	  (2010).	  Inhaled	  bronchodilators	  for	  chronic	  bronchitis	  and	  emphysema.Nursing Standard	  (through	  2013), 25(5),	  61-­‐2,	  64-­‐6,	  68.	  Retrieved	  from	  http://ezproxy.otterbein.edu/login?url=http://search.proquest.com.ezproxy.otterbein.edu/docview/757766712?accountid=28350Kim,	  V.,	  Oros,	  M.,	  Durra,	  H.,	  Kelsen,	  S.,	  Aksoy,	  M.,	  Cornwell,	  W.	  D.,	  .	  .	  .	  Criner,	  G.	  J.	  (2015).	  Chronic	  bronchitis	  and	  current	  smoking	  are	  associated	  with	  more	  goblet	  cells	  in	  moderate	  to	  severe	  COPD	  and	  smokers	  without	  airflow	  obstruction. PLoSOne, 10(2)	  doi:	  http://dx.doi.org.ezproxy.otterbein.edu/10.1371/journal.pone.0116108Kim,	  V.,	  &	  Criner,	  G.	  (2013).	  Chronic	  bronchitis	  and	  chronic	  obstructive	  pulmonary	  disease. American	  Journal	  of	  Respiratory	  &	  Critical	  Care	  Medicine, 187(3),	  228-­‐237	  10p.	  doi:	  10.1164/rccm.201210-­‐1843CIPelkonen,	  M.	  K.,	  Notkola,	  I.	  K.,	  Laatikainen,	  T.	  K.,	  &	  Koskela,	  H.	  O.	  (2014).	  Twenty-­‐five	  year	  trends	  in	  prevalence	  of	  chronic	  bronchitis	  and	  the	  trends	  in	  relation	  to	  smoking. Respiratory	  Medicine, 108(11),	  1633-­‐40.	  doi:	  http://dx.doi.org.ezproxy.otterbein.edu/10.1016/j.rmed.2014.08.007Martin,	  M.	  J.,	  &	  Harrison,	  T.	  W.	  (2015).	  Causes	  of	  chronic	  productive	  cough:	  An	  approach	  to	  management. Respiratory	  Medicine, 109(9),	  1105-­‐1113.	  doi:	  http://dx.doi.org.ezproxy.otterbein.edu/10.1016/j.rmed.2015.05.020Mitchell,	  J.	  (2015).	  Pathophysiology	  of	  COPD:	  Part	  2. Practice	  Nursing,26(9),	  444-­‐449	  6p.Sarli,	  A.	  (2016,	  April	  12).	  CSA	  Medical	  Announces	  the	  First	  Chronic	  Bronchitis	  Patient	  Treatments	  in	  the	  RejuvenAir®	  System	  Safety	  and	  Feasibility	  Study.	  Retrieved	  June	  29,	  2016,	  from	  http://www.prnewswire.com/news-­‐releases/csa-­‐medical-­‐announces-­‐the-­‐first-­‐chronic-­‐bronchitis-­‐patient-­‐treatments-­‐in-­‐the-­‐rejuvenair-­‐system-­‐safety-­‐and-­‐feasibility-­‐study-­‐300250008.html	  References	  Continued	  Understanding	  the	  pathophysiology	  of	  chronic	  bronchitis	  will	  help	  health	  care	  provider	  understand	  the	  progression	  and	  manifestation	  of	  the	  disease,	  hence	  will	  help	  diagnose	  and	  appropriately	  treat	  preventing	  further	  progression	  and	  complications.	  (Image	  retrieved	  from	  https://www.spiriva.com/img/content/reduced-­‐airflow.jpg)(Image	  retrieved	  from	  https://edc2.healthtap.com/ht-­‐staging/user_answer/reference_image/2537/large/Bronchitis.jpeg?1386670574)(Image	  retrieved	  from	  http://img.webmd.com/dtmcms/live/webmd/consumer_assets/site_images/articles/health_tools/bronchitis_slideshow/webmd_composite_image_of_bronchitis.jpg)

Chronic Bronchitis

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Chronic Bronchitis

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