Chronic bronchitis natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

Several determining factors have been known to influence the course of chronic bronchitis including: cigarette smoking, level of airflow obstruction, and recurrent infection. It may be complicated by pneumonia, cor-pulmonale or anemia. Also, because of chronic nature of this disease, depression and increased risk of lung cancer are expected to seen in the disease course. Prognosis depends on early diagnosis and adequate treatment. However, FEV1 level is the most important prognostic factor.

Natural History

Prognosis may vary depending on the time of diagnosis and severity of airflow obstruction, which may be measured by FEV1, FVC and FEV1/FVC. Chronic Bronchitis has a wide range of severity from well controlled chronic bronchitis to severe obstructed airways with multiple exacerbations that require hospitalization and even may develop into lung cancer.^[1] COPD gradually deteriorates over time and can lead to death if left untreated.

Complications

Common complications of chronic bronchitis include:

Recurrent pneumonia: chronic inflammation and airways damage predispose chronic bronchitis patients to recurrent pneumonia either viral or bacterial infections. Additionally, chronic use of inhaled corticosteroids may cause recurrent infections^[2]
Depression: may require psychiatry consultation^[3]
Cor pulmonale: chronic hypoxia and subsequent vasoconstriction in pulmonary vasculature results in pulmonary hypertension and right sided heart failure, termed cor pulmonale^[4]
Anemia: anemia of chronic disease may develop in this patients and indicates a poor prognosis.
Polycythemia: secondary to chronic hypoxemia, Hematocrit level may rise up to 60 (normal range: adult men: 46±4, adult women:40±4).

Prognosis

A good prognosis of COPD relies on an early diagnosis and prompt treatment. Majority of patients will have improvement in lung function once treatment is started. The most important prognostic factor is the FEV1 level. Other determining factors include:^[5]

Cigarette smoking
BMI ≤ 21
Decreased exercise capacity
Increased C-reactive protein level
Co-morbid diseases

References

↑ Mannino DM, Buist AS, Petty TL, Enright PL, Redd SC (2003). “Lung function and mortality in the United States: data from the First National Health and Nutrition Examination Survey follow up study”. Thorax. 58 (5): 388–93. PMC 1746680. PMID 12728157.
↑ Singh S, Amin AV, Loke YK (2009). “Long-term use of inhaled corticosteroids and the risk of pneumonia in chronic obstructive pulmonary disease: a meta-analysis”. Arch. Intern. Med. 169 (3): 219–29. doi:10.1001/archinternmed.2008.550. PMID 19204211.
↑ Ohayon MM (2014). “Chronic Obstructive Pulmonary Disease and its association with sleep and mental disorders in the general population”. J Psychiatr Res. 54: 79–84. doi:10.1016/j.jpsychires.2014.02.023. PMID 24656426.
↑ Klinger JR, Hill NS (1991). “Right ventricular dysfunction in chronic obstructive pulmonary disease. Evaluation and management”. Chest. 99 (3): 715–23. PMID 1995228.
↑ Vanfleteren LE, Spruit MA, Wouters EF, Franssen FM (2016). “Management of chronic obstructive pulmonary disease beyond the lungs”. Lancet Respir Med. doi:10.1016/S2213-2600(16)00097-7. PMID 27264777.

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[pmid12728157-1] Mannino DM, Buist AS, Petty TL, Enright PL, Redd SC (2003). “Lung function and mortality in the United States: data from the First National Health and Nutrition Examination Survey follow up study”. Thorax. 58 (5): 388–93. PMC 1746680. PMID 12728157.

[pmid19204211-2] Singh S, Amin AV, Loke YK (2009). “Long-term use of inhaled corticosteroids and the risk of pneumonia in chronic obstructive pulmonary disease: a meta-analysis”. Arch. Intern. Med. 169 (3): 219–29. doi:10.1001/archinternmed.2008.550. PMID 19204211.

[pmid24656426-3] Ohayon MM (2014). “Chronic Obstructive Pulmonary Disease and its association with sleep and mental disorders in the general population”. J Psychiatr Res. 54: 79–84. doi:10.1016/j.jpsychires.2014.02.023. PMID 24656426.

[pmid1995228-4] Klinger JR, Hill NS (1991). “Right ventricular dysfunction in chronic obstructive pulmonary disease. Evaluation and management”. Chest. 99 (3): 715–23. PMID 1995228.

[pmid27264777-5] Vanfleteren LE, Spruit MA, Wouters EF, Franssen FM (2016). “Management of chronic obstructive pulmonary disease beyond the lungs”. Lancet Respir Med. doi:10.1016/S2213-2600(16)00097-7. PMID 27264777.

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