Chronic Bronchitis

What is chronic bronchitis?

Bronchitis is inflammation of the breathing tubes. These are the airways called bronchi. This inflammation causes too much mucus production and other changes. There are different types of bronchitis. But the most common are acute (short-term) and chronic (long-term).

Chronic bronchitis is long-term inflammation of the bronchi. It's common among smokers. People with chronic bronchitis tend to get lung infections more easily. They also may have episodes of acute bronchitis, when symptoms are worse due to a respiratory infection, such as a cold.

To be classified as chronic bronchitis:

• You must have a cough and mucus that lasts at least 3 months and happens multiple times over the course of at least 2 years.

• Other causes of symptoms, such as tuberculosis or other lung diseases, must be ruled out.

Chronic bronchitis is a form of chronic obstructive pulmonary disease (COPD). The other form of COPD is emphysema. Most people who smoke and have chronic breathing problems have some combination of chronic bronchitis and emphysema.

What causes chronic bronchitis?

Chronic bronchitis is not caused by a virus or bacteria. Most experts agree that the main cause of chronic bronchitis is cigarette smoking. Air pollution and your work environment may also play a role. This is especially true if you also smoke.

Bronchitis symptoms often happen with other lung diseases, such as:

• Asthma

• Pulmonary emphysema

• Scarring of the lungs (pulmonary fibrosis)

• Lung cancer

• Tuberculosis

• Upper respiratory infections

What are the symptoms of chronic bronchitis?

Below are the most common symptoms of chronic bronchitis. But each person may have slightly different symptoms.

Symptoms may include:

• Cough, often called a smoker’s cough

• Coughing up mucus or sputum (expectoration)

• Wheezing

• Chest discomfort

• Shortness of breath

People with chronic bronchitis often have a cough and make mucus for many years before they have shortness of breath.

Chronic bronchitis may cause:

• Disability

• Frequent and severe infections that affect your airways

• Narrowing and plugging of your breathing tubes (bronchi)

• Trouble breathing

Other symptoms may include:

• Bluish fingernails, lips, and skin because of lower oxygen levels

• Wheezing and crackling sounds with breathing

• Swollen feet

• Heart failure

The symptoms of chronic bronchitis may look like other lung conditions or health problems. See your healthcare provider for a diagnosis.

How is chronic bronchitis diagnosed?

Your healthcare provider will take a complete health history and do a physical exam. Your provider may order the following tests:

Pulmonary function tests

These tests help to measure the lungs’ ability to move air in and out of your lungs. The tests are often done with special machines that you breathe into. They may include:

Spirometry. This test uses a spirometer device to see how well your lungs are working. It's one of the simplest, most common pulmonary function tests. It may be used for any or all these reasons:

• To find out how well your lungs take in, hold, and move air

• To keep watch on a lung disease

• To see how well treatment is working

• To find out how serious your lung disease is

• To find out if your lung disease is restrictive or obstructive. Restrictive means less air will get into your lungs. Obstructive means less air will get out of your lungs.

Peak flow monitor.  This test measures the fastest speed you can blow air out of your lungs. Inflammation and mucus in the large airways in the lungs narrow the airways. This slows the speed of air leaving the lungs. It can be measured with a peak flow monitor. This measurement is very important in telling how well your disease is being controlled.

Arterial blood gas

This blood test is used to check the amount of oxygen and carbon dioxide in your blood. It also measures the acidity of your blood.

Pulse oximetry

An oximeter is a small machine that measures the amount of oxygen in your blood. To get this measurement, a small sensor is taped or clipped onto a finger or toe. When the machine is on, a small red light can be seen in the sensor. The sensor is painless, and the red light does not get hot.

Chest X-ray

This test makes pictures of your internal tissues, bones, and organs, including the lungs. It helps find out if you have other lung conditions or diseases.

CT scan

This imaging test uses a combination of X-rays and computer technology to make images of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

Other tests

You may have other tests, such as a blood test or sputum test, to check eosinophil levels. You may also have screening for a condition called alpha-1 antitrypsin deficiency (AATD).

How is chronic bronchitis treated?

Treatment for chronic bronchitis is aimed at treating the causes and symptoms. It may include:

• Steps to quit smoking if you smoke. If you smoke, quit. Smoking is the main cause of COPD. Quitting will help you be able to better manage your COPD. Don't use e-cigarettes or vaping products either. Ask your healthcare provider about ways to help you quit smoking.

• Ways to stay away from secondhand smoke and other lung irritants

• Medicines to take by mouth (oral) to open airways and help clear away mucus

• Inhaled medicines, such as bronchodilators and steroids. Always review and discuss how to use each device correctly with your healthcare provider.

• Oxygen from portable containers

• Lung volume reduction or bullectomy surgery to take out damaged areas of the lung

• A lung transplant

• Increase humidity in the air and an assessment for long-term oxygen therapy

• Ways to prevent lung infections. Ask your healthcare provider about getting a flu shot and pneumococcal vaccine.

• Pulmonary rehab to help you learn how to live with your breathing problems and stay active. Community-based and home-based programs work as well as hospital-based programs as long as they are held as often and are as intense. Standard home-based pulmonary rehab programs help with shortness of breath in people with COPD. Traditional, supervised pulmonary rehab is the best choice for people with COPD.

• Self-management program for you and your family

• Eating a healthy, balanced diet. This is important to staying as healthy as possible. So is trying to stay at your ideal weight. Being overweight or underweight can affect your health. Eat lots of fruits and vegetables every day. Also eat balanced portions of whole grains, lean meats and fish, and low-fat dairy products.

During each appointment, your healthcare provider will check how well you:

• Cope in your daily life. This may focus on supportive, palliative, or end-of-life care.

• Correctly use your inhaler, nebulizer, oxygen equipment, and other medicines. It's very important to use your inhaler or other devices correctly to best manage your COPD.

• Cope with other health conditions you have, the medicines you take for them, and how they affect managing your COPD.

Key points about chronic bronchitis

• Bronchitis is inflammation of the breathing tubes (bronchi). There are several types of bronchitis, but the most common are acute and chronic.

• Chronic bronchitis is a form of chronic obstructive pulmonary disease (COPD). This is a group of lung diseases that cause airflow blockage and breathing problems.

• The most important cause of chronic bronchitis is cigarette smoking. Air pollution and your work environment may also play a role. Stay away from both indoor and outdoor pollution. Indoor pollution includes burning wood, smoke from home cooking, or heating fuels. Outdoor pollution includes dusts, vapors, fumes, gases, and other chemicals.

• This condition causes a cough that’s often called smoker’s cough. It also causes you to cough up mucus, wheeze, and have chest discomfort. These may get worse over time and lead to severe breathing problems.

• Tests that help measure how well your lungs are working are used to diagnose chronic bronchitis. Blood, breathing, and imaging tests will determine how severe the problem is and watch it over time.

• Your vitamin D, hemoglobin, and hematocrit levels may be checked. You may also be screened for a condition called alpha-1 antitrypsin deficiency (AATD). 

• The goal of treatment is to live more comfortably by controlling symptoms. A key part of treatment is to quit smoking, including the use of e-cigarettes and vaping products. Remember that cold weather can trigger flare-ups.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your healthcare provider tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your healthcare provider gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your healthcare provider if you have questions.