Chronic Bronchitis & Emphysema Essay

Chronic bronchitis and emphysema are the representatives of a group of pathologic conditions called COPD (Chronic pulmonary obstructive diseases). Those are characterized by partial or complete blockage of the respiratory airways leading to the functional disability of the lungs (Mohan 2010). They are both quite common and may even occur together, but for clinicians, they have distinct differences.

Emphysema is a condition that arises due to a combination of dilated alveoli and destruction of the alveoli walls. The main etiological factors leading to this condition are smoking cigarettes and air pollutants, other minor factors like hereditary and genetics can contribute to this condition. The pathogenesis of this condition as it relates to eventual alveolar wall destruction is based on the fact that oxidants from cigarette smoke cause an imbalance between elastase and anti-elastase (Mohan 2010). An increase in elastase activity causes a breakdown of elastin in the alveolar leading to expansion or hyperinflation and its destruction. Mohan (2010) has stated that according to WHO, emphysema can be classified into five types: centriacinar, panacinar, para-septal, irregular and mixed and these are based on the part of acinus involved. Patients with emphysema are also called ‘pink-puffers. Their health conditions are characterized by shortness of breath, cough (often not productive), barrel-shaped chest, weight loss and terminally could lead to a condition called cor-pulmonale.Chronic Bronchitis & Emphysema Essay

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Chronic bronchitis, on the other hand, can be defined literally as chronic inflammation of the bronchi, but it is clinically defined as a persistent cough lasting for three months in a year for two consecutive years, the cough is usually productive. Like emphysema, the two most common etiological factors are smoking and air pollutants. The pathogenesis is that prolonged smoking can impair the ciliary movements in the lungs, which inhibits the function of alveolar macrophages, and as a result leads to hypertrophy and hyperplasia of mucus-secreting glands, accompanied by an inflammatory cell infiltrate, which results in increased sputum production. It can also lead to vagus stimulation which can cause bronchoconstriction. Patients are also called ‘blue-bloaters,’ and they are characterized by a persistent productive cough with purulent mucus, shortness of breath but not as severe as people with emphysema, features of cor-pulmonale, like cyanosis and edema, and others factors.

Pulmonary function test is carried out by the use of spirometry, which measures the volume and force of air as it is exhaled from the lungs. It is used to determine airway obstruction regardless of whether it is chronic bronchitis or emphysema. Two values are determined, forced expiratory volume in one second (FEV1) which is the maximum amount of air a person can exhale in one second and forced vital capacity (FVC) which is the amount of air a person can forcefully exhale. It helps determine the severity of COPD, FEV1 of less than 80% indicates a person with COPD, and if it is severe, FEV1 would be between 50 and 80%.

Arterial blood gas determines the amount of oxygen and carbon dioxide in the blood. High carbon dioxide level and low oxygen level indicates chronic bronchitis because the bronchi are narrowed. Pulse oximetry test can also be carried out which determines oxygen level in the blood. Another indicative test is carbon monoxide diffusing capacity (DLCO) which helps determine how gases are exchanged in the lungs which helps differentiate emphysema from other COPDs ( umm.edu, Chronic obstructive pulmonary diseases). A patient with emphysema would have low DLCO because the alveoli are unable to exchange gases.Chronic Bronchitis & Emphysema Essay