Chronic Bronchitis

Chronic bronchitis is a type of chronic obstructive airway disease, or COPD. People with COPD have limitations in the flow of air through their airways. Chronic bronchitis is an ongoing inflammation of the breathing tubes.

What is going on in the body?

Chronic bronchitis results from long-term exposure of the airways to irritants. These irritants include tobacco smoke, air pollution, and chemicals. They cause the airways to secrete excess mucus and to become inflamed. With time, the inflammation becomes widespread. The cells lining the airways change. The glands that produce the mucus become enlarged. Inflammation and excess mucus combine to cause a cough that produces sputum, or phlegm, almost every day.

The World Health Organization, also known as WHO, has recently developed a classification system for the severity of chronic bronchitis and other forms of COPD. There are four stages of severity, as outlined below:

Stage 0, or at risk for COPD. These people have chronic cough and sputum production. Their lung function tests are still normal.

Stage I, or mild COPD. Individuals in this group have mild limitations in their airflow and changes in their lung function tests. They generally have chronic cough and sputum production.

Stage II, or moderate COPD. People at this stage have worsening of airflow that leads to shortness of breath with exertion. Their lung function tests show marked limitations.

Stage III, or severe COPD. Individuals at this stage have severe airflow limitations that impair their quality of life. Their lung function tests are markedly abnormal.

What are the causes and risks of the condition?

Cigarette smoking is the most common cause of chronic bronchitis. The risk goes up with the amount of tobacco smoked and the number of years of smoking. Chronic bronchitis is most common in countries where smoking is prevalent. It is less common in countries where people smoke less. Passive smoking, or exposure to secondhand smoke, does increase a person’s risk for chronic bronchitis.

Other risk factors for chronic bronchitis include the following:

indoor air pollution, such as smoke from home cooking or home heating fuels

occupational dusts and chemicals

outdoor air pollution, such as motor vehicle exhaust fumes

previous viral infection of the lungs

untreated lung infections

What are the signs and symptoms of the condition?

Individuals with chronic bronchitis have a chronic cough that produces sputum. Less commonly, they may develop fever and shortness of breath. The shortness of breath worsens with exertion.

How is the condition diagnosed?

Diagnosis of chronic bronchitis begins with a medical history and physical examination. Lung function tests can identify chronic bronchitis in Stage 0, even before the individual has symptoms. Lung function tests measure how much air a person can take in with a deep breath. They also measure how fast the person can push the air back out of the lungs. The healthcare provider may also order a chest X-ray and blood tests.

What can be done to prevent the condition?

Many risk factors for chronic bronchitis can be completely eliminated. Smoking cessation is vital for those who smoke. Sources of indoor air pollution can be identified and removed. It is also important to avoid secondhand smoke.

What are the long-term effects of the condition?

Chronic obstructive pulmonary diseases, including chronic bronchitis, are the fourth leading cause of death in the world. The long-term effects depend on how severe the disease is when diagnosed and if a reduced exposure to the lung irritant occurs. The most effective treatment is quitting smoking. This will typically result in a modest improvement or no further decline in function.

People with chronic bronchitis have a higher mortality than those with normal lung function. Causes of death include respiratory failure, lung infections such as pneumonia and influenza, and other diseases related to smoking. These include cancer, heart disease, and stroke.

What are the risks to others?

Chronic bronchitis is not contagious and poses no risk to others.

What are the treatments for the condition?

WHO has identified the following four components for management of chronic bronchitis:

assessing and monitoring of the disease

managing exacerbations, or episodes where symptoms are worse

managing stable chronic bronchitis

reducing the person’s risk factors

Assessment and monitoring

Assessment and monitoring of the disease incorporates the following steps:

doing a medical history and physical exam to evaluate symptoms

identifying people at risk for chronic bronchitis, even if they don’t have symptoms

performing lung function tests to measure airflow limitations

Reducing risk factors

Reducing the person’s risk factors includes the following recommendations:

Avoid vigorous outdoor exercise when air quality is poor.

Eliminate sources of indoor pollution, such as wood-burning stoves.

Limit exposure to secondhand smoke.

Reduce occupational dusts and chemicals.

Stop smoking, if the person smokes.

Managing stable chronic bronchitis

Management of stable chronic bronchitis includes the following:

Learn to identify and avoid risk factors.

Learn to identify problems and seek appropriate treatment.

Take medications as directed.

WHO recommendations for management of chronic bronchitis are broken down by the severity of the disease. Recommendations for Stage 0 chronic bronchitis include the following:

Get a flu vaccine once or twice a year.

Identify and eliminate risk factors.

Use antibiotics only for bacterial infections, but not for chronic bronchitis itself.

Recommendations for Stage I chronic bronchitis are the same as those for Stage 0. In addition, people with Stage I chronic bronchitis should use short-acting bronchodilators as needed. Bronchodilators relieve coughing and shortness of breath by opening the airways. In general, WHO recommends inhaled bronchodilators rather than oral medications.

Recommendations of Stage II chronic bronchitis include the recommendations from Stage I. Additional measures are recommended for times when symptoms are present. They include the following:

Use long-acting bronchodilators on a regular basis.

Use inhaled glucocorticosteroids, for people with significant cough or shortness of breath.

Participate in a pulmonary rehabilitation program that uses teaching and exercise to improve lung function.

WHO recommendations for Stage III chronic bronchitis are as follows:

Use long-acting bronchodilators regularly.

Take short-acting bronchodilators as needed.

Seek treatment for complications, such as pneumonia.

Participate in a pulmonary rehabilitation program.

Use oxygen as needed.

Discuss surgical options with the healthcare provider.

Managing worsening symptoms

People with chronic bronchitis may have worsening, or exacerbation, of symptoms when they develop a respiratory infection. Symptoms may also be worsened by cigarette smoke, as well as other factors. Following are the WHO guidelines for management of worsening symptoms:

Increase the dose and/or frequency of inhaled bronchodilators.

Take oral glucocorticosteroids to decrease airway swelling.

Take antibiotics for bacterial infection.

Take oxygen by mask or cannula.

Use a ventilator, or artificial breathing machine.

What are the side effects of the treatments?

Bronchodilators may cause an increased heart rate and blood pressure. Oral glucocorticosteroids can cause increased risk for infection, high blood sugar, and osteoporosis. Antibiotics can cause rash, stomach upset, and allergic reaction.

What happens after treatment for the condition?

Early diagnosis of chronic bronchitis and effective treatment can slow its progression. People who eliminate risk factors and follow treatment guidelines have better outcomes. Those who continue to smoke may be increasingly disabled by breathing problems and complications of chronic bronchitis.

How is the condition monitored?

Chronic bronchitis is monitored through regular visits with the healthcare provider. Lung function tests can be used to monitor limitations in airflow. Any new or worsening symptoms should be reported to the healthcare provider.