What Is Chronic Bronchitis?
By definition, chronic bronchitis describes a productive cough lasting more than three months at a time and occurring at least two years in a row [1,2]. Chronic bronchitis is the less deadly but more bothersome side of the broader condition known as chronic obstructive pulmonary disease (COPD). Collectively, COPD is the fourth most common cause of death in the U.S. .
Treatment begins with pulmonary rehabilitation and inhaled medications to open up the obstructed airways, then often progresses to oxygen therapy or occasionally lung transplant. Unfortunately, available treatments cannot cure or reverse COPD; the only effective way to slow its progression is to quit smoking [1,2,5].
You should visit your primary care physician to discuss your symptoms. Treatment often involves prescription inhaler medication.
How common is chronic bronchitis?
Symptoms that always occur with chronic bronchitis:
Symptoms that never occur with chronic bronchitis:
- Nausea or vomiting
Chronic bronchitis is also known as
- Chronic obstructive pulmonary disease: Or COPD, an umbrella term combining chronic bronchitis and emphysema
Chronic Bronchitis Symptoms
By definition, chronic bronchitis is characterized by prolonged bouts of coughing with significant mucus production. Specifically, the diagnosis requires a productive cough that lasts more than three months at a time for at least two consecutive years [1-3].
In addition to a cough and mucus production that define chronic bronchitis, several other symptoms are commonly seen. These include the following [1,2,4].
- Shortness of breath
- Difficulty with physical tasks such as climbing stairs
Chronic Bronchitis Causes
Cigarette smoking is by far the predominant cause of chronic bronchitis [1,2,4]. Usually, chronic bronchitis does not develop for several decades, generally after smoking for 30 years or more.
Who is at a higher risk
Chronic bronchitis can occur sooner in particularly heavy smokers or those with other risk factors. Anyone with asthma, allergies or gastroesophageal reflux disease (GERD) is at higher risk of developing chronic bronchitis. Chronic bronchitis is also more common in women, older smokers, and those with family or personal history of lung disease [1,2,4].
Long-term exposure to chemicals or toxins
While cigarette smoking is the most common cause of chronic bronchitis, broadly speaking it can be caused by long-standing exposure to a variety of toxic and irritating substances. Aside from cigarettes, chronic inhalation of chemical fumes or noxious dust can have a similar effect. These things are less likely to cause chronic bronchitis on their own but can often accelerate its development in cigarette smokers. In some cases, prolonged exposure to toxic fumes at home (such as from a poorly ventilated cooking fire) or in the workplace (such as industrial chemicals) can be enough to cause chronic bronchitis without any history of smoking [1,2,4,5].
Chronic bronchitis, in general, is caused by exposure to cigarette smoke or other toxic fumes, but episodes of acute exacerbation are usually due to respiratory infections. Sometimes these infections are caused by viruses such as the flu. Other times they are caused by bacteria like Streptococcus pneumoniae and Pseudomonas.
Treatment Options and Prevention for Chronic Bronchitis
Smoking cessation remains the single most important thing that can be done to treat chronic bronchitis [1,2,4,5]. While other treatments can help relieve the symptoms of chronic bronchitis, the only way to stop the disease from progressing is to eliminate the toxic exposures which caused it.
Pulmonary rehabilitation is another important tool to help manage COPD, including chronic bronchitis. It consists of exercises and breathing techniques, such as pursed-lip breathing, which can help make it easier to breathe and better control your symptoms. Pulmonary rehabilitation also often involves nutritional and other lifestyle counseling as part of a holistic approach to COPD management [1,2,4-6].
Bronchodilators and steroids
The main group of medications used to manage chronic bronchitis are known as bronchodilators. These are medications which act to open up the airway and make it easier to breathe. Most are inhaled, either through an inhaler or a nebulizer, though a few of the less commonly used agents come in pill form. Perhaps the single most commonly used bronchodilator is albuterol (Ventolin, Proair). Albuterol works rapidly to open up airways and provide immediate relief, but the effects are short-lived. It should not be used more than a few times a day. If you find yourself using albuterol frequently, it is time to see your doctor about improving your long-term regimen [1,2,4,5].
Long-term bronchodilators come in a variety of formulations and combinations. In most cases, multiple medications are used in conjunction to maximize efficacy. Typically this will include one anticholinergic agent such as tiotropium (Spiriva) and one beta-agonist agent such as salmeterol (Serevent) .
Alongside bronchodilators, steroid medications are often used to reduce inflammation in chronic bronchitis. The inhaled forms are commonly used in combination with bronchodilators as part of long-term COPD management. Examples include the combination of budesonide and formoterol (sold as Symbicort) and the combination of fluticasone and salmeterol (sold as Advair) . During acute exacerbations, your doctor may prescribe a course of steroid pills such as methylprednisolone (Medrol) or prednisone. These medications are very effective at reducing inflammation, but they can cause some important side effects, particularly when taken as a pill or an intravenous solution. That’s why it is important to only use them as recommended [1,2,4,5].
For the most part, antibiotics are an important part of managing acute exacerbations of chronic bronchitis but typically do not help as a regular treatment for stable chronic bronchitis [1,2,4,5]. That is because infections are the main cause of acute exacerbations but do not cause the underlying disease. Giving antibiotics when they are not needed runs the risk of potentially serious side effects. Perhaps most importantly, frequent use of antibiotics increases the chance of developing resistant bacteria, a particularly important problem for those with chronic bronchitis. Because lung infections are so common in chronic bronchitis, it is vital to save antibiotics for when they are really needed. If they are overused, resistant bacteria develop and we can find ourselves with nothing left in our toolkit when we need it most.
One possible exception is a specific subset of advanced chronic bronchitis where infections are so frequent and severe that antibiotics may be needed even outside of acute exacerbations. This use of prophylactic antibiotics, given even when there’s no clear infection, is highly controversial and remains a subject of ongoing research. For now, most research suggests that prophylactic antibiotics are not helpful or appropriate in the majority of cases .
Advanced interventions (long-term oxygen and surgery)
For those with severe chronic bronchitis that has been difficult to manage, several advanced interventions may be considered. Long-term oxygen therapy, surgery or even lung transplant can be beneficial in certain cases. That said, they are not for everyone and can do more harm than good if used inappropriately [1,2,4,5].
Oxygen therapy is often used in the short-term to alleviate exacerbations, but long-term oxygen therapy is only appropriate for those who have consistently low oxygen levels. This is because using oxygen when it is not required can actually interfere with the normal transfer of oxygen through healthy lung tissue [2,5].
Surgery for advanced COPD can include removal of damaged lung, placement of valves to redirect airflow or even transplantation of one or both lungs. The evaluation of who would benefit from which surgery is beyond the scope of this article; suffice it to say that surgery is not for everyone and should be carefully discussed with your medical team on a case-by-case basis .
Chronic bronchitis can be prevented by avoiding the toxic fumes and inhaled irritants which cause it. As described above, the most important step would be not smoking. For those who already smoke tobacco, quitting offers the greatest health benefits but even cutting down can significantly reduce the chance of developing diseases like chronic bronchitis.
In addition to not smoking, avoidance of other toxic fumes and dust can reduce the risk of developing chronic bronchitis. In industrialized territories such as North America and Europe, those kinds of exposures occur primarily in the workplace. Anyone working with potentially toxic chemicals (such as paints, solvents, etc.) should wear appropriate protective gear. If you are concerned about potential workplace exposures, it is important to speak with your employer about any hazardous conditions. In less developed areas including much of Asia and Africa, indoor cooking fires represent a major source of potential exposure to toxic fumes. It is important to ensure that cooking fires are well ventilated and that those in the household are not inhaling potentially harmful smoke or fumes [1,2,4].
If you have already been diagnosed with chronic bronchitis
For those already diagnosed with chronic bronchitis, hand hygiene and vaccination are the best things you can do to prevent exacerbations (apart from quitting smoking). As described above, exacerbations of chronic bronchitis result mainly from respiratory infections. Thankfully, some of these infections can be prevented with vaccines, which is why it’s particularly important for those with chronic bronchitis (or other respiratory diseases) to get their pneumonia vaccines and their annual flu shot. These infections may seem commonplace but they kill many, many people every year and are particularly dangerous to anyone with underlying diseases like chronic bronchitis [1,3-5]. Vaccination is never a perfect solution, but it is the best chance we have at preventing these deadly infections. Be sure to ask your doctor about which vaccinations can help protect you.
When to Seek Further Consultation for Chronic Bronchitis
While most cases of bronchitis are short-lived and resolve on their own, chronic bronchitis by definition lasts for months on end. Anyone who has had persistent coughing or difficulty breathing for more an extended period of time would be wise to see their doctor about those symptoms. The same is true for anyone who is coughing up very large quantities of phlegm or coughing up sputum of abnormal color or consistency.
If you have been diagnosed with chronic bronchitis
For those who have been diagnosed with chronic bronchitis, it is important to follow up regularly with your medical team. This is particularly true during periods of worsening symptoms since these acute exacerbations often require antibiotics or other additions to your regular treatment regimen.
If you are trying to quit smoking
It’s also always worth talking to your doctor about any tobacco use and things that can help you quit smoking. Even cutting down can significantly decrease the health risks that smoking imposes. Not only is it the only way to slow diseases like chronic bronchitis, quitting smoking is often the single most important things you can do to live a longer, healthier life.
Questions Your Doctor May Ask to Determine Chronic Bronchitis
To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.
- Any fever today or during the last week?
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
- Does your cough produce phlegm?
- Have you experienced any nausea?
- Do you currently smoke?
The above questions are also covered by our A.I. Health Assistant.
- Bronchitis. National Heart, Lung, and Blood Institute. NHLBI Link
- Chronic obstructive pulmonary disease (COPD). U.S. National Library of Medicine: MedlinePlus. MedlinePlus Link
- Chronic Obstructive Pulmonary Disease (COPD) Includes: Chronic Bronchitis and Emphysema. Centers for Disease Control and Prevention. Updated May 3, 2017. CDC Link
- Chronic Bronchitis. American Academy of Family Physicians: Familydoctor.org. Updated June 6, 2017. Familydoctor.org Link
- Chronic Obstructive Pulmonary Disease: Diagnosis and Management. Am Fam Physician. 2017 Apr 1;95(7):433-441. AAFP Link
- Pulmonary Rehabilitation. U.S. National Library of Medicine: MedlinePlus Link. Updated Dec. 28, 2018. MedlinePlus Link