Physiotherapy Treatment in Chronic bronchitis

Chronic bronchitis

Definition: - It has been defined as a disorder in which a patient’s cough is productive of excessive sputum on most days for at least 3 consecutive months for at least 2 consecutive years.

Aetiology: - It is more common in men compared to women in the ratio 5:1 and in individuals older than 40 years. Atmosphere pollution, cigarette smoking will predispose to the development of the disease.

Clinical features

·        Cough - It begins slowly and becomes intermittent then gradually becomes continuous. It is increased during winter.

·        Sputum – Mucoid and usually becomes mucopurulent.

·        Wheeze – Worse in the morning.

·        Prolonged expiration.

·        Dyspnoea

·        Deformity – Barrel chest with indrawn abdomen. Thoracic movements are gradually diminished. Paradoxical in drawing of intercostal spaces.

·        Cyanosis

·         Loss of weight

·        Tremor and corpulmonale in later stages

                

Physical signs

·        Hyperinflation of lungs

·        Hypoxemia

·        polycythemia.

Investigations

·        LFT – Reduction in FEV1/FVC ratio. RV increased because of air trapping and alveolar distortion.

·        Blood gases – PaCO2 rises and PaO2 falls.

·        Auscultation – aspirator and expiratory rhonchi can be heard. Breath sounds are vesicular.

Prophylaxis

1) Control of atmospheric pollution.

2) Stop smoking.

3) Maintain general good health.

Principles of treatment

1)        Decrease the bronchial obstruction

2)        Control infections.

3)        Control bronchospasm.

4)        Control/decrease amount of sputum

5)        Oxygen therapy

Physiotherapy management

Aims

·        To assist in removal of secretion

·        To improve the pattern of breathing and breathing control

·        To maintain or improve the thorax and shoulder girdle mobility

·        To teach relaxation

Means

·        Postural drainage

·        Clapping, shaking  

·        Breathing exercises

·        Thoracic mobility exercises

·        Active shoulder exercises

·        Advice for graded ambulatory exercises.