A 21-year-old college senior presents to the clinic reporting shortness of breath and a nonproductive nocturnal cough. She states she used to feel this way only with extreme exercise, but lately she has felt this way continuously. She denies any other upper respiratory, gastrointestinal, and urinary symptoms and says she has no chest pain. Her past medical history is significant only for seasonal allergies, for which she takes a nasal steroid spray; she takes no other medications. She has had no surgeries. Her mother has allergies and eczema; her father has high blood pressure. She is an only child. She denies smoking and illegal drug use but drinks three to four alcoholic beverages per weekend. She is a junior in finance at a local university and has recently started a job as a bartender in town. On examination she is in no acute distress. Temperature is 98.6, blood pressure is 120/80, pulse is 80, and respirations are 20. Head, eyes, ears, nose, and throat examinations are essentially normal. Inspection of her anterior and posterior chest shows no abnormalities. On auscultation of her chest, there is decreased air movement and a high-pitched whistling on expiration in all lobes. Percussion reveals resonant lungs. Which disorder of the thorax or lung does this presentation best describe? Show Sets found in the same folderPresentation HistoryObtain a complete history, including information on exposure to toxic substances and smoking. Patients with chronic bronchitis are often overweight and cyanotic. Initially, cough is present in the winter months. Over the years, the cough progresses from hibernal to perennial, and mucopurulent relapses increase in frequency, the duration and severity of which increase to the point of exertional dyspnea. Cough is the most commonly observed symptom. It begins early in the course of many acute respiratory tract infections and becomes more prominent as the disease progresses. Acute bronchitis may be indistinguishable from an upper respiratory tract infection during the first few days, though cough lasting greater than 5 days may suggest acute bronchitis. [7] In patients with acute bronchitis, cough generally lasts from 10-20 days. Sputum production is reported in approximately half the patients in whom cough occurred. Sputum may be clear, yellow, green, or even blood-tinged. Purulent sputum is reported in 50% of persons with acute bronchitis. Changes in sputum color are due to peroxidase released by leukocytes in sputum; therefore, color alone cannot be considered indicative of bacterial infection. Fever is a relatively unusual sign and, when accompanied by cough, suggests either influenza or pneumonia. Nausea, vomiting, and diarrhea are rare. Severe cases may cause general malaise and chest pain. With severe tracheal involvement, symptoms include burning, substernal chest pain associated with respiration, and coughing. Dyspnea and cyanosis are not observed in adults unless the patient has underlying chronic obstructive pulmonary disease or another condition that impairs lung function. Other symptoms of acute bronchitis include the following:
Physical ExaminationThe physical examination findings in acute bronchitis can vary from normal-to-pharyngeal erythema, localized lymphadenopathy, and rhinorrhea to coarse rhonchi and wheezes that change in location and intensity after a deep and productive cough. Diffuse wheezes, high-pitched continuous sounds, and the use of accessory muscles can be observed in severe cases. Occasionally, diffuse diminution of air intake or inspiratory stridor occurs; these findings indicate obstruction of a major bronchi or the trachea, which requires sequentially vigorous coughing, suctioning, and, possibly, intubation or even tracheostomy. Sustained heave along the left sternal border indicates right ventricular hypertrophy secondary to chronic bronchitis. Clubbing on the digits and peripheral cyanosis indicate cystic fibrosis. Bullous myringitis may suggest mycoplasmal pneumonia. Conjunctivitis, adenopathy, and rhinorrhea suggest adenovirus infection. ComplicationsComplications occur in approximately 10% of patients with acute bronchitis and include the following:
 Author Coauthor(s) Klaus-Dieter Lessnau, MD, FCCP Former Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory, Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, Society of Critical Care Medicine Disclosure: Nothing to disclose. Chief Editor Zab Mosenifar, MD, FACP, FCCP Geri and Richard Brawerman Chair in Pulmonary and Critical Care Medicine, Professor and Executive Vice Chairman, Department of Medicine, Medical Director, Women's Guild Lung Institute, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine Zab Mosenifar, MD, FACP, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Thoracic Society Disclosure: Nothing to disclose. Acknowledgements Paul Blackburn, DO, FACOEP, FACEP Attending Physician, Department of Emergency Medicine, Maricopa Medical Center Paul Blackburn, DO, FACOEP, FACEP, is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American Medical Association, and Arizona Medical Association Disclosure: Nothing to disclose. David FM Brown, MD Associate Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital David FM Brown, MD, is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine Disclosure: Lippincott textbook royalty; Wiley textbook royalty Ali Hmidi, MD Resident Physician, Department of Internal Medicine, Brooklyn Hospital Center, Weill Cornell Medical College Disclosure: Nothing to disclose. Jeffrey Nascimento, DO, MS Fellow, Department of Pulmonary Medicine, Lenox Hill Hospital Jeffrey Nascimento, DO, MS, is a member of the following medical societies: American College of Chest Physicians, American Medical Association, American Osteopathic Association, American Thoracic Society, New York County Medical Society, and Society of Critical Care Medicine Disclosure: Nothing to disclose. Robert E O'Connor, MD, MPH Professor and Chair, Department of Emergency Medicine, University of Virginia Health System Robert E O'Connor, MD, MPH, is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society Disclosure: Nothing to disclose. Samuel Ong, MD Visiting Assistant Professor, Department of Emergency Medicine, Olive View-UCLA Medical Center Disclosure: Nothing to disclose. Samer Qarah, MD Pulmonary Critical Care Consultant, Department of Internal Medicine, Division of Pulmonary and Critical Care, The Brooklyn Hospital Center and Cornell University Samer Qarah, MD, is a member of the following medical societies: American College of Critical Care Medicine Disclosure: Nothing to disclose. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Medscape Salary Employment What associated symptoms might a client with a history of chronic bronchitis have?What are the symptoms of chronic bronchitis?. Frequent coughing or a cough that produces a lot mucus.. Wheezing.. A whistling or squeaky sound when you breathe.. Shortness of breath, especially with physical activity.. Tightness in your chest.. What are the symptoms of chronic bronchitis?For either acute bronchitis or chronic bronchitis, signs and symptoms may include:. Cough.. Production of mucus (sputum), which can be clear, white, yellowish-gray or green in color — rarely, it may be streaked with blood.. Fatigue.. Shortness of breath.. Slight fever and chills.. Chest discomfort.. What is associated with chronic bronchitis?Cigarette smoking is a major cause of chronic bronchitis. Other factors that increase your risk of developing this disease include exposure to air pollution as well as dust or toxic gases in the workplace or environment. It may also occur more frequently in individuals who have a family history of bronchitis.
How does chronic bronchitis affect the patient?Chronic bronchitis.
In this condition, your bronchial tubes become inflamed and narrowed and your lungs produce more mucus, which can further block the narrowed tubes. You develop a chronic cough trying to clear your airways.
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What associated symptoms might a patient with a history of chronic bronchitis have?
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