Chronic bronchitis

This is a chronic inflammatory condition of the medium sized and small bronchi, associated with destructive changes in the bronchial wall and peribronchial space. As a rule, it is a secondary

disease. It is characterized by dyspnea, cough and various types of expectoration.

Most cases of chronic bronchitis occur in those past middle life. In the young it may be caused 'by some irritating condition within the upper air passages, the trachea or the bronchi, and also by the presence of enlarged tonsils, sinus infections, focal infections, enlarged pendulous uvula, adenoids, congenital malfor­mation of the trachea. A foreign body in the bronchi or lungs may at times be the cause of chronic bronchitis.

Symptoms: These are cough which occurs in paroxysms, copious expectoration, absence of fever, and a history of long-standing cough.

Physical signs: A person suffering from chronic bronchitis is usually emphysematous. Inspection, therefore, will reveal an em-physematous chest. Palpation will give evidence of diminished tactile fremitus throughout the- chest. Percussion will elicit a hyperresonant note, except when associated congestion of the bases is present, in which case, impaired resonance or relative dullness is obtained over these areas. On auscultation the examiner will hear low-pitched, prolonged inspiration, accompanied by low-pitched, prolonged wheezy expiration. The rales heard will be large and small, moist and dry. A profusion of all kinds of rales is usually audible in this class of cases, though the rales may disappear temporarily after the secretion has been coughed up.