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Inflammatory diseases of the airways – acute and chronic bronchitis, bronchiolitis

Chronic bronchitis:

Persistent productive cough for at least 3 consecutive months in at least 2 consecutive years

3 types

  •  simple bronchitis: productive cough raises mucoid sputum, but no airflow obstruction
  • ashmathic bronchitis: hyper-­‐responsive airways with intermittent bronchospasm and wheezing
  • obstructive bronchitis: heavy smokers develop this, usually associated with emphysema

Pathogenesis:

  1. Distinct feature: hypersecretionof mucus (beginning in the largeairways)
  2. Irritants: cigarette smoking, airpollutants (sulfur oxide, nitrogen oxide)
  3. Mechanism:
    • induce hypertrophy of the mucous glands in the trachea and main-­‐ stem bronchi
    • marked increase in mucin-secreting goblet cells in the surface epithelium of smaller bronchi and bronchioles
    • 3. causes inflammation of CD8+ Tcells, macrophages and neutrophils
  4. Defining feature – morphologic feature of airflow obstruction is more peripheral and results from:
    • “Small airway disease”: induced by goblet cell metaplasia with mucus plugging of the bronchiolar lumen, inflammation and bronchiolar fibrosis
    • Co-existent emphysema: significant airflow obstruction is always worsened by emphysema
  5. Microbial infection is involved but as a secondary role,chiefly maintaining the inflammation and exacerbating symptoms

Morphology:

  • Mucosal lining:
    • Hyperemic and swollen by edema fluid
    • Often covered by a layer of mucinous or mucopurulent secretions
    • Diagnostic feature: enlargement of the mucus-­‐secreting glands
    • Presence of inflammatory cells (mononuclear, but sometimes also neutrophils) in the bronchial mucosa
    • Increased neutrophilia with exacerbations of bronchitis

Chronic bronchiolitis:

  • Goblet cell metaplasia, mucus plugging, inflammation and fibrosis
  • Severe cases: complete obliteration of the lumen due to fibrosis
  • Peribronchiolar fibrosis and luminal narrowing leads to airway obstruction

 

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About The Author
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Dr.Iqbal
“So be sure when you step, Step with care and great tact. And remember that life's A Great Balancing Act. And will you succeed? Yes! You will, indeed! (98 and ¾ percent guaranteed) Kid, you'll move mountains.” ― Dr. Seuss, Oh, The Places You'll Go!
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