Chronic bronchitis - Classification

There is no generally accepted classification of chronic bronchitis. In practical medical practice, it is advisable to use the following.

The most widely used classification of chronic bronchitis is that of N. R. Paleev, V. A. Ilchenko, and L. N. Tsarkova (1990, 1991). The classification is based on the following principles: determination of the nature of the inflammatory process, the presence or absence of bronchial obstruction and complications.

1. The nature of the inflammatory process in the bronchi.
   1. Simple (catarrhal) bronchitis.
   2. Purulent bronchitis with the release of purulent sputum.
   3. Mucopurulent bronchitis with the release of mucopurulent sputum.
   4. Special forms:
      1. Hemorrhagic bronchitis with the release of sputum mixed with blood.
      2. Fibrinous bronchitis - with the separation of very viscous sputum, rich in fibrin, in the form of casts of small bronchi.
2. Presence or absence of bronchial obstruction syndrome.
   1. Non-obstructive bronchitis.
   2. Obstructive bronchitis.
3. The level of damage to the bronchial tree.
   1. With predominant damage to large bronchi (proximal).
   2. With predominant damage to small bronchi and bronchioles (distal - "small airway disease").
4. Flow.
   1. Latent.
   2. With rare exacerbations.
   3. With frequent exacerbations.
   4. Continuously recurring.
5. Phase.
   1. Exacerbation.
   2. Remission.
6. Complications.
   1. Pulmonary emphysema.
   2. Hemoptysis.
   3. Respiratory failure.
      1. Acute.
      2. Chronic.
      3. Acute against the background of chronic.
   4. Secondary pulmonary hypertension:
      1. Transitional stage.
      2. Stable stage without circulatory failure.
      3. Stable stage with circulatory failure.

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Severity levels of chronic respiratory failure

• Grade I - obstructive ventilation disorders without arterial hypoxemia;
• Grade II - moderate arterial hypoxemia (PaO2 from 79 to 55 mm Hg);
• Grade III - severe arterial hypoxemia (PaO2 below 55 mmHg) or hypercapnia (PaCO2 above 45 mmHg).

A. N. Kokosov and N. N. Kanaev (1980) identified two variants of chronic non-obstructive bronchitis:

1. functionally stable with predominant damage to the central bronchi;
2. functionally unstable, in which, along with damage to the large bronchi, there is a syndrome of moderate obstruction of the peripheral bronchi (a kind of preclinical stage of chronic obstructive bronchitis) due to the development of bronchospasm.

Classification of chronic bronchitis

1. By etiology - bacterial, viral, mycoplasma, from exposure to chemical and physical factors, dust.
2. By the nature of the inflammatory process:
   • catarrhal;
   • purulent;
   • catarrhal-purulent;
   • fibrinous;
   • hemorrhagic.
3. By functional changes:
   • non-obstructive;
   • obstructive.
4. Downstream:
   • remission phase;
   • exacerbation phase.
5. By complications:
   • respiratory (pulmonary) failure;
   • pulmonary emphysema;
   • chronic pulmonary heart disease (compensated, decompensated);
   • development of bronchiectasis.

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