How Chronic Bronchitis Affects the Lungs
Chronic bronchitis is a lung disease that causes a cough with increased mucus production for at least three months in two consecutive years.
It generally falls under the category of chronic obstructive pulmonary disease, or COPD.
The most common cause is cigarette smoking, although the inhalation of irritants at work, air pollution and lung infections may also cause it.
Considering most people develop this disease due to exposure to cigarette smoke, one might wonder: Why does smoking cause chronic bronchitis?
To best answer this question it's helpful to understand the basics of airway anatomy, which is covered in the pithy post "Your Journey Down the Respiratory Tract." Knowledge of lung anatomy is helpful because long-term exposure to inhaled cigarette smoke may cause changes inside the airways.
These changes may include:
1.
支气管粘液腺变大:
This causes increased mucus or secretion production inside the lungs.
2.
Goblet cells increase in number:
这也会导致粘液产生增加。
3.
Bronchial walls become inflamed:
这是由于反复暴露于卷烟烟雾的有害化学品。
这些化学品伤害了墙壁，身体试图修复它们导致它们变得发炎或肿胀。
Common treatments for this are inhaled corticosteroids such as Qvar, Pulmicort, Advair, and Symbicort. Systemic corticosteroids are also sometimes needed.
4.
Bronchial walls become thick and scarred:
This is often referred to as airway remodeling.
It occurs when inflammation lasts for such a long time that the body tries to fix it.
这导致疤痕组织，导致气道成为纤维化或僵硬。这种伤害是永久性的，没有治疗。
5.
纤毛衬里支气管墙消失：纤毛是精细的，毛发状结构，充当自动扶梯，使粘液带到上部气道，可以吞咽，咳嗽或吐痰。
缺乏玉米岛，气道对上呼吸道移动了艰难的时间，导致肺部粘液堆积。
6.
Mucus plugging in the smaller airways: This means that dried up secretions block air passages.
7.
支气管痉挛:
Inflamed airways are extra sensitive to certain triggers (such as inhaled irritants, allergens, and strong smells) that may cause flare-ups.
这可能导致肌肉环绕气道痉挛。
在我最近的“COPD FLARE-UP原因”帖子中讨论了FLARE-UPS。
Treatment for this include albuterol (ventolin), levalbuterol (xopenex), ipatropium bromide (Atrovent), Duoneb, Combivent, theophylline, serevent, formoterol, Advair, and Symbicort.
8.
气道阻塞/缩小: The combination of increased mucus, mucus plugging, scarring, inflammation, and bronchospasm cause air passages to become permanently narrowed and frequently obstructed.
Air traveling through narrowed or obstructed airways may cause a wheeze.
9.Air Trapping:
Air can get past an obstruction in the airway, but has a hard time getting out.
换句话说，遭受这一点的人可能会觉得他们无法空气，但事实是他们无法冒空。这导致延长的呼气。
A good treatment technique for this is to exhale through pursed lips, thus allowing more time for trapped air to get out.
10.
气肿: Most people with chronic bronchitis also suffer from emphysema, which is the breakdown or destruction of lung tissue, which is probably also caused by inflammation. More specifically, it is the breakdown of the walls of the air sacs, or alveoli. This makes it so the lungs lose their ability to expand.
由于击穿，肺泡囊也可以从小的空气通道中脱离，降低可用于气体交换的区域。
The treatment for emphysema is usually supportive, and often includes wearing oxygen.
11.
气流限制:
狭窄和阻塞的气道导致耐受流过它们的空气抗性，从而减慢了这种空气的流动。这可能导致呼吸困难的感觉或呼吸急促。
气流限制在慢性支气管炎中部分可逆，具体取决于原因：
Reversible:
Obstruction caused by increased mucus, inflammation and bronchospasmIrreversible: Obstruction caused by airway remodelling and emphysema
气流限制is best measured during pulmonary function testing, a test that can determine how severe your airflow limitation is, or how severe our COPD is.
12.
缺氧血症:
由于上述疾病过程的组合，将存在肺部不能通过血液的肺部的区域。
这可能导致低氧血液水平。
This makes it so the blood has less available oxygen to take to tissues, and so it takes it to vital organs before less vital areas of the body like fingertips and lips.
Common symptoms of this are dyspnea and cyanosis, or a blue tinge around the fingertips and lips. Treatment for this is wearing oxygen.
13.
hypercapnia.:
随着允许较少的氧气进入血液，将使较少的二氧化碳（CO2）允许离开血液并进入肺部呼出。CO2是肺部呼气的细胞代谢的废物。如果不能进入肺部，CO2在血液中累积。
这的症状包括感到困倦和混乱。
It's important to note that not all of the above occur in every person with chronic bronchitis, which is kind of what makes this disease so complicated for physicians to understand and treat. Also, the progression of these disease processes are often so gradual that a person may not even notice them happening, especially in the early stages of the disease.
A neat thing about this disease, however, is that, while damage already done cannot be undone, quitting smoking will almost immediately slow down its progression.
It is for this reason most physicians recommend people diagnosed with it quit smoking immediately.
For tips on how to quit smoking check out "6 tips to help you quit smoking."
所以，现在你应该概述人们如何发展慢性支气管炎，症状是什么，以及支气管炎的物理影响如何影响肺部。
参考：
Wilkins，Robert L.，James R. Dexter，“呼吸系统疾病：原则与实践”，1993，费城，F.A. Davis公司
"Understanding Chronic Bronchitis," American Lung Association,http://www.lung.org/lung-disease/bronchitis-chronic/understanding-chronic-bronchitis.html, accessed 4/9/14
“什么是copd？”国家心肺和血液研究所，https://www.nhlbi.nih.gov/health/health-topics/topics/copd/, accessed 4/9/14
Hanania，Nicola A.，Amir Sharafkhaneh，编辑，“COPD：诊断和临床管理指南”，2011年，纽约，伦敦，斯普林斯，DONDRECHT HEIDELBERG，
pages 2-5慢性阻塞性肺病（金）的全球倡议，“慢性阻塞性肺病的诊断，管理和预防的全球战略，”2014年更新
