Clinical syndrome of chronic dyspnoea and cough with expiratory air way obstruction produced by either chronic bronchitis and/or emphysema.

Clinical Features

Chronic productive cough for many years with slowly progressive breathlessness that develops with reducing exercise tolerance. Tachypnea, purse-lip breathing, use of accessory muscles of respiration. Chest hyper-resonance, breath sound decreased, wheezes with or without rhonchi. Cyanosis may be present. Note Absence of clubbing.

In acute exacerbations, symptoms worsen and the sputum becomes yellow or may increase in quantity.

Investigations

• Chest X-ray: Note flattened diaphragms, hyperlucency, diminished vascular markings with or without bullae. Look for pneumothorax

• Haemogram: Especially polycythaemia, eosinophilia, WBC (to suggest infection).

Management

Acute exacerbations

• Bronchodilators: Salbutamol 4 mg TDS or inhalation 2 puffs 6-8 hourly or theophylline 250 mg BD or TDS

• Chest physiotherapy

• Amoxycillin 250-500 mg TDS or cotrimoxazole or tetracycline for 5 days.

Admit If

• Cyanosis is present

• Hypotension or respiratory failure is present

• Chest X-ray shows features of pneumothorax, chest infection or bullous lesions

• Cor pulmonale present.

Patient Education

• Stop smoking and avoid dusty and smoky environments

• Relatives should seek medical help if hypersomnolence and/or agitation occurs.