Another effect of unchecked inflammation in alpha-1 antitrypsin deficiency is chronic bronchitis, resulting from increased mucus production and narrowing of the airways.
Even though an increased Reid index goes along with chronic bronchitis, the diagnosis is still done clinically and this measurement is not usually used diagnostically.
Lung diseases like chronic bronchitis, emphysema, and asthma shrink the passageways that carry oxygen, while weakening the membrane that brings oxygen into the blood.
As a result of having too much mucus and poorly functioning cilia, people with chronic bronchitis end up relying on coughing to get rid of their mucus plugs.
Normally, this ratio should be less than 40%, but it can be over 40% for people with chronic bronchitis, because of the hyperplasia and hypertrophy of the glands.
These two are different in that chronic bronchitis is defined by clinical features, like a productive cough, whereas emphysema is defined by structural changes —specifically enlargement of the air spaces.
Other risk factors for chronic bronchitis include exposure to air pollutants like sulfur and nitrogen dioxide, exposure to dust and silica, as well as genetic factors like having a family history of chronic bronchitis.
And finally another consequence of mucus plugging in chronic bronchitis is that people can develop lung infections behind the mucus blockages in the airway, and these infections can worsen the pulmonary and cardiac symptoms.
The increased CO2 levels in the blood can get so bad that some people develop cyanosis, which is a blue discoloration of the skin, and this is why patients with chronic bronchitis are sometimes referred to as blue bloaters.