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Chronic obstructive pulmonary disease (COPD)

Chronic bronchitis

Reviewers: Elliot Weisenberg, M.D. (see Reviewers page)
Revised: 30 August 2011, last major update August 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.


Diagnosis: persistent cough with sputum for 3 months in 2 consecutive years without other apparent explanation (eMedicine)
● Chronic disease of large airways, variable inflammation

Clinical features

● Simple chronic bronchitis: cough but no physiologic evidence of airway obstruction
● Chronic asthmatic bronchitis: hyperreactive airways with intermittent bronchospasm and wheezing
● Obstructive bronchitis: often have associated emphysema, small airway disease
● Causes: 4-10x more common in smokers, chronic irritation and infections may contribute
● Other causes and contributors are air pollution including passive cigarette smoke, marijuana smoke and occupational dust exposure
● Tobacco interferes with ciliary action, directly damages airway epithelium, and inhibits ability of white blood cells to clear bacteria; infections maintain but do not initiate chronic bronchitis
● Often diagnosed at time of acute respiratory illness (Prim Care Respir J 2010;19:371)
● More infections, purulent sputum, hypercapnia, hypoxia than emphysema; clinically called “blue bloaters”
● May cause secondary pulmonary vascular hypertension, cor pulmonale, congestive heart failure, death due to respiratory acidosis and coma, congestive heart failure and pneumothorax
Reid index: ratio of thickness of mucus gland layer to thickness of wall between epithelium and cartilage; normal is 0.4, increased in chronic bronchitis

Gross description

● Boggy mucosa with excessive mucinous secretions, pus, prominence of bronchial mucosal pits overlying the orifices of bronchial mucous glands

Micro description

Early - hypersecretion of mucus in large airways with hypertrophy of submucosal glands in tracheobronchial tree
Later - increase in goblet cells in small airways contributes to excessive mucus production and airway obstruction
● Increased percentage of bronchial wall is occupied by submucosal mucous glands, as measured by Reid index; this directly correlates with sputum production, variable dysplasia, squamous metaplasia, bronchiolitis obliterans
● Chronic inflammatory infiltrates range from absent to prominent

Micro images

Mucosal glandular hyperplasia

Chronic inflammatory infiltrate

End of Lung-nontumor > Chronic obstructive pulmonary disease (COPD) > Chronic bronchitis

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