What is Chronic Bronchitis?
Chronic bronchitis is a condition where a person has a persistent cough that produces mucus, lasting for at least three months and occurring over two years. Smoking is highly linked to this condition, and it’s also frequently related to a lung disease called chronic obstructive pulmonary disease (COPD).
What Causes Chronic Bronchitis?
Chronic bronchitis can be caused by many factors, but the biggest one is exposure to cigarette smoke. This can involve actively smoking or passively inhaling someone else’s smoke. Inhaling other harmful substances like smog, pollutants from factories, and toxic chemicals can also cause chronic bronchitis.
While bacterial and viral infections more often lead to short-term (or “acute”) bronchitis, frequently getting these infections can turn into chronic bronchitis. Certain types of viruses and bacteria like Influenza A and B and Staphylococcus, Streptococcus, and Mycoplasma pneumonia are the main culprits.
People who already have respiratory diseases like asthma, cystic fibrosis, or bronchiectasis are more likely to develop chronic bronchitis. The same goes for people who are often exposed to environmental pollutants like dust or airborne chemicals like ammonia and sulfur dioxide.
Lastly, chronic gastroesophageal reflux, where stomach acid frequently flows back into the tube connecting your mouth and stomach, is a less common but known cause of chronic bronchitis.
Risk Factors and Frequency for Chronic Bronchitis
Chronic bronchitis is a condition that affects between 3% to 7% of healthy adults. Yet, this number can go up to as high as 74% in people diagnosed with a disease called COPD. It’s important to note that many people in the general population may have symptoms of chronic bronchitis, but have not been formally diagnosed with a respiratory condition.
Folks less than 50 years old, who are otherwise healthy but have chronic bronchitis, are more likely to face health risks and premature death compared to those without the condition. Factors such as getting older, smoking, exposure at work, and socio-economic status are thought to contribute to the likelihood of developing chronic bronchitis.
Signs and Symptoms of Chronic Bronchitis
Chronic bronchitis is a condition where individuals experience a persistent cough. The cough typically lasts for the majority of days in a month, for at least three months, and episodes of this kind happen for at least two consecutive years. Notably, about half of the patients may have a cough productive of sputum. The color of this sputum can differ from clear, yellow, green, and even have traces of blood. It’s important to note that these color changes might not necessarily mean there’s a bacterial infection – they can often be due to a chemical called peroxidase released by white blood cells in the sputum.
When talking to healthcare professionals, patients should share their history thoroughly, including any exposure to irritants or chemicals, or detailed information about their smoking habits. Other symptoms can include tiredness or malaise. Fever is uncommon in chronic bronchitis and can indicate other conditions like the flu or pneumonia when it is present. Some patients may even experience chest pain or abdominal muscle pain due to continuous, forceful coughing. Inflammation of the airway can be associated with a wheezing sound.
Uncomplicated chronic bronchitis does not show evidence of airway blockage and is primarily characterized by a cough. However, patients with chronic bronchitis with associated asthma often present wheezing due to overactive airways causing intermittent bronchospasms. In severe cases, the disease can progress to obstructive bronchitis, affecting the small airways and leading to another respiratory disease known as emphysema.
Testing for Chronic Bronchitis
To diagnose chronic bronchitis, it’s essential to take a detailed patient history to rule out other lung-related illnesses. Some tests can help confirm the diagnosis.
Key among these tests is a complete blood count, which could indicate if there’s an infection. A particular blood test, called the procalcitonin test, helps tell if a bacterial infection is present, differentiating it from other non-bacterial infections.
Other useful tests include a chest X-ray, which is especially crucial for older patients, and anyone showing symptoms of pneumonia. If there’s a suspect of a bacterial infection, a culture test might be done on the patient’s phlegm (sputum).
Additionally, measuring oxygen levels in the blood and undergoing a pulmonary function test, an exam that measures how well your lungs are working, can also provide valuable information.
Treatment Options for Chronic Bronchitis
The main goal of chronic bronchitis treatment is to ease symptoms, prevent complications, and slow down disease progression. This can be done by reducing excess mucus, managing inflammation, and reducing cough. Treatment involves both medication and lifestyle changes.
Medication usually includes:
1. Bronchodilators: These drugs help to widen the airways, improve the function of hair-like structures (cilia) that move mucus and dirt out of the lungs, and hydrate the mucus.
2. Glucocorticoids: These drugs are used to reduce inflammation and mucus production. Inhaling these medications can reduce worsening symptoms (exacerbations) and improve quality of life. However, they should be used under a doctor’s guidance and for short durations as long-term use can lead to osteoporosis (weak bones), diabetes, and high blood pressure.
3. Antibiotics: Normally, antibiotics are not used for chronic bronchitis treatment, but a specific type called macrolides can reduce inflammation and therefore may be beneficial.
4. Phosphodiesterase-4 inhibitors: These drugs help reduce inflammation and relax the airways, primarily by preventing the breakdown of a natural substance within the body (cyclic adenosine monophosphate) that, when depleted, triggers inflammation.
Lifestyle changes play a critical role:
The most crucial lifestyle change is quitting smoking. Stopping smoking enhances the function of the cilia and reduces the excessive growth of mucus cells (goblet cell hyperplasia). Quitting smoking also decreases damage to the airways, which results in less mucus shedding in airway cells.
Pulmonary rehabilitation is another vital part of chronic bronchitis treatment. It includes education, lifestyle changes, regular physical activity, and avoiding exposure to pollutants at the workplace or home.
What else can Chronic Bronchitis be?
When properly diagnosing a patient, doctors must consider a range of potential health conditions that might cause the presented symptoms. In the context of respiratory or sinus-related issues, the following conditions may be included:
- Acute sinusitis (a short-term inflammation of the sinuses)
- Alpha 1 antitrypsin deficiency (a genetic disorder that can cause lung and liver disease)
- Asthma (a condition that causes difficulty in breathing)
- Bacterial pharyngitis (a bacterial infection in the throat)
- Bronchiectasis (a condition where there’s a permanent enlargement of parts of the airways of the lung)
- Bronchiolitis (an inflammation of the small airways in the lung)
- Bronchitis (an inflammation of the bronchial tubes)
- Chronic obstructive pulmonary disease (a chronic inflammatory lung disease)
- Chronic sinusitis (long-term sinus inflammation)
- Influenza (commonly known as the flu)
It is crucial that healthcare professionals consider each of these possible conditions and perform the necessary examinations to ensure an accurate diagnosis.
What to expect with Chronic Bronchitis
Chronic bronchitis, a long-term inflammation of the airways, is known to lead to worsening airflow obstruction and a decrease in lung function. Large-scale health studies have found that excessive mucus production is linked to a decrease in one’s ability to exhale forcefully (known as FEV1). Individuals showing symptoms of chronic bronchitis face a three times higher risk of developing new Chronic Obstructive Pulmonary Disease (COPD) compared to those without symptoms.
Chronic bronchitis not only causes an increased risk of death but also indicates higher levels of certain inflammatory markers in the blood, like serum IL8 and C reactive protein. This suggests that the body’s widespread inflammatory response could increase the chances of heart disease and other health-related ailments. It’s also worth noting that chronic bronchitis tends to decrease one’s overall quality of life.
