What is Chronic bronchitis?

Chronic bronchitis is continuing inflammation of the breathing passages in the lung. The cause of the inflammation is long-term exposure to airway irritants such as cigarette smoking, occupational dusts and fumes, or allergy-producing materials that are specific to the individual. When the airways of the lung are chronically irritated and inflamed, there is thickening of the walls of the airways, increased mucus production, and decreased ability to clear mucus from the airways. This results in pooling of secretions in the lungs. Airway obstruction follows, setting the stage for increased pulmonary infections.

Chronic bronchitis is sometimes divided into three subcategories. Simple chronic bronchitis is characterized by a chronic productive cough on most days for three months out of the year for two or more years. A small percentage of these individuals will go on to develop chronic obstructive bronchitis, in which irreversible changes in the airways occur. Chronic asthmatic bronchitis is characterized by over-reactive airways that easily go into spasm when irritated, resulting in wheezing. Between ten and twenty-five percent of the adult population are affected by simple chronic bronchitis. It is more common in men than in women. It is not well understood why some of these persons progress to chronic obstructive bronchitis and some do not.

Chronic bronchitis is one of three major lung diseases (bronchitis, emphysema, and asthma) included under the general term chronic obstructive pulmonary disease (COPD). All three diseases have overlapping symptoms. A person may have more than one chronic process at any given time.

How is it diagnosed?

The doctor usually suspects COPD on the basis of the symptoms and examination of the patient. However, they may also arrange for blood tests, a chest x-ray and some special breathing tests (called spirometry) to be done, or in difficult cases, organize an appointment with a specialist to advise on the diagnosis and further treatment.

Spirometry involves the patient blowing out into a tube for as long and as hard as they can. The tube is attached to a machine that analyses various aspects of the person's lung function. The test is then usually repeated after the administration of certain drugs (via a mask attached to a device called a nebuliser) which are designed to open the airways of the lungs. This can help to identify whether the person is suffering from COPD or asthma and can gauge the severity of the condition.

How is Chronic bronchitis treated?

The most important thing that the patient can do for themselves is to give up smoking. This can significantly slow down the progress of the condition and may even allow some parts of the lung to heal up. Stopping smoking is one of the few things which has been proven to make a difference to the progress of COPD and its importance for people with this condition cannot be over-emphasized.

The occasional use of antibiotics for the episodes of chest infection characteristic of COPD has been found to help the occasional worsening of symptoms associated with these infections. However, it is often difficult to tell when a true chest infection is present and antibiotics have not been shown to affect the general progression of the condition.

Occasionally, sufferers of chronic bronchitis can contract chronic lung infections that are resistant to all usual antibiotics. In these cases, certain antibiotics are sometimes given directly into the lungs via the nebuliser (a machine which produces a fine mist of medication which is inhaled through a mask attached to the machine).

There are a number of types of inhaled medication that can help with the symptoms of chronic bronchitis. These are administered either in the form of an inhaler or via a nebuliser.

Steroids given in tablet form are sometimes used in high doses for short periods of time to treat acute exacerbations of the breathlessness of COPD, often in combination with a course of antibiotics if infection is thought to be contributing to the sudden deterioration. The response to this treatment tends to vary from one patient to another

In cases of severe COPD, long term oxygen therapy can help not only to relieve some of the symptoms, but it has also been found to prolong the lifetime of sufferers. The oxygen is administered through a mask or nasal tubing attached either to an oxygen cylinder kept in the home or from a machine called an oxygen concentrator, which takes room air and concentrates the amount of oxygen in it before blowing it out along the tubing to the patient.

Physiotherapy can sometimes be useful to assist the clearing of mucus from the lungs.

It is strongly advised that sufferers of COPD have an annual flu injection each autumn and a one-off pneumonia vaccination. These immunisations will give them extra protection from illnesses that would potentially cause them serious problems in the light of their already reduced lung capacity.

Medications

• Don't take cough suppressants; they make chronic bronchitis worse.
• Antibiotics to fight chronic or recurrent infection.
• Expectorants to loosen secretions.
• Bronchodilators to open bronchial tubes.
• Drugs may be prescribed to treat severe depression or anxiety if they occur.

Biaxin (Clarithromycin), Ilosone (Erythromycin), Adoxa (Doxycycline), Flovent (Fluticasone), Proventil (Albuterol)

Predicted outcome

Simple chronic bronchitis has a generally good prognosis. With smoking cessation and vigorous treatment early on, the disease can be reversible. However, recovery time from episodes of acute bronchitis or pneumonia will be longer than normal. Individuals with chronic obstructive bronchitis usually become permanently disabled at some point even with treatment and smoking cessation. Shortness of breath, declining lung function, airflow obstruction, and increasingly frequent complications gradually worsen and can be common.

Alternatives

Other diagnoses with similarities to chronic bronchitis are asthma, emphysema, acute bronchitis, bronchiectasis, and pneumonia. Tuberculosis, lung cancer, pulmonary embolism, and AIDS-related complex are other possibilities.

Appropriate specialists

Pulmonologist and infectious disease specialist.

Last updated 27 June 2015