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Chronic Bronchitis

The cilia are key to removing foreign particles that have invaded the large and small airways of the respiratory tract. Prolonged exposure to heat, noxious fumes, and particulates assaults the airway lining and decreases the sweeping activity of the cilia. Inflammation results and triggers the hypersecretion of mucus. This Venn diagram is nonproportional and is for illustrative purposes only. Asthma with reversible obstruction is classified in subset. COPD comprises 3 through 8. Asthma that is unremitting is classified as COPD in subsets 6, 7and 8. Asthma associated with emphysema and chronic bronchitis is classified in subset 8. Asthma with subsequent cough due to exposure to chronic irritation is classified as chronic bronchitis in subset 6. Chronic bronchitis and emphysema occurring together is designated in subset 5. Emphysema (subset 1) and chronic bronchitis (subset 2) without airflow obstruction are not classified as being COPD. Subset 10 is classified as airway obstruction due to specific diseases such as cystic fibrosis predominant symptom of chronic bronchitis. Subsequent airflow limitation is attributed to ensuing airway fibrosis, remodeling of small airways, and progressive mucus hypersecretion. Cough and expectoration increase throughout the progression of chronic bronchitis. The signs and symptoms of chronic bronchitis may present as early as the third decade of life with productive cough and increased incidence of bronchial infections.


Oxygen and carbon dioxide are exchanged at the alveolar level. Destruction of the alveoli results in decreased oxygenation of the tissues and is associated with the compromise of elastic lung recoil. The patient with emphysema is able to inhale but is not able to easily exhale due to the progressive alveolar destruction and loss of lung elastic recoil. Dyspena and fatigue become prominent symptoms as emphysema worsens over time. Patients tend to be middle to older age adults when symptoms of emphysema first present. The major factors that accounted for the poor compliance to portable oxygen therapy were the weight of the equipment, the negative feelings associated with the aesthetics of the devices (especially the nasal cannulae), and the short duration of the oxygen supply from the gaseous cylinder. Unfortunately, patients with severe lung disease are least able to manage the added burden of transporting an oxygen delivery system when walking because of poor exercise tolerance. Possible mechanisms for exercise intolerance are multifactorial and may include moderate to severe impairment of lung mechanics, poor gas exchange, and respiratory muscle fatigue. Exercise limitation may also be due to right ventricular dysfunction, malnutrition, and deconditioning. Patients adapt to this severe disability by employing countermeasures that help conserve energy and reduce dyspnea. Some examples are the pacing of activities, pursed-lip breathing, and the use of assistive devices such as wheeled carts to transport the portable oxygen system. Although various researchers have studied the portability of liquid and gaseous oxygen, there seems to be a lack of consensus on the magnitude of the burden that a portable oxygen system imposes on the patient during walking.


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