The Natural History, Pathology and Treatment of Chronic Bronchitis

1. Chronic bronchitis is the major cause of loss of working time and the third most important cause of death in England. It occurs in 36 per cent of men over age 30 and is four times as common in men as in women, being more common in the working classes.

2. Important in the pathogenesis are: atmospheric pollution and cigarette smoking, both of which lead to an excess of mucus.

3. There is an obliterative bronchiolitis together with a varying degree of super-added infection mostly due to H. influenzae and pneumococcus.

4. Pulmonary emphysema is the main complication of chronic bronchitis. The most important symptom is dyspnea of effort.

5. Cor pulmonale is the end result of emphysema and is due to respiratory failure together with changes in the pulmonary vascular bed. Right ventricular hypertrophy is always present due to pulmonary hypertension.

6. The main treatment of chronic bronchitis is the abolition of cigarette smoking and atmospheric pollution. In the well-established case, pathogens must be prevented from reaching the bronchioles by using appropriate antibiotics.