Chronic Bronchitis

There are two types of bronchitis -- acute bronchitis and chronic bronchitis. Acute bronchitis usually appears after a respiratory infection, such as a cold, and can be caused by either a virus or bacteria. Chronic bronchitis does not have a sudden onset and is most frequently caused by long term irritation of the bronchial tubes. A case if bronchitis is considered chronic if symptoms continue for three months or longer.

Click for Larger ImageChronic bronchitis is an inflammation, or irritation, of the airways in the lungs. Airways are the tubes in your lungs that air passes through. They are also called bronchial tubes. When the airways are irritated, thick mucus forms in them. The mucus plugs up the airways and makes it hard for you to get air into your lungs. Symptoms of chronic bronchitis include a cough that produces mucus (sometimes called sputum), trouble breathing and a feeling of tightness in your chest. Bronchitis caused by allergies can also be classified as chronic bronchitis.

Asthma is sometimes under diagnosed, especially in children under 5 years old. Their asthma is sometimes labeled as chronic bronchitis or wheezy bronchitis. Although not all wheezes and coughs are caused by asthma, asthma should be considered whenever there is episodic, chronic, or recurrent cough or wheezing without a clear reason -- especially in children.

 What Causes Chronic Bronchitis?

Cigarette smoking is the main cause of chronic bronchitis. The more a person smokes, the more likely it becomes that the person will get bronchitis and that the bronchitis will be severe. When tobacco smoke is inhaled into the lungs, it irritates the airways and they produce mucus. People who have been exposed for a long time to other things that irritate their lungs, such as chemical fumes, dust and other substances, can also get chronic bronchitis. Secondhand smoke may also cause chronic bronchitis. Air pollution, infection, and allergies make chronic bronchitis worse.

 Click for Larger ImageSymptoms

The first noticeable symptom of chronic bronchitis is a persistent, mucus-producing cough. In its early stages, chronic bronchitis has few symptoms. It often begins with a recurring morning cough that brings up mucus from the lungs (phlegm). Smokers often dismiss this cough as a smoker's cough. Many people also complain of postnasal drip or sinus congestion, a bad taste in their mouth, or bad breath (halitosis). As time passes, the amount of phlegm gradually increases and coughing continues throughout the day.

Narrowing of the airways due to inflammation, coupled with increased mucus in the lungs, leads to shortness of breath that worsens over time. This shortness of breath may be accompanied by episodes of wheezing, which is a raspy, whistle-like sound heard with breathing. Wheezing occurs when air moves through the narrowed air passages in the lungs. The wheezing and shortness of breath of chronic bronchitis often occur or worsen with exertion.

In the later stages of the disease, chronic bronchitis may cause the skin and lips to develop a bluish tinge due to a lack of oxygen in the blood. Lack of oxygen in the blood, coupled with the increased work it takes to breathe through obstructed air passages, can cause a person to tire easily with even small amounts of activity.

Swelling in the ankles and legs, and sometimes swelling in the abdomen, may occur in advanced chronic bronchitis. This happens because blood vessels narrow (constrict) to try and divert blood to less damaged areas of the lungs where more oxygen is available. This constriction can lead to high blood pressure in the lungs (pulmonary hypertension). Pulmonary hypertension causes the right side of the heart to work harder than it should. Eventually, that side of the heart may not be able to keep up with the workload. This is called right heart failure, or cor pulmonale. Right heart failure may cause blood to back up in the liver, intestines, and legs. This may cause swelling in the ankles, legs, and abdomen. High blood pressure and chest pain may also occur.

A sudden worsening of chronic bronchitis is called an exacerbation. Symptoms of an exacerbation include coughing up more mucus or mucus that is a different color than usual, as well as increased shortness of breath. Viral infections are the most common trigger of an exacerbation of chronic bronchitis. When chronic bronchitis is in its later stages, even a mild cold can trigger a severe worsening of symptoms. Exacerbations of chronic bronchitis can make it hard for you to breathe. If you cannot get your breath, begin to wear out from the effort it takes to breathe, become confused, or have a new or worsening dusky tint of the skin of your fingers or mouth, seek medical attention immediately.

 Treatment

Specific treatment for chronic bronchitis will be determined by your physician based on:

  • Your age, overall health, and medical history
  • Extent of the disease
  • Your tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Your opinion or preference

Treatment may include:

  • Oral medications
  • Bronchodilators for inhaled medications
  • Oxygen supplementation from portable containers
  • Lung reduction surgery to remove damaged area of lung
  • Lung transplantation

The main way to treat chronic bronchitis is to avoid the irritant that is causing the illness. For allergy-induced bronchitis, this means removing the allergens from the home or work environment. For smokers, this means quitting smoking.

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