I- Overview :
- Very frequented, willingly ignored, unknown potential evolution.
- 20% progress to IR and the rest dyspnea.
- Every year 1200 DC COPD.
- In France : 3 million, 1/3 presents trbles obstructive lung.
- 6th rank of chronic conditions just after’asthma.
- public health issue.
II- Definition :
clinical definition (anamnestique)
Chronic bronchitis « BC » is a very common condition characterized by hypersecretion of mucus sufficient to cause a cough leading to sero-mucous and / or muco-purulent sputum occurring a n’any time of day, for at least 3 consecutive months and for at least 2 successive years.
it s’also acts’an obstructive ventilatory deficit characterized by a little or not reversible ratio.
III- etiological factors :
A- Extrinsic factors :
- active or passive smoking (90 % cases).
- Professional pollution (inhalation of dust, vapors.), industrial, atmospheric, household.
- The weather and climate.
B- Intrinsic factors :
- especially viral infections (virus diseases explain BC in’child).
- Allergy and bronchial hyperresponsiveness.
- genetic predisposition (premature).
- Some immune deficiencies (especially secretory IGA and al antitrypsin.)
C- other factors :
- Adverse socioeconomic conditions.
- L’age and gender (men more 50 years.)
IV- Anapath :
Histological Changes in BC can be :
- enlarged sero-mucous glands along the’tracheobronchial tree .
- modification of the proportions of the different cells of the’epithelium with hyperproduction of mucus responsible for’airway obstruction .
- inflammation of the airways with tendency to’atrophy and fibrosis thereof
- mucus infection n’is not compulsory (la purulence n’not always accompany l’infection).
V- Clinical Diagnostics :
it s’most often acts’a man 40 – 50 years who consults for a productive chronic cough + dyspnea (can be a woman or a child).
* A l’interrogation we insist on :
- The search of’etiological elements elicited and signs of’severe hypoxia (cyanose, hippocratisme digital).
- the characteristics of the cough, l’expectoration.
- dyspnea and characteristics.
* Clinical examination Search :
- sick obese, bréviligne, cyanosé, thorax distendu, with the presence of signs of Hoover (↓ paradoxical the basal diameter thoracic), and sign Combell (↓ distension cartilage with respect to the sternum)
- Groans sounding. Sometimes associated with wheezing.
- Sometimes signs of impact on the heart right (right gallop, signs of’IT, signs of’Htap, edema of the lower limbs).
WE- Diagnostic Paracliniques :
A- Standard chest radiograph :
It is normal at the beginning, but at an advanced stage, one can find:
1- thoracic distension signs:
- Horizontalization odds
- Increase in’espace intercostal
- Flattening of the diaphragmatic
2- Signs of parenchymal destruction : A lucency associated with depletion of peripheral vascularization => Installation of emphysema
3- Bronchitic signs : An area-type image.
4- Inflammatory signs: An image reticular micronodular.
5- Rights heart signs: With a cardiomegaly (Htap, dilatation, IVD,…)
B- TDM :
- Make an early and accurate lesion inventory
- Dgc of Kc
- she n’is not systematic
- Extent of the’inflammation and confirmation
- Appearance and abundance of secretions (hemoptysis)
- Bx so d’establish a histological dgc (dysmitose : Prior Kc lesion)
- Detecting COPD
- Eliminate any local cause (foreign body)
D- Pulmonary function testing :
But : dgc, prognosis and therapeutic
- classic spirometry : flow rates and gas volumes
- Curve flow / volume : l’study of respiratory flows (dynamic) Fct in volumes (static)
- Measurement of lung compliances (static and dynamic)
- Measurement of the transfer capacity of CO (DLCO^)
- measurement of arterial blood gases at rest and at’effort
E- Biology report.
VII- Evolution :
Variable d’a subject to’other, depends on the genotype
Evolved by stages, from simple bronchitis to chronic bronchitis with disorders of the’hematosis and sometimes to death (does not take into account the time factor)
A- Bluetongue Stadium Chronic bronchitis or single (beginning) : purely clinical, Absence d’functional respiratory abnormalities, Tiffeneau N, WHOSE / CV >70% (normal)
B- Chronic Bronchitis Stage with Obstructive Ventilation Disorders :
- Thrust cyanosis.
- Rails sounding with wheezing.
- Signs of thoracic distension and / or parenchymal destruction.
EFR : Sd obstructive little or no reversible
- WHOSE base, low CV, Tiffneau bas <70, high VR, CPT normal, CRFÎTT, lung elasticity preserved but increased resistance.
Depending on COPD can be classified in FEV :
Stade 1 : mild COPD for FEV> 80
Stade 2 : COPD moderate to between FEV 50 and 80%.
Stade 3 : Moderately severe COPD for FEV between 30 and 50%.
Stade 4 : severe COPD for FEV < 30%.
C- Chronic Bronchitis Stage with Disorder’hematosis respiratory failure : It must absolutely be corrected. If not, it will cause :
- Ler in time : d’hypoxia that reflects the’effet shunt
- in 2nd time : d’hypercapnie (severe if greater than or equal to 60mmHg) sign of seriousness
- polycythemia, Southeast Htap, IVD and d’oligurie.
The obstructive syndrome is exacerbated with increased CPT.
VIII- Treatment :
A- Preventive treatment :
- Screening for patients at risk.
- Location and treatment of infections.
- Investigating Causes
B- Medical treatment :
1- Stade catarrhal :
- Chest physiotherapy.
- Antibiotic therapy if infection.
2- Stade obstructif :
- Chest physiotherapy.
- Antibiotic therapy if infection.
- Weight loss if obesity.
- Never d’antitussifs.
3- Stage d’respiratory failure :
- assisted ventilation or oxygen therapy.
- Bled if polycythemia.
- anti-inflammatory (AIS = steroids) : stade III
- Diuretics and anticoagulants.
IX- Differential diagnosis :
- obliterating bronchitis.
- bronchiectasis : DDB.
- cardiac problem : IVG, ICG => dyspnea.
- cystic fibrosis.
Dr Mokrane Course – Faculty of Constantine