Chronic bronchitis

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Chronic bronchitis

Respiratory system

Apnea and hypoventilation

Apnea of prematurity

Sleep apnea

Pleura and pleural space disorders

Mesothelioma

Pleural effusion

Pneumothorax

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Chronic bronchitis

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Chronic bronchitis

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USMLE® Step 1 style questions USMLE

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A 61-year-old man comes to the clinic for a routine evaluation. He has had a chronic productive cough for the past 5 years, with occasional dyspnea and wheezing. He smoked a pack of cigarettes a day for 40 years, but stopped several months ago. Vitals are within normal limits. Physical examination reveals bilateral diffuse crackles and rales on chest auscultation. Pulmonary function testing (PFT) is performed, which confirms the diagnosis of chronic bronchitis-predominant chronic obstructive pulmonary disease. Which of the following PFT findings are most likely present in this patient?  

External References

First Aid

2022

2021

2020

2019

2018

2017

2016

Bronchitis

croup p. 167

cystic fibrosis p. 58

Haemophilus influenzae p. , 140

Cyanosis

bronchitis p. 698

Polycythemia

bronchitis and p. 698

Transcript

Content Reviewers

Bronchitis means inflammation of the bronchial tubes in the lung, and it’s said to be chronic when it causes a productive cough—which means produces mucus—for at least 3 months each year for 2 or more years.

Chronic bronchitis is actually lumped under the umbrella of chronic obstructive pulmonary disease (or COPD), along with emphysema.

These two are different in that chronic bronchitis is defined by clinical features, like a productive cough, whereas emphysema is defined by structural changes—specifically enlargement of the air spaces.

That being said, they often coexist, probably because they share the same major risk factor — smoking.

Other risk factors for chronic bronchitis include exposure to air pollutants like sulfur and nitrogen dioxide, exposure to dust and silica, as well as genetic factors like having a family history of chronic bronchitis.

With COPD, the airways become obstructed, and the lungs don’t empty properly, and that leaves air trapped inside the lungs.

For that reason, the maximum amount of air people with COPD can breath out in a single breath, known as the FVC, or forced vital capacity, is lower.

This reduction is especially noticeable in the first second of air breathed out in a single breath, called FEV1—forced expiratory volume (in one second), which typically is reduced even more than the FVC.

A useful metric therefore is the FEV1 to FVC ratio, which, since the FEV1 goes down even more than FVC, causes the FEV1 to FVC ratio to go down as well.

Alright so say normally your FVC is 5 L, and your FEV1 is 4 L, your FEV1 to FVC ratio would end up being 80%.

Now, someone with COPD’s FVC might be 4 L instead, which is lower than normal, but the volume of air that he or she can expire in the first second is only 2 L, so not only are both these values lower, but their ratio is lower as well—and this is a hallmark of COPD.

All that had to do with air breathed out right? Conversely, for air going in, the TLC, or total lung capacity, which is the maximum volume of air that can be taken in or inspired into the lungs, is actually often often higher because of the air trapping.

Sources

  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Lung Disease 2017 Report" Respirology (2017)
  6. "Breathing exercises for chronic obstructive pulmonary disease" Cochrane Database of Systematic Reviews (2012)
  7. "Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease" American Journal of Respiratory and Critical Care Medicine (2013)
Elsevier

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