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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

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 oxygen partial pressure 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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