Chronic Bronchitis

Chronic bronchitis is a long-term condition causing inflammation and irritation of the bronchial tubes – the airways through which air passes to and from the lungs. People with chronic bronchitis will typically experience a persistent cough that will often bring up mucus. Other symptoms include fatigue, wheezing and shortness of breath. 1

Chronic bronchitis is differentiated from acute bronchitis by its persistent nature. Acute bronchitis – which shares the same symptoms as chronic bronchitis – is a short-term condition that typically fades in two to three weeks, whereas chronic bronchitis is a permanent or constantly recurring condition, most often caused by smoking or the inhalation of irritants or dust.

According to the World Health Organisation (WHO), bronchitis can be classified as chronic if it affects a person in two consecutive years, over a duration of at least three months each time. Although chronic bronchitis cannot be cured, treatment options are available to manage the condition. 2

If you are concerned that you may have chronic bronchitis, try using the Ada app to find out what the problem is.

People with chronic bronchitis, emphysema, or both, are said to have chronic obstructive pulmonary disease (COPD). The condition makes it difficult for the lungs to take in air and expel it while breathing, due to the narrowing or obstruction of the airways. COPD is usually caused by smoking. 3

A cough and the production of mucus are the principal symptoms of chronic bronchitis. The severity of the coughing and the amount of mucus produced will differ from person to person, but these symptoms will generally persist for a minimum of three months at a time. Mucus, which is brought up when coughing, may be blood-tinged. Nasal mucus can vary in color, and can be green, yellow or clear. Often, mucus production will be at its height early in the day. 4

Other symptoms of chronic bronchitis include:

• Nasal congestion
• Shortness of breath (dyspnea)
• Wheezing
• Sore throat
• Fatigue
• Headaches
• Muscle aches

The symptoms of chronic bronchitis can on occasion become exacerbated. If this occurs, symptoms will include:

• Severe coughing and chest pain
• Blue or grey skin discolouration, typically under the nails
• High fever

If you are concerned that you may have chronic bronchitis, try using the Ada app to find out what the problem is.

To prevent damage to the lungs, it is important to seek medical attention if chronic bronchitis is suspected. Contact a doctor if the following symptoms occur: 5

• Symptoms persist for three weeks or longer
• The condition is disturbing sleep
• Fever is 100.4 F/38 °C or above
• Mucus is discoloured
• Wheezing or shortness of breath occurs

Always consult a doctor if there is blood present in mucus; this can be an indication of other serious conditions, such as lung cancer.

Chronic bronchitis is caused by smoking in the majority of cases. Smoking can cause severe damage to the cilia – the tiny hairs that protect the lungs against germs and mucus – leading to repeated bouts of mucus buildup, as well as inflammation and irritation of the bronchial tubes. The longer an individual has smoked, the more severe the condition is likely to be. In some cases, chronic bronchitis can be caused by continual exposure to secondhand smoke.

Less commonly, chronic bronchitis can also be triggered by the inhalation of irritants such as air pollution, chemical fumes or toxic gas. Repeated exposure to such irritants increases the chances of developing the condition. People with certain underlying conditions, e.g. asthma or cystic fibrosis, as well as those with a genetic predisposition, are more likely to develop the chronic bronchitis. 6

The symptoms of chronic and acute bronchitis are very similar, yet their causes and prognoses are quite different.

In most cases, the chronic form of the condition is brought about by smoking or exposure to irritants and is permanent. Acute bronchitis, however, is a relatively non-serious and short-term condition that typically develops out of a common cold or the flu and which normally fades within two to three weeks. 7

Read more about Acute Bronchitis »

In order to diagnose chronic bronchitis, a doctor will typically begin by inquiring about the symptoms a person is experiencing and performing a full physical examination. For further confirmation, a number of tests may also be ordered. These include: 8

• Pulmonary Function Test (PFT): A series of tests to measure lung volume, capacity and other functions that gives doctors a rounded picture of lung health.
• Chest X-ray: Useful in diagnosing chronic bronchitis and other lung conditions.
• Sputum examination: Sputum, or mucus, can be tested to determine the cause of mucus buildup.
• High Resolution Computed Tomography (HRCT): A type of CT scan that allows doctors to image the lungs.

If you are concerned that you may have chronic bronchitis, try using the Ada app to find out what the problem is.

There is no cure for chronic bronchitis – it can, however, have its symptoms managed effectively through a combination of medical treatments and lifestyle changes. 9

A number of medications are available to help manage chronic bronchitis, by treating the symptoms. The chosen treatment route will depend on the severity of the condition.

• Bronchodilator: A medicinal substance breathed in through an inhaler which helps open up the bronchial tubes and aids breathing.
• Theophylline: Particularly useful for treating shortness of breath, this oral medication relaxes the muscles in the airways in order to help with breathing. Usually, this is only used under direct medical supervision, in a clinical setting.
• Steroids: Corticosteroids help bring bring many of the condition’s symptoms under control, specifically by reducing both mucus production and the inflammation of the bronchial tubes.

There are a number of lifestyle changes that can be made to help manage chronic bronchitis, including:

• Quitting smoking: Smoking is the leading cause of chronic bronchitis and can help aggravate its symptoms. See below for further information.
• Avoiding irritants: Those who live in areas with high levels of air pollution, or those who come into regular contact with other airborne irritants should wear a mask or take other steps to avoid them.
• Use a humidifier: Regular exposure to warm, moist air from a humidifier can be helpful in managing symptoms.
• Exercise: Ideally for at least 30 minutes, three days per week. Exercise can help strengthen the muscles used to breathe.

Those experiencing chronic bronchitis may also benefit from pulmonary rehabilitation (PR), a program designed to help improve the overall well-being of those with respiratory problems. Typically, the program will involve exercise training, nutritional education, breathing strategies and counselling. 10

Quitting smoking is often a very difficult process, but it is vital for treating, as well as preventing, chronic bronchitis.

The first step in quitting smoking should be a consultation with a doctor or healthcare provider who will be able to outline the best way to quit, taking into consideration a person’s individual needs and medical history. 11

A combination of behavioral changes and medication is often the most effective way of quitting. Behavioral changes include avoiding situations in which you are around people smoking, or situations in which you would typically smoke yourself, as well as taking steps to avoid stress, such as taking up a new exercise regimen. Learning to recognise cravings and devising methods of counteracting them may also be useful. 11

Several medications are available to aid people in nicotine withdrawal. Some of these are available over the counter, others may require a prescription from a doctor. The overarching name for this method of treatment is nicotine replacement therapy. Medication is available in a variety of forms, including patches, gum and lozenges, and can be effective in reducing the intensity of cravings and gradually weaning people off their addiction to nicotine. 11

Chronic bronchitis cannot always be avoided. However, taking certain steps will lessen a person’s chances of developing the condition. These include: 12

• Stopping or never starting smoking: Ideally, smoking should be avoided completely. Those who have already started should stop.
• Wearing a mask: Avoid irritants in the air by wearing a mask when outdoors.
• Controlling asthma: Managing the symptoms of asthma may be useful in avoiding chronic bronchitis.

Complications associated with chronic bronchitis include: 13

• Dyspnea: shortness of breath
• Pneumonia: an inflammatory condition of the lungs
• Respiratory failure: the inadequate intake of oxygen and exhalation of carbon dioxide in the respiratory system
• Cor pulmonale: failure of the right side of the heart
• Pneumothorax: a collapsed lung
• Polycythemia: increased levels of red blood cells
• Emphysema: a long-term, chronic condition affecting the function of the air sacs in the lungs

Proactively managing the condition can be effective in reducing the risk of complications arising.

Chronic bronchitis is a progressive condition, meaning it gradually worsens over time. There is no cure, but the prognosis can be significantly improved through managing the condition via medication and lifestyle changes. However, in cases where an individual continues to smoke, where there is a considerable drop in lung function or where complications occur, the prognosis is generally poor, with patients typically given a life expectancy of five years or under. 14

Q: Is chronic bronchitis contagious?
A: Chronic bronchitis is not contagious – it is principally caused by smoking or exposure to irritants, meaning that it cannot be passed from person to person. 15

Q: What is the difference between chronic bronchitis and emphysema?
A: Chronic bronchitis and emphysema are both types of obstructive pulmonary disease – an umbrella term for lung conditions that affect a person’s ability to breathe. Though the symptoms of each are similar, the way they affect the lungs is significantly different. Emphysema is a condition in which the alveoli (air sacs) in the lungs become distended and thereby deteriorate, whereas chronic bronchitis is a long-term inflammation of the lungs. 16

Q: How can I tell if my cough is caused by chronic bronchitis?
A: A cough caused by chronic bronchitis can typically be differentiated from a cough caused by another condition by its duration and the other symptoms that accompany it. A chronic bronchitis cough will typically persist for at least three months and be accompanied by the bringing up of mucus, which may contain traces of blood and be green, yellow or clear in color.

Q: Is chronic bronchitis linked to lung cancer?
A: Research suggests that chronic bronchitis is associated with a higher risk of developing lung cancer. Although the exact reason behind this is not completely clear, cigarette smoking is thought to play a role. 17