=Definition.=—A chronic inflammation of the mucous membrane of the
large and middle sized bronchial tubes.
=Osteopathic Etiology= and =Pathology=.—Chronic bronchitis may be
either primary or secondary. The primary form is the result of exposure
to wet and cold or to the daily inhalation of irritating vapors or
dust. This form is rare, the affection being almost always a secondary
one, and is most commonly met with in chronic lung affections, heart
disease, gout or renal disease. It may be caused by any disease which
favors congestion of the air tubes by obstruction of the circulation;
especially mitral diseases and Bright’s disease. It is also caused by
chronic alcoholism and may be the result of repeated attacks of the
acute form. Chronic vertebral and rib lesions are found from the first
to the seventh dorsal, inclusive. Elderly people are often subject to
the disorder.
=Pathologically=, the lesions of chronic bronchitis present great
variation, as to both their nature and extent. In some cases the
mucous membrane is atrophied, so that some of the elastic fibers are
noticeable. The epithelial layer is in great part missing. The muscular
coat and mucous glands are atrophied.
In certain cases the mucous membrane of the bronchi is thickened,
and there may be ulceration. In long standing bronchitis, there is
frequently dilation of the tubes (bronchiectasis) and emphysema.
=Symptoms.=—Pain is rarely present; there is merely a feeling of
constriction beneath the sternum. The cough varies with the weather and
season and there is often an absence of the cough during the summer.
It is apt to be worse at night than in the morning, and is frequently
paroxysmal. There is rarely any fever. As a rule, there is free
expectoration of mucopurulent or distinctly purulent matter. Sometimes
it is abundant, seromucous in character, and again there are severe
cases of dry cough in which there is almost no expectoration. Unless
associated with other diseases, the general health suffers but little,
if at all. The appetite, as a rule, is good and the body weight is well
maintained.
=Physical Signs.=—=Inspection.=—There is considerable immobility of the
chest and if emphysema is present there is distension. =Percussion= is
clear, and hyperresonant in emphysema. =Auscultation.=—The expiration
is prolonged and forcible. This is associated with sonorous and
sibilant rales and moist rales of all sizes.
=Special Varieties.=—Bronchorrhea, dry catarrh, putrid bronchitis or
fetid bronchitis.
=Bronchorrhea.=—In this form there may be an excessive bronchial
secretion. This may be liquid and watery, but more frequently it is
purulent, thin and containing greenish masses; or again it may be
thick. Dilation of the tubes and fetid bronchitis may be developed.
=Fetid Bronchitis.=—Fetid expectoration is associated with gangrene of
the lungs, abscesses, bronchiectasis, decomposition of matter within
phthisical cavities, or empyema with perforation of the lungs; or it
may occur independently. There is considerable expectoration that is
thin and offensive. When =putrefactive changes= take place during
the course of chronic bronchitis, as a rule, the following symptoms
immediately appear: fever, which may be septic; increase of cough; pain
in the side, and sometimes a chill. There is increased prostration. The
symptoms may abate followed by the usual course of bronchitis.
=Dry Catarrh.=—The cough is distressing and paroxysmal. It is usually
associated with emphysema and is a very troublesome form.
=Diagnosis.=—This is not usually difficult. Phthisis—the absence of
fever, of hemorrhage, of tubercle bacillus and the signs of localized
consolidation (usually at one or other apex) will serve to distinguish
between the two.
=Prognosis.=—Recovery is not always accomplished. The diseases being
generally a secondary affection, the prognosis must depend upon
the primary condition. The danger from development of emphysema,
bronchiectasis and dilatation of the right ventricle must be thought
of. Frequently cures will be obtained, even in old persons. Care must
be taken that there are no serious organic lesions. Deep treatment to
readjust the upper and middle dorsals is most essential.
=Treatment.=—In the first place there must be a careful regulation
of the hygiene of the patient. The diet should be a nutritious one,
care being taken to give food that is easily digested. A liberal diet
can easily be selected from the various meats, vegetables, cereals,
fruits, soups, broths, eggs and milk. The clothing should be carefully
selected. Flannel should be worn next the skin the year around, care
being taken that the sufferer is not too warmly clad. Due attention
should be given to bathing, exercising, etc. The patient should be
out in the open air a great deal, but be careful that it is not too
stormy. The air of the room should be kept at an even temperature and
not subject to abrupt changes. Two or three treatments per week will
be required, and when the condition is considerably aggravated, do not
hesitate to treat oftener, but be careful not to unduly irritate the
lesions.
Lesions will be found to the ribs and vertebræ from the first to the
seventh dorsal inclusive. Many cases present lesions in the vertebræ
from the second to fourth, usually of a lateral nature. Other lesions
of frequent occurrence are displacements of both vertebræ and ribs.
Correcting these deviations relieves the chronic inflammation of the
tubes. Also in those cases where dilatation of the bronchial tubes
occurs, the obstruction to the motor fibers is to be removed by the
correction of the vertebræ and by removing obstruction to fibers of
the pneumogastric; the fibers of the latter supplying the transverse
muscles of the bronchial tubes.
It generally requires a considerable course of treatment for the cure
of chronic bronchitis, and one of the hardest things to contend with in
the treatment is the likelihood of the patient “catching cold.” When a
fresh cold gets thoroughly started, it is almost impossible to prevent
the disease from extending down the bronchial tubes, as the innervation
is less rich in the smaller tubes.
Hazzard says: “The obese should be taught the habit of deep
respiration, as should all persons subject to the attacks of the
disease. This measure, together with the daily cold sponge or shower
bath, is a great aid in overcoming the chronic tendency.”
Those cases that are due to cardiac or nephritic diseases require the
treatment of the primary disease in addition to a light bronchial
treatment.
A lesion between the gladiolus and manubrium of the sternum may be
found, but it is of rare occurrence in these cases. The upper portion
of the sternum may be held very rigidly and slightly underneath the
middle portion of the sternum; or at the point of articulation of the
two portions a distinct ridge may be found, caused by the articular
ends being pushed anteriorly. Probably such lesions affect the
innervation to the bronchial tubes and lung tissues. Associated with
this condition the upper chest is considerably immobilized, affecting
the lymph and rib bone marrow function. Examine the first ribs and
clavicles carefully. Changes of climate are often beneficial.