[Music] hi everybody dr. Mikey let's talk about chronic bronchitis chronic bronchitis is a disease of hypersecretion within the airways that means too much mucus is being produced and this mucus stops efficient gas exchange from occurring now this is usually due to chronic exposure to particulate or pollutants predominately cigarette smoke or maybe it's some other irritant that the individual has been exposed to over a longer period of time now if we have a look at the alveoli we know that this is where gas exchange occurs so we want oxygen to go from the alveoli into the bloodstream and then it oxygenates that blood which goes back to the left side of the heart and they can distribute that oxygenated blood to the body obviously once the body has taken that oxygen it brings deoxygenated blood back to the heart which sends it back to the lungs to collect more oxygen now in chronic bronchitis where you have all this mucus being produced this mucus tends to block up these alveoli and Airways and that means that the oxygen that's coming in has a thicker membrane that it needs to pass through in order to jump into the bloodstream now your pulmonary arterioles which are coming through to try and collect that oxygen they respond very very rapidly to changes in oxygen levels in the alveoli and what happens is this if the the pulmonary arterial that are coming across this alveoli think that there's not enough oxygen what they do is they tend to constrict so if this pom or arterial comes along doesn't think there's any oxygen here it constricts itself the blood will back up and then resend that blood to other better oxygenated alveoli this is great we want this to happen but the problem with chronic bronchitis is that all the alveoli are filled with this mucus which means all the alveoli have low oxygen levels or at least the Pommery arterioles think they do all the pulmonary arterial start to close off and the blood backs up into the right-hand side of the heart that means you have pulmonary hypertension occurring okay now the right hand side of the heart tries to deal with this tries to overcome it and because the hearts are muscle how does a muscle overcome resistance it gets bigger and stronger so you get hypertrophy that's the term when the muscle of the heart gets bigger and thicker and specifically the right-hand side of the heart this is called cor pulmonale so called pulmonary thickening of the right-hand side of the heart because it's trying to overcome this pulmonary hypertension now the other problem with this is that this can lead to right-side heart failure but also the blood continues to back up into the venous system that's coming from the body and therefore you get this venous hypertension and fluid begins to leak out of the venous system into the body and this is edema so this is why individuals with chronic bronchitis are termed blue bloaters because one there's no oxygen being jumping from the alveoli into the blood so they're not getting oxygen they're cyanotic they're blue they're bloaters because they've got edema because of this pulmonary hypertension backing up to the right-hand side of the heart continues to back up and fluid leaks out into the body okay so this is chronic bronchitis