Bronchitis (Chronic)

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Facts and Definition of Chronic Bronchitis

  • Bronchitis is an inflammation of the airways in the lungs. Acute bronchitis happens when this inflammation of the air passages comes on quickly and resolves within two to three weeks. Chronic bronchitis is when a cough with mucus persists for most days of the month, for at least three months, and at least two years in a row.
  • Chronic bronchitis is caused by
  • Risk factors for chronic bronchitis include
  • Symptoms of chronic bronchitis include cough that persists for most days of the month, for at least three months, and at least two years in a row. Coughing may be painful and can cause chest and abdominal muscles to be sore. Other symptoms include wheezing and shortness of breath.
  • Chronic bronchitis is diagnosed based on the symptoms and physical exam. By definition, chronic bronchitis must persist for most days of the month, for at least three months, and at least two years in a row.
    • Treatment of chronic bronchitis depends on the cause. There is no cure, and treatment is aimed at reducing symptoms. Medications may be prescribed including
    • cough suppressants or expectorants,
    • bronchodilator inhalers,
    • nebulizer treatments,
    • corticosteroids (inhaled and oral), and
    • in some cases antibiotics.
  • Severe cases of chronic bronchitis may be treated with home oxygen or hospitalization.
  • The best way to prevent chronic bronchitis is not to smoke or be around secondhand smoke. Avoid exposure to inhaled irritants and air pollution, stay away from others who have a cold or the flu, and wash hands frequently to prevent the spread of infection.
  • Quitting smoking is the biggest factor in determining an individual's ultimate prognosis. Untreated or poorly managed chronic bronchitis can result in permanent and severe damage to the lungs.

What Is Chronic Bronchitis?

Bronchitis is considered chronic when a cough with mucus persists for most days of the month, for at least three months, and at least two years in a row. Bronchitis occurs when the trachea (windpipe) and the large and small bronchi (airways) within the lungs become inflamed because of infection or irritation from other causes. Chronic bronchitis and emphysema are forms of a condition characterized by progressive lung disease termed chronic obstructive pulmonary disease (COPD).

Picture of the lung, bronchi, and airways of the lung
Picture of the lung, bronchi, and airways of the lung

Chronic Bronchitis Symptoms

  • Cough is the most common symptom of chronic bronchitis. The cough may be dry or it may produce phlegm. Significant phlegm production suggests that the lower respiratory tract and the lung itself may be infected, symptoms which may also be concerning for pneumonia.
  • The cough in chronic bronchitis persists for most days of the month, for at least three months, and at least two years in a row.
  • Continued forceful coughing from chronic bronchitis may be painful, and can make your chest and abdominal muscles sore. Coughing can be severe enough at times to injure the chest wall, break ribs, or even cause a person to pass out (faint).
  • During exacerbations (periods where the condition is worsens) of chronic bronchitis, wheezing may occur because of the muscular tightness and inflammation of the airways. This may leave the affected individual short of breath.
  • Asthmatic bronchitis symptoms include a combination of wheezing and shortness of breath, in addition to the other symptoms of chronic bronchitis.

Causes of Chronic Bronchitis

Chronic bronchitis can occur any time during the year, but it occurs most often during the cold and flu season, usually coupled with an upper respiratory infection.

  • Smoking is one of the leading causes of chronic bronchitis.
  • Inhaled irritants from the workplace, pollution, or secondhand smoke are another common cause of chronic bronchitis.
  • Inhaling irritating fumes or dust can also cause a worsening of chronic bronchitis. Chemical solvents have been linked to worsening chronic bronchitis.
  • Several viruses can cause chronic bronchitis, including influenza A and B, commonly referred to as "the flu."
  • A number of bacteria are also known to cause chronic bronchitis, such as staph, strep, and Mycoplasma pneumoniae, which causes so-called "walking pneumonia."
  • People at increased risk of both getting chronic bronchitis and of having more severe symptoms include the elderly, those with weakened immune systems, smokers, individuals with chronic obstructive pulmonary disease (COPD), and anyone with repeated exposure to lung irritants.

Is Chronic Bronchitis Contagious?

Chronic bronchitis describes a group of symptoms (including airway inflammation, over-production of phlegm, and cough), which can have various causes and are the result of repeated injury or irritation to the lungs.

  • Chronic bronchitis is not contagious if the cause is due to:
    • smoking,
    • air pollution, or
    • other inhaled irritants.
  • Chronic bronchitis is contagious if the cause is viral or bacterial infection.
Kid with bronchitis

Acute Bronchitis Symptoms

What are Causes and Symptoms of Acute Bronchitis?

Inflammation of the bronchial tubes narrows the inside opening of the bronchial tubes. Narrowing of the bronchial tubes result in increased resistance, this increase makes it more difficult for air to move to and from the lungs. This can cause:

  • wheezing,
  • coughing, and
  • shortness of breath.

Chronic Bronchitis Diagnosis

Health-care professionals diagnose chronic bronchitis on the basis of the patient's symptoms and physical examination. By definition, chronic bronchitis must persist for most days of the month, for at least three months, and at least two years in a row. A history of smoking is also pertinent in making the diagnosis.

  • Usually no blood tests are necessary.
  • If pneumonia is suspected, a chest X-ray may be ordered.
  • Oxygen saturation (how well oxygen is reaching the blood cells) may be measured by placing a sensor on the finger. This is referred to as pulse oximetry.
  • Pulmonary function testing by a pulmonologist may be helpful in diagnosing chronic bronchitis.
  • A microscopic examination and/or culture of a sample of phlegm may be obtained to look for a bacterial infection.

Chronic Bronchitis Self-Care and Home Remedies

  • Adequate fluid intake is important because fever causes the body to lose fluid faster. Lung secretions will be thinner and easier to clear when the patient is well hydrated.
  • A cool mist vaporizer or humidifier can help decrease bronchial irritation.
  • An over-the-counter (OTC) cough suppressant may be helpful. Preparations with guaifenesin (Robitussin, Breonesin, Mucinex) will loosen secretions; formulations with dextromethorphan (Benylin DM, Mucinex DM, Robitussin DM, Vicks 44) suppress cough.
  • Natural treatments and home remedies for chronic bronchitis include foods that have properties that reportedly reduce bronchitis symptoms. These foods include:
    • honey,
    • lemon,
    • ginger,
    • bay leaf, and
    • almonds.
  • Consult with a health-care professional before taking or using any natural remedies, and tell your health-care professional about all supplements and herbal remedies you use.

Chronic Bronchitis Medical Treatment

Treatment of chronic bronchitis can differ depending on the suspected cause. There is no cure for chronic bronchitis, and treatment is aimed at reducing symptoms and improving lung function.

  • Medications to help suppress the cough or loosen and clear secretions may be helpful. If the patient has severe coughing spells that cannot be controlled, a doctor may prescribe prescription-strength cough suppressants. In some cases, only these stronger cough suppressants can stop a vicious cycle of coughing which leads to more irritation of the bronchial tubes, which in turn causes more coughing.
  • Bronchodilator inhalers will help open airways and decrease wheezing.
  • Albuterol (Proventil, Ventolin) and/or ipratropium (Atrovent) nebulizer treatments may be recommended.
  • Corticosteroids may be prescribed to decrease the inflammation in the airways. These may be used as inhaled corticosteroids such as fluticasone (Flovent) and budesonide (Pulmicort), or taken orally such as prednisone and methylprednisolone (Medrol).
  • Though antibiotics play a limited role in treating chronic bronchitis, they become necessary in some situations.
    • If the doctor suspects a bacterial infection, antibiotics may be prescribed.
    • People with underlying chronic lung problems may also need to be treated with antibiotics.
  • In severe cases of chronic bronchitis, home oxygen may be necessary.
  • In rare cases, the patient may be hospitalized if they experience breathing difficulty that doesn't respond to treatment. This usually occurs because of a complication of chronic bronchitis, or in individuals with other underlying lung problems.

The affected individual should follow-up with their health-care professional regularly to monitor their chronic bronchitis, especially during flare-ups.
Call the doctor's office if any new problems or acute worsening of symptoms occur.

Chronic Bronchitis Prevention

  • Stop smoking.
  • The dangers of secondhand smoke are well documented. Children should never be exposed to secondhand smoke.
  • Avoid exposure to irritants. Proper protection in the workplace is vital to preventing exposure.
  • Avoiding long exposure to air pollution from heavy traffic may help prevent bronchitis.
  • Stay away from others you know have a cold or the flu.
  • Wash the hands frequently to prevent the spread of infection.

Chronic Bronchitis Prognosis

  • Chronic bronchitis can cause symptoms for prolonged periods.
  • In many cases, the symptoms of chronic bronchitis can be controlled with strict adherence to treatments recommended by your health-care professional.
  • Smoking cessation is a critical component in determining an individual's ultimate prognosis.
  • In some cases, the symptoms will progressively worsen and become debilitating from the repeated exacerbations of the disease.
  • Untreated or poorly managed chronic bronchitis can result in permanent and severe damage to the lungs.

When to Seek Medical Care for Chronic Bronchitis

When to call the doctor for chronic bronchitis

Chronic bronchitis can be diagnosed by your doctor. If you have been diagnosed with chronic bronchitis, see doctor if the following symptoms occur:

  • Increased shortness of breath
  • Chest pain with cough
  • Severe coughing that interferes with rest or sleep
  • Wheezing
  • Fever
  • Coughing up blood, rust-colored sputum, or an increased amount of green phlegm

When to go to the hospital for chronic bronchitis

Go to a hospital's emergency department immediately if the following symptoms occur:

  • Severe difficulty breathing with or without wheezing
  • Chest pain
Reviewed on 9/11/2017

REFERENCES:

COPD Foundation.

American Lung Association. Understanding Chronic Bronchitis.
<http://www.lung.org/lung-disease/bronchitis-chronic/understanding-chronic-bronchitis.html>

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