Chronic Bronchitis: Causes, Symptoms and Treatment

Chronic bronchitis is one of the two main types of COPD (chronic obstructive pulmonary disease), a group of lung diseases that make breathing hard and get worse over time; the other is emphysema. Most people with COPD have both, in differing degrees.

In chronic bronchitis, the bronchial tubes, the airways that carry air to and from the air sacs of the lungs, are inflamed (swollen) and irritated, and mucus builds up in them. The swelling and mucus make it harder for the lungs to take in oxygen and get rid of carbon dioxide.

Causes and risk

It is usually caused by long-term exposure to irritants that damage the lungs and airways. In the United States, the main cause is cigarette smoke. Pipe, cigar and other tobacco smoke can cause it too, especially if inhaled, and secondhand smoke, air pollution, and chemical fumes or dusts at home or work can contribute. Rarely, a genetic condition called alpha-1 antitrypsin deficiency plays a part.

Risk factors include:

• smoking, the main one: up to 75% of people with chronic bronchitis smoke or used to smoke
• long-term exposure to other lung irritants
• age: most people are at least 40 when symptoms start
• genetics, including alpha-1 antitrypsin deficiency; smokers with a family history of COPD are also more likely to develop it

Symptoms

At first there may be no symptoms, or only mild ones, but they usually worsen as the disease progresses:

• frequent coughing, or a cough that brings up a lot of mucus
• wheezing, a whistling or squeaky sound when breathing
• shortness of breath, especially during physical activity
• chest tightness

Some people get frequent respiratory infections such as colds and flu. In severe cases, chronic bronchitis can cause weight loss, weakness in the lower muscles, and swelling of the ankles, feet or legs.

Diagnosis

A provider will take a medical and family history and may order lung function tests, a chest x-ray or CT scan, and blood tests.

Treatment

There is no cure, but treatment can ease symptoms, slow the disease, help people stay active, and prevent or treat complications.

• Lifestyle changes. Quitting smoking is the most important step. Avoid secondhand smoke and other lung irritants, ask a provider for an eating plan that meets your needs, and ask how much physical activity is safe; activity strengthens the muscles used for breathing.
• Medicines. Bronchodilators relax the muscles around the airways, opening them and easing breathing; most are inhaled, and in more severe cases the inhaler may also contain steroids to reduce inflammation.
• Vaccines against flu and pneumococcal pneumonia, since people with chronic bronchitis are at higher risk of serious complications.
• Antibiotics, if you get a lung infection.
• Oxygen therapy, for severe disease with low blood oxygen, all the time or only at certain times.
• Pulmonary rehabilitation, a program for people with chronic breathing problems that may include exercise, disease management training, nutrition counseling and psychological counseling.
• A lung transplant, as a last resort for severe symptoms that medicines have not helped.

When to get help

Get emergency care for severe symptoms, such as trouble catching your breath or talking. Call your provider if symptoms are getting worse or you have signs of infection, such as a fever.

Prevention

Because smoking causes most cases, the best prevention is not to smoke, and to avoid lung irritants such as secondhand smoke, air pollution, chemical fumes and dust.

Sources

• MedlinePlus (National Library of Medicine), "Chronic Bronchitis," from the National Heart, Lung, and Blood Institute. https://medlineplus.gov/chronicbronchitis.html