Chronic Bronchitis

Question 1

What is the clinical definition of chronic bronchitis?

Answer 1

A productive cough lasting at least 3 months per year for 2 consecutive years, in the absence of another identifiable cause.

Question 2

Chronic bronchitis is classified under which major disease group?

Answer 2

Chronic obstructive pulmonary disease (COPD).

Question 3

What is the hallmark of chronic bronchitis?

Answer 3

Excessive mucus production resulting in a persistent productive cough.

Question 4

What is the most important risk factor for chronic bronchitis?

Answer 4

Cigarette smoking.

Question 5

List environmental and occupational risk factors for chronic bronchitis.

Answer 5

Air pollution, industrial fumes, dust exposure, and recurrent respiratory infections.

Question 6

What age group is most commonly affected by chronic bronchitis?

Answer 6

Middle-aged to elderly adults, particularly long-term smokers.

Question 7

What structural measurement reflects gland enlargement in chronic bronchitis?

Answer 7

Reid index (ratio of gland thickness to wall thickness).

Question 8

What value of Reid index is diagnostic of chronic bronchitis?

Answer 8

Greater than 0.5 (normal ≤ 0.4).

Question 9

What other condition is often coexistent with chronic bronchitis?

Answer 9

Emphysema.

Question 10

Why is chronic bronchitis considered an obstructive disease?

Answer 10

Because mucus and inflammation narrow airways, reducing expiratory airflow.

Question 11

What is the initiating factor in chronic bronchitis pathogenesis?

Answer 11

Inhalation of irritants (especially cigarette smoke).

Question 12

Which cells proliferate abnormally in chronic bronchitis?

Answer 12

Goblet cells and submucosal glands.

Question 13

What cytokines mediate airway inflammation in chronic bronchitis?

Answer 13

IL-1, IL-8, TNF-α; they recruit neutrophils and macrophages.

Question 14

How does cigarette smoke affect ciliary function?

Answer 14

It paralyzes and damages cilia, impairing mucus clearance.

Question 15

What change occurs in mucus composition?

Answer 15

It becomes thick and viscous, promoting bacterial colonization.

Question 16

Why do patients with chronic bronchitis have recurrent infections?

Answer 16

Because mucus retention provides a medium for bacteria and impairs clearance.

Question 17

What structural change occurs in small airways?

Answer 17

Fibrosis and narrowing due to chronic inflammation.

Question 18

What is the effect of airway obstruction on gas exchange?

Answer 18

It causes ventilation-perfusion mismatch, leading to hypoxemia and hypercapnia.

Question 19

How does chronic hypoxia cause pulmonary hypertension?

Answer 19

By inducing vasoconstriction and vascular remodeling of pulmonary arteries.

Question 20

What cardiac complication arises from pulmonary hypertension in chronic bronchitis?

Answer 20

Cor pulmonale (right ventricular hypertrophy and failure).

Question 21

What is the role of alpha-1 antitrypsin deficiency in bronchitis?

Answer 21

It predisposes to both chronic bronchitis and emphysema due to lack of protease inhibition.

AATD is a genetic condition that increases the risk of chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. The deficiency stems from a lack of alpha-1 antitrypsin (AAT), a protein made in the liver to protect the lungs from damage by enzymes like neutrophil elastase. Without enough AAT, the lungs are more susceptible to damage from environmental factors, and a chronic inflammation develops

Question 22

How do infections worsen the disease process?

Answer 22

They cause acute exacerbations and further mucosal injury.

Question 23

What happens to elastic recoil in chronic bronchitis?

Answer 23

It is reduced due to small airway collapse and alveolar damage.

Question 24

How does chronic bronchitis differ pathologically from emphysema?

Answer 24

Bronchitis affects airways with inflammation and mucus; emphysema affects alveoli with wall destruction.

Question 25

What happens to airway smooth muscle in chronic bronchitis?

Answer 25

It hypertrophies and contributes to airway narrowing.

Question 26

What is the most prominent symptom of chronic bronchitis?

Answer 26

Chronic productive cough with sputum production.

Question 27

Why does the cough worsen in the morning?

Answer 27

Mucus accumulates overnight and is expelled on waking.

Question 28

What term describes chronic bronchitis patients with cyanosis and obesity?

Answer 28

‘Blue bloaters.’

Question 29

What are typical arterial blood gas findings?

Answer 29

Low PaO₂, elevated PaCO₂, and respiratory acidosis.

Question 30

What cardiovascular complication results from chronic bronchitis?

Answer 30

Right-sided heart failure (cor pulmonale).

Question 31

Why does polycythemia occur in chronic bronchitis?

Answer 31

Chronic hypoxia stimulates erythropoietin release from the kidneys.

Question 32

What is the cause of digital clubbing in chronic bronchitis?

Answer 32

Chronic hypoxemia causing vascular proliferation in the fingers.

Question 33

What happens during an acute exacerbation?

Answer 33

Increased sputum, dyspnea, and infection symptoms (fever, malaise).

Question 34

Why are chronic bronchitis patients more prone to infections?

Answer 34

Mucus stasis and poor clearance facilitate bacterial growth.

Question 35

What is the long-term outcome if untreated?

Answer 35

Progressive respiratory failure, pulmonary hypertension, and cor pulmonale.

Question 36

What are gross features of chronic bronchitis?

Answer 36

Thickened bronchial walls, mucus-filled airways, and hyperemia.

Question 37

What are microscopic features of chronic bronchitis?

Answer 37

Goblet cell hyperplasia, submucosal gland hypertrophy, and chronic inflammation with lymphocytes and macrophages.

Question 38

What inflammatory cells predominate?

Answer 38

Neutrophils and CD8+ T cells.

Question 39

What change occurs in the epithelium?

Answer 39

Squamous metaplasia due to repeated irritation.

Question 40

What does a mucus plug indicate histologically?

Answer 40

Airway obstruction and mucus retention in bronchioles.

Question 41

What change occurs in the basement membrane?

Answer 41

It becomes thickened and fibrotic.

Question 42

What is the significance of the Reid index?

Answer 42

It quantifies mucus gland enlargement; increased in chronic bronchitis.

Question 43

What happens to peribronchiolar tissue?

Answer 43

Fibrosis and scarring leading to airway narrowing.

Question 44

How do the bronchioles appear in severe cases?

Answer 44

Obliterated or distorted by chronic inflammation and fibrosis.

Question 45

What finding differentiates chronic bronchitis from asthma microscopically?

Answer 45

Asthma shows eosinophils and basement membrane thickening; chronic bronchitis shows gland hypertrophy and neutrophils.

Question 46

What is the key diagnostic criterion for chronic bronchitis?

Answer 46

History of productive cough ≥3 months per year for ≥2 consecutive years.

Question 47

What PFT pattern is typical?

Answer 47

Obstructive: decreased FEV₁, decreased FEV₁/FVC ratio, increased residual volume.

Question 48

What imaging findings support the diagnosis?

Answer 48

Prominent bronchovascular markings and peribronchial thickening.

Question 49

What lab test confirms hypoxemia and hypercapnia?

Answer 49

Arterial blood gas analysis.

Question 50

What test measures chronic CO₂ retention?

Answer 50

Arterial blood gases showing elevated PaCO₂.

Question 51

What non-drug therapy is most important?

Answer 51

Smoking cessation.

Question 52

What pharmacologic agents improve airflow?

Answer 52

Bronchodilators (β₂-agonists, anticholinergics).

Question 53

When are corticosteroids indicated?

Answer 53

Inhaled corticosteroids for frequent exacerbations; systemic for acute attacks.

Question 54

What role do antibiotics play?

Answer 54

They treat bacterial exacerbations (e.g., amoxicillin-clavulanate, macrolides).

Question 55

When is oxygen therapy prescribed?

Answer 55

In chronic hypoxemia (PaO₂ <55 mmHg or O₂ saturation <88%).

Question 56

What lifestyle measures are beneficial?

Answer 56

Vaccinations, pulmonary rehab, nutrition, and regular exercise.

Question 57

Which vaccines are recommended?

Answer 57

Influenza and pneumococcal vaccines.

Question 58

When is lung transplantation considered?

Answer 58

In end-stage COPD with severe functional limitation.

Question 59

What is the main goal of long-term management?

Answer 59

Prevent exacerbations and improve quality of life.

Question 60

What is the most effective preventive strategy?

Answer 60

Smoking cessation and early treatment of infections.