Review Question - QID 212817

This patient with a significant smoking history, wheezing and crackles, and a chronic productive cough of at least 3 months out of the year for greater than 2 years likely has chronic bronchitis, which is associated with hyperplasia of the bronchial wall.

Chronic bronchitis and emphysema are 2 forms of chronic obstructive pulmonary disease (COPD). Chronic bronchitis is due to hyperplasia of the mucus-secreting glands in the bronchial wall, and is characterized by the Reid index (ratio of the thickness of the glandular layer to the total thickness of the bronchial wall) being greater than 50%. As a result, patients produce mucus with frequent expectoration. On exam, patients will have wheezing and rhonchi and may use accessory muscles for respiration. In later stages, patients will develop signs of right heart failure, such as cyanosis and peripheral edema, which is why patients with this disease are also termed “blue bloaters.”

Incorrect Answers:
Answer 1: Bronchial necrosis is seen in bronchiectasis, where chronic infection leads to dilated airways. In this disease, sputum will be purulent rather than clear

Answer 2: Destruction of alveolar walls is seen in emphysema. This results in the enlargement of air spaces with decreased recoil. As a result, patients will exhale with increased positive pressure to keep their airways open.

Answer 4: Hypersensitivity reactions to environmental antigens are seen in hypersensitivity pneumonitis, which are types III or IV reactions to antigens. These tend to result in dyspnea and chest tightness.

Answer 5: Smooth muscle hypertrophy is seen in asthma, which is associated with reversible bronchoconstriction. Asthma is typically associated with certain stressors or environmental triggers.

Bullet Summary:
Chronic bronchitis is characterized by hyperplasia of the glands in the bronchial walls, along with a productive cough of greater than 2 years.