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BRONCHITIS - CHRONIC IN ACUTE EXACERBATION

Chronic bronchitis is an infection of the trachea and bronchi for at least 3 consecutive months for more than 2 consecutive years.
The patient experiences symptoms of increase in dyspnea, sputum volume and sputum purulence over baseline on most days.

Diagnosis is basically based on clinical presentation.

Supportive Therapy

Supportive Therapy

Hydration

  • Maintain adequate hydration to prevent excessive mucus viscosity

Nutritional Programs

  • There are no direct or measurable effects on lung function in treating malnutrition but subjective relief and objective improvement in strength and exercise performance do occur
    • Dietary supplementation should be considered if patient is malnourished (body weight <85% of ideal) or experiencing early satiety
  • Advise patient to obtain nutritional counseling to reduce weight if obese

Oxygen Therapy

  • Cornerstone of COPD exacerbation treatment
  • Low-flow O2 should be administered if hypoxemia is present
  • Excess use of O2 should be avoided as this may lead to progressive hypercapnia, either by decreasing hypoxic ventilatory drive or by worsening ventilation-perfusion mismatching within the lung
  • Once O2 therapy is initiated, arterial blood gas should be monitored 30-60 minutes later to ensure satisfactory oxygenation without acidosis or CO2 retention
  • Goal of supplemental O2 therapy should be arterial blood gas at or just above 60 mmHg

Noninvasive Positive Pressure Ventilation

  • Frequently used for inpatient management of AECB patients who are significantly hypoxemic or with a serum pH <7.3
  • Improves ventilation and lower pCO2 levels and may be a means of avoiding intubation
  • Decreases hospital or intensive care unit length of stay and morbidity
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