Special examination of Chronic bronchitis

Special examination :

•  X-ray photo PA and left lateral chest

-  Typically show no abnormalities, except when it occurs cor pulmonale or emphysema.
-  It may also seem an increase in "bronchovascular markings".

• Sputum: direct smear, Gram staining.

Please note: the existence of cells in sputum, whether the material is indeed contaminated with sputum or saliva from the oropharynx. Sputum can be identified because of alveoler macrophages (histiocytes). Macrophages alveoler this form round cells, large, with eccentric nuclei and oval or kidney-shaped near the edge of the cell.
Tues skuamus flat and very large and has a spherical nucleus in the middle. If there were> 25 epithelial cells in sputum skuamus, means contaminated with saliva or secretions from the oropharynx.
In chronic bronchitis who experience eksaserbrasi yellow sputum, bronchial ciliated epithelium that despite apparent in sputum neutrophil and looks.
At the time of remission decreased number of neutrophils, but macrophages alveoler increased, resulting in mucoid sputum and grayish-white color.
When sputum is contaminated, it should be repeated sputum collection or rinsed with water (washed sputum), a new Gram staining was made. Note the presence of neutrophils and bacteria. If the bacteria seemed gather very much and the same morphology, mean as a result of stasis, so sputum should be discarded. If it seems a variety of bacteria and many in the sputum, saliva possible, should be attempted again looking for new specimens. Look for the etiology of bronchial inflammation.

• If the Gram-positive cocci in pairs or forming short chains means "Streptococcus pneumoniae" (diplococus).
• If the Gram-positive cocci and form large clusters, meaning "Staphylococci".
• Basil Gram-negative, such as haemophilus influenza, Seratia, Pseudomonas, Klebsiella, E. Colli, and others.

Guidelines for assessment of sputum on COPD:

1. Gram staining of pus cells --> <1-5  inflammation (-) and germs (-); seed germ (+) --> not the cause of the disease.
2. Gram staining (+) and seed (+) --> possible causes of infection.
3.  Gram staining (-) and seed a little (+) --> sputum contaminated with saliva.

If the sputum culture results did not confirm the results of gram staining on sputum smears are true, then breeding considered untrustworthy. If the breeding is not the same as the results of gram staining, a new specimen should be made when antibiotics are used not deliver results.

Tests pulmonary physiology:
To determine the presence of airflow obstruction in chronic bronchitis, pulmonary physiology need to check:

• FVC (Forced Vital Capacity)
• FEV1 (Forced expiratory volume one second)
• FEF 25-75% (Forced expiratory flow over the mid - 50% of the vital capacity) to detect obstruction in small airways.
• PEFR (peak expiratory flow rate), only to find out the existence of a large obstruction in the airway, can be done in the clinic.
• TLC (Total Lung Capacity), can only be examined at a hospital that has a complete facility in the form of "body plethysmograph or by helium dilution or nitrogen washout method technique".

In chronic bronchitis:

• VC is normal or decreased (<80%)
• FEV1 is normal or decreased (<80%)
• FEV1 / FVC is always decreased (<75%)
• FEF 25-75% was always decreased (<80%)
• TLC normal / increased (N = 80-120%)
• RV / TLC% is always increasing (N = 25-40%)

Pulmonary Physiology showed obstruction

• ECG is necessary to know the existence of right heart hypertrophy, such as in cronic cor pulmonale.
• Examination Arterial Blood Gases:

- PaO2 decreased to 70-80%, normal 80-100 mm Hg.
- PaCO2 normal / increased to 25-35%. Normal = PaCO2 = 35-45 mm Hg.
- pH is normal or decreased (when the state information). Normal pH = 7.35 to 7.45.

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