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 the & rsquo; asthma.
• public health issue.

II- Definition :

clinical definition (anamnestique)

Chronic bronchitis “BC” is a very common condition characterized by an hypersecretion of mucus sufficient to cause a cough bringing back serum-mucous and / or mucopurulent sputum occurring at any time of the day, for at least 3 consecutive months and for at least 2 successive years.

It s & rsquo; also acts d & rsquo; an obstructive ventilatory defect characterized by little or no reversible report.

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 (viroses explain BC in the & rsquo; child).
• Allergy and bronchial hyperresponsiveness.
• L & rsquo; obesity.
• genetic predisposition (premature).
• Some immune deficiencies (especially secretory IGA and al antitrypsin.)
• RGO

C- other factors :

• Adverse socioeconomic conditions.
• L & rsquo; age and sex (men more 50 years.)

IV- Anapath :

Histological Changes in BC can be :

1. hypertrophy of sero-mucous glands along the & rsquo; tracheo-bronchial tree .
2. changing the proportions of the different cells of the & rsquo; epithelium with overproduction of mucus responsible for the & rsquo; airway obstruction .
3. airway inflammation with tendency to the & rsquo; atrophy and fibrosis of it
4. infection of the mucus n & rsquo; is not mandatory (purulence n & rsquo; not accompanied tjrs l & rsquo; infection).

V- Clinical Diagnostics :

It s & rsquo; is usually d & rsquo; a man 40 – 50 years who consults for a productive chronic cough + dyspnea (can be a woman or a child).

* At & rsquo; interrogation is emphasized :

• Search d & rsquo; raised etiological factors and signs of & rsquo; 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, signes d’IT, signes d’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 & rsquo; intercostal space
• 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

C- endoscopy:

• It n & rsquo; is not systematic
• Extended the & rsquo; inflammation and confirmation
• Appearance and abundance of secretions (hemoptysis)
• Bx to d & rsquo; 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 & rsquo; study of respiratory flow rates (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 the & rsquo; stress

E- Biology report.

F- ECG.

VII- Evolution :

Variable d & rsquo; s one subject & rsquo; other, depends on the genotype

Evolved by stages, from simple bronchitis chronic bronchitis with disorders & rsquo; hematosis and sometimes to death (does not take into account the time factor)

A- Bluetongue Stadium Chronic bronchitis or single (beginning) : purely clinical, Absence & rsquo; functional respiratory abnormalities, Tiffeneau N, WHOSE / CV >70% (normal)

B- Chronic Bronchitis Stage with Obstructive Ventilation Disorders :

clinically :

• Dyspnea effort
• Thrust cyanosis.
• Rails sounding with wheezing.

radiologically :

• 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 Stadium with Disorder & rsquo; hematosis respiratory failure : It must absolutely be corrected. If not, it will cause :

• Ler in time : d & rsquo; hypoxia reflecting the & rsquo; shunting
• in 2nd time : d&rsquo;hypercapnie (severe if greater than or equal to 60mmHg) sign of seriousness
• polycythemia, Southeast Htap, IVD and d & rsquo; oliguria.

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
• Vaccination

B- Medical treatment :

1- Stade catarrhal :

• Chest physiotherapy.
• Antibiotic therapy if infection.

2- Stade obstructif :

• Bronchodilators.
• Chest physiotherapy.
• Antibiotic therapy if infection.
• Weight loss if obesity.
• Never d & rsquo; antitussives.

3- Stade d & rsquo; respiratory failure :

• assisted ventilation or oxygen therapy.
• Bronchodilators.
• Bled if polycythemia.
• anti-inflammatory (AIS = steroids) : stade III
• Diuretics and anticoagulants.

IX- Differential diagnosis :

• asthma.
• embolism.
• obliterating bronchitis.
• bronchiectasis : DDB.
• cardiac problem : IVG, ICG => dyspnea.
• cystic fibrosis.

Dr Mokrane Course – Faculty of Constantine