Lung Disorder - Chronic Bronchitis

What is Bronchitis?

  • Bronchitis is an inflammatory condition that can involve the air passages starting from the nose to the terminal airways of the lung. Bronchitis can either be acute (short duration) or chronic (long duration).

What is the Difference Between Acute and Chronic Bronchitis?

  • Acute bronchitis is usually caused by a virus, but bacterial infections can also be a cause. Patients with acute bronchitis can usually heal without serious complications. Chronic bronchitis is a serious progressive lung disease that can be controlled but not cured.
  • Acute bronchitis is more common in the winter and can be accompanied by a secondary bacterial infection. Acute bronchitis usually resolves in two weeks, but a lingering cough is quite common. Many patients are prone to a pneumonia after developing acute bronchitis.
  • Infants, young children and the elderly are all susceptible to acute bronchitis. Smokers, patients with chronic lung or heart conditions, people with immune deficiency disorders or even people exposed to high levels of chemicals or pollution are at higher risk of developing acute bronchitis.
  • Chronic bronchitis is a progressive lung disease that is usually caused by tobacco smoke. Chronic bronchitis is not a curable disease. The inflammatory changes in the lung result in a patient having excessive amounts of phlegm production that is difficult to stop.
  • Chronic bronchitis usually occurs in middle-aged to older people.
  • Chronic bronchitis is one of the three diseases (the other two are emphysema and chronic asthma) associated with COPD (Chronic Obstructive Pulmonary Disease).

What is Chronic Bronchitis?

  • Chronic bronchitis is an inflammatory condition that results in excessive production of mucus in the large or main bronchial air passages resulting in reduced airflow and shortness of breath.
  • Chronic bronchitis is a major cause of disability and death throughout the world. In the United States, the American Lung Association estimates that 14 million Americans have this disorder.
  • Smoking is the main cause of chronic bronchitis.
  • Chronic bronchitis is defined by productive (producing phlegm) cough for three months in two consecutive years without any other medical cause. Many patients are told they have a “smoker’s cough” since it usually is worse in the morning hours. Unfortunately, with time, the cough will persist and last throughout the day.
  • Chronic bronchitis can also occur with emphysema and is difficult for your physician or healthcare provider to tell them apart.
  • In chronic bronchitis, the early stages affect only the large airways. In time, eventually the whole bronchial tree is affected.
  • If the disease progresses, patients have greater difficulty getting oxygen and develop shortness of breath. As the pulmonary system gets further, taxed patients go on to develop right-sided heart failure called cor pulmonale.
  • Patients with chronic bronchitis are at greater risk for developing infections. These infections are notoriously more difficult to treat due to the thick mucus in these patients lungs.
  • Patients who develop infections must immediately contact their physician, because if left untreated, these patients are prone to severe infections resulting in hospitalizations and even long stays in an intensive care unit.
  • Patients with this condition go on to develop thick mucus secretions resulting in great difficulty in clearing the mucus from their airways. This thick mucus damages the small hair- like projections in the lung called cilia. Impaired cilia leads to poor mucus clearing (mucociliary clearance) and prevents adequate lung defense against airborne particles and bacterial infections.
  • There is no known cure for this condition. Treatment is aimed at: stopping smoking and medical treatment to relieve symptoms of cough, shortness of breath and infections.

How to Diagnose Bronchitis?

  • First, a detailed medical history is obtained by your doctor who will focus on the time of onset of symptoms and the quality and duration of your productive cough. Next, the physician will listen with a stethoscope, looking for signs of inflammation such as wheezes or other sounds in your chest.
  • A sputum sample may be asked for if the phlegm is discolored (green) or bloody. This specimen is then cultured to see which antibiotic would be most appropriate. Results are usually available in 2-3 days, however, in the case of tuberculosis, the results may take as long as 8 weeks.
  • A chest x-ray may be obtained more to rule out pneumonia rather than to diagnose either acute or chronic bronchitis. A diagnosis of either acute or chronic bronchitis is rarely made by x-ray.
  • A critical test in the diagnosis of chronic bronchitis is the PFT or Pulmonary Function Test. This is a test that uses a spirometer. This is a computerized device that can measure a patient’s volume of air a patient can inhale or exhale during a few seconds. This is a painless non-invasive test done in a doctor’s office. Measurements below 80% predicted of normals matched for age, height, gender and race indicate an obstructive lung disease.

How Do You Treat Acute Bronchitis?

  • Acute bronchitis can be treated just like the common cold as long as there is no evidence of respiratory distress or secondary bacterial infection. The use of fluids, acetaminophen, humidification (cold or warm), rest and OTC antitussives (cough suppressants) are all helpful. Aspirin in children must be avoided due to the risk of Reye’s syndrome. Cough suppressants should only be used if the cough is non-productive.
  • Expectorants are cough medicines that do not suppress cough but are used to thin the mucus in the lungs. This is done to help the patient clear the mucus that is difficult to dislodge from the lung.
  • If a secondary bacterial infection is present, an antibiotic is usually prescribed.
  • Unfortunately, in the last few years the incidence of drug resistance has been rising in the world and in the United States. Different geographic areas of the United States have differing rates of resistance to the common bacterial infections usually infecting patients. Streptococcus pneumoniae (Strep.) is the most common organism that infects patients with acute bronchitis. The resistance of Strep. is becoming alarming since this bacterium, until recently, was very susceptible to Penicillin.
  • Common antibiotics used for acute bronchitis in adults are:(1)Tetracycline, (2)Penicillin or its derivatives, (3) Trimethoprim/sulfamethozaxole (Bactrim® or Septra®), (4) Erythromycin-like drugs, azithromycin (Zithromax®), clarithromycin (Biaxin®), (5) Quinnolones (Avelox®), (Levaquin®). Children cannot be given tetracycline or quinolones because of potential serious side effects.
  • Children are usually treated with amoxicillin (Amoxil, Sumox, Trimox, Pentamox). Other antibiotics are given if the child has a history of drug allergy to Penicillin.

How Do You Treat Chronic Bronchitis?

  • Chronic bronchitis is significantly more challenging to treat compared to acute bronchitis.
  • Treatment of chronic bronchitis depends on the stage of the disease.
  • There are published guidelines that help to stage a patient and guide appropriate therapy. This is best done under the careful eye of your doctor and health professional. The very first step is a change in lifestyle. This means immediately quitting smoking. This is the most effective change that can make a long and short-term difference in the quality and life expectancy of a patient. Unfortunately, it is by far the hardest step for a patient to make when given the diagnosis of chronic bronchitis.

Drug Therapy For Chronic Bronchitis

  • Prescription medications come in two main varieties: (1) Bronchodilators and (2) Steroids.
  • Bronchodilators are drugs that relax the smooth muscles that encircle the bronchial tube, allowing for increased air to flow. Bronchodilators are available in: (1) Pll form, (2) Metered-dose inhaler (MDI), (3) Small Volume Nebulizer (SVN) and Dry Powder Inhaler (DPI) {for more detailed information see asthma section of website}.
  • All of the guidelines (Both United States and European) recommend using a spacer/holding chamber to help coordinate inhaling a steroid metered-dose inhaler correctly.
  • All MDI’s in  2012 (including Primatene Mist®) will be formulated with HFA (Hydrofluoroalkane) gas because of the Montreal Protocol signed by over 180 countries. Originally, all MDI’s were formulated with CFC’s (Chloroflurocarbons) which contributed to the depletion of atmospheric ozone. Al new MDI’s are formulated with HFA  which will not deplete the atmosphere of ozone. An added feature of HFA formulated MDI’s is that they produce a finer airspray, allowing more medication to travel deeper into the lung.
  • Steroids are anti-inflammatory drugs. Steroids have been shown to help patients with acute attacks or exacerbations. Long-term therapy with steroids does not alter the course of chronic bronchitis. Short bursts of steroids in oral form have been shown to be most effective in controlling the inflammation during an acute illness or an exacerbation.
  • Oral steroids taken over long peroids of time have serious side effects. Be sure to ask your doctor or healthcare professional about these long-term side effects. Inhaled steroids have a safer profile compared to the more serious side effects of oral steroids.
  • As chronic bronchitis progresses, a patient may require supplemental oxygen.
  • Chronic bronchitis may progress to the point of respiratory failure. Lung volume reduction surgery is now an option for certain patients who are in the last stages of disease. Please ask your doctor if you are a candidate for this procedure.

What is the Prognosis of Patients with Emphysema?

  • If a patient fails to stop smoking, the prognosis is often very poor. This is a chronic disease that cannot be reversed or cured. If a patient immediately stops smoking, progression of disease is often slowed.
  • Complications of emphysema include acute bronchitis and pneumonia. Many patients fail to be properly vaccinated and this alone can improve survival.
  • The prognosis of patients diagnosed with emphysema is usually poor, especially if left untreated. The overall medical survival rate for all COPD patients has been estimated at approximately four years and even less with a diagnosis of emphysema. However, individual cases differ and many patients live longer if they: stop smoking, begin better nutrition, start exercising and follow the recommendations of their doctors or healthcare professionals.