CHRONIC BRONCHITIS

2. CHRONIC BRONCHITIS  GENERAL CONSIDERATION

The definition of chronic bronchitis requires that productive cough be present on most days for a minimum of three months in the year in at least two consecutive years in order to make the diagnosis. The disease is probably the most common debilitating respiratory disease in China. There is a strong association with inhalation of irritant substance such as various forms of air pollution and heavy smokers.  The pathologic findings include hyperplasia and hypertrophy of the submucosal bronchial mucous glands, hyperplasia of bronchiolar goblet cells, sequamous metaplasia of bronchial mucosal cells, chronic and acute inflammatory infiltrates in the bronchial submucosa, profuse inflammatory exudates in the lumens of brochi and bronchiolesand denudation of bronchial mucosa.
     In traditional Chinese medicine, this disorder is called "Ke Sou" and is thoughtto be caused by damp, cold and heat phlegm and deficiency of the lungs.
CLINICAL MANIFESTATIONS
     The hallmark of chronic bronchitis is chronic cough and sputum production.
Productive cough may be present on most of the days, at least for many years. The
disease is commonly seen in old men and women with an onset related to winter and
is caused by cold. At early stage, cough is productive and often occurs in the morning. This may be the only symptoms and may gradually become serious and symptoms such as dyspnea on exertion may develop.
     As the disease progresses, the course of the illness is usually marked by recurrent episodes of acute respiratory failure resulting from infectious exacerbations of the bronchitis. Clinically, the manifestations are increased cough, change in sputum from clear and mucoid to purulent, fever, "dyspnea and varying degrees of respiratory distress. The course of the disease is one of gradual increase in frequency and severity of episodes of acute infection and respiratory failure, eventually resulting in intubation and the need for almost constant ventilatory assistance. Death usually occursduring an episode  of respiratory failure.
     The physical findings vary with the stage in which the patient is examined. During relatively quiescent period, the only findings may be increased anteroposterior diameter of the chest, hyperresonance to percussion, prolonged expiratory phase, scattered diffuse coarse or moderate rhonchi and tales and wheezing. Later the patient may manifest the signs and symptoms of pulmonary hypertension and right ventricular failure, i.e. increased second heart sound, pedal edema, hepatomegaly and ascites.
     If examined during an acute attack, the patient is found in respiratory distress as evidenced by tachypnea and use of accessory muscles for respiration. Cough is often prominent and cyanosis during acute attack is not uncommon.
DIAGNOSIS
     Essentials of diagnosis:
     ? Productive cough be present on most days for a minimum of 3 months in the year in at least two consecutive years.
     ? During relatively quiescent period, the only finding may be increased antero- posterior diameter of the chest. Other findings such as hyperresonance to percussion, prolonged expiratory phase, scattered diffuse coarse or moderate rhonchi and rales and wheezing are also present.
     ? Chest x-ray shows  evidence of pulmonary overinflation with increased anteroposterior diameter, flattened diaphragm and increased retrosternal air space.
There are often prominent and increased bronchial markings at the lung base as
parallel or tapering shadows ("tram lines") which reflect the increased thickness of the bronchial wall.
TREATMENT
     The patient should be vigorously encouraged to discontinue cigrette smoking
and avoid exposure to other toxic inhalants and postural drainage exercises when
possible. The preferred drug is Ampicillin or Erythromycin and Tab Amnophylline
for five to seven days.
     In traditional Chinese medicine, this disorder is divided into cold-phlegm and
heat-phlegm types, the therapy of each varies. Cold-phlegm is characterized clinically by cough with copious and easily coughed up sputum and relief of cough after expectoration and accompanied by such symptoms as a feeling of suppression of the chest, poor appetite, white glossy coating of the tongue, superficial and slippery pulse, etc. But the heat type is due to the accumulation and retention of the phlegm and the pathogenic heat in the lungs with major symptoms such as cough, dyspnea, yellowish thin or bloody sputum, chest and hypochondriac pain, red tongue with yellowish glossy coating, smooth and rapid pulse.
     1. Herb therapy
     For chronic  bronchitis caused by cold phlegm. The rules of treatment are to dry the dampness and to eliminate phlegm. The formula is Er Chen Tang Jia Jian.
     Constituents:
     Dried old orange peel  12g
     PJnellia (tuber)  12g
     Tuckahoe  12-13g
     Tatarian aster (root) 15-30g
     Common coltsfoot flower 10g
     Root of purple-flowered peucedanum  15g
     Apricot kernel 12g
     Bulb of fritillary  10g
     Perillaseed  15g
     Root of the narrow-leaved polygala  12g
     Licorice root  6g
     Decoction and dosage. All the above herbs make a dose and six to ten doses are prescribed with one dose daily. Each dose is simmered twice and then the broth of each mixed, half of the mixed broth each time, twice a day.
     For chronic bronchitis  caused by heat phlegm. The rules of treatment are to eliminate phlegm and clear pathogenic heat. The formula is Qin Jin Hua Tan Yang Jia Jian.
     Constituents:
      Skullcap 12g
      Capejasmine (fruit) 12g
      Root of balloonflower 12g
      Tuber of dwarf lilyturf 12-18g
      Root-bark of white mulberry 18g
      Bulb of fritillary  10g
      Rhizome of wind-weed  10g
      Seed of Mongolian snakeground 12g
      Tangerine peel  12g
      Cordate houttuynia  30g
      Decoction and dosage is the same.
      If there is blood in the sputum, the following herbs are added to the formula: donkey-hide gelatin 10-12g, node of lotus rhizome 12-30g, hy