Bronchitis

What Is Bronchitis?

Bronchitis is an inflammation of the bronchial tubes, or bronchi, that bring air into the lungs. Inflammation is a chemical reaction in the body that produces redness, swelling, and pain.

Bronchitis can be caused by:

• Viruses
• Bacteria
• Smoking
• Breathing in certain kinds of irritating chemicals

When the cells lining the bronchi are irritated, the tiny hairs (cilia) that normally trap and eliminate things from the outside stop working. Formation of material associated with irritation (inflammation) also increases; causing the passages to become clogged.

There is currently no cure for chronic bronchitis. Most treatment is focused on making the symptoms less severe and trying to prevent further damage.

Types Of Bronchitis

There are two types of bronchitis:

• Acute bronchitis usually lasts only a few days. It is often caused by a viral infection and may begin after you develop a cold or sore throat. It usually produces no long-lasting, harmful effects.
• Chronic bronchitis is diagnosed when a person has too much phlegm in the airways, which leads to a persistent, productive cough. An individual is considered to have chronic bronchitis if cough and sputum (matter that is coughed up from the lungs) are present on most days for a minimum of three months for at least two successive years, or for six months during one year.

Chronic bronchitis is often neglected until it is in an advanced state, because people mistakenly believe that the disease is notserious. But prompt medical attention will reduce the risk of damage to the lungs.

What Causes Bronchitis?

Smoking is the leading cause of chronic bronchitis. The substances in cigarette and other forms of tobacco smoking cause irritation of the bronchial tubes.

While smoking is the leading cause of bronchitis, environmental pollution and some kinds of occupational exposures to chemicals have also been shown to lead to chronic bronchitis. Of course, if you smoke and work or live in a polluted environment, the chances of getting chronic bronchitis are much greater.

In addition, there are some early studies showing that those exposed to high enough levels of second-hand smoke may be more likely to get chronic bronchitis. There also are people with no known risk factors who still get the disease.

What Are The Symptoms Of Bronchitis?

The symptoms of chronic bronchitis include:

• Coughing and/or coughing up sputum with chest pain
• Yellow or green phlegm
• Shortness of breath
• Increased cough

How Is The Diagnosis Made?

Chronic bronchitis is diagnosed if these symptoms have lasted for at least three consecutive months during two consecutive years, or for six months in one year.

In the early stages of chronic bronchitis, a cough usually occurs in the morning. As the disease gets worse, coughing continues throughout the day.

Chronic bronchitis is suspected when a person experiences coughing with sputum on most days for at least three months a year for a minimum of two years. Tests for bronchitis include:

• History and physical exam
• Lung function tests
• Other tests

History And Physical Exam

A doctor will ask about your medical history, including information on past and present smoking. The doctor will ask about your endurance by questioning whether you have trouble climbing stairs or the distance you can walk without getting winded. The doctor also will ask about exposure to any industrial pollutants.

The doctor will perform a simple examination of your chest area. Using a stethoscope, he or she will listen to your breathing for signs of disease and will tap your chest to listen for certain sounds.

Lung Function Tests

The best tests for confirming the presence and severity of lung disease are called pulmonary function tests (PFT). Among the most common PFTs are:

• Spirometry – A spirometer is an instrument that measures the air taken into and exhaled from the lungs. The test measures the volume of air the lungs can hold, and how well the lungs exhale air.
• Peak flow meter – This device measures the peak expiratory flow rate (PEFR), or the maximum amount of air a person can breathe out during a forced exhalation.

Other Tests

Other tests that may be performed include:

• A chest x-ray may be suggested to check for other problems such as pneumonia. Changes in x-rays tend to be mild in chronic bronchitis.
• Since chronic bronchitis is a disease that impacts how well the lungs do their job, a doctor may request an arterial blood gas (ABG) test to determine the amount of oxygen and carbon dioxide in the blood. This procedure involves drawing blood from an artery, which may cause more discomfort than drawing blood from a vein. A blood gas analysis that shows very low oxygen levels is useful for determining who would benefit from oxygen therapy.

Additional tests may be necessary if the doctor suspects other medical problems. For example, if an infection is suspected, blood and sputum tests and cultures may be conducted to find the cause of infection.

How Is Bronchitis Treated?

Unfortunately, there is currently no cure for chronic bronchitis. Most treatment is focused on making the symptoms less severe and trying to prevent further damage. Treatment involves:

• Lifestyle changes
• Medication
• Self-care and alternative treatments
• Oxygen

Lifestyle Changes

The first and probably the most important treatment is to stop smoking. Quitting smoking is a two-step process that includes getting over the physical addiction to nicotine and breaking the psychological aspects of the smoking habit.

Nicotine replacement therapy helps take care of the nicotine addiction so that the smoker can work on breaking the habit. Research has shown that smokers who use some form of nicotine replacement therapy and participate in a behavior change program can double their chances of quitting for good.

For more information about quitting smoking, go to Smoking: How To Stop.

A change in environment or job may be necessary if you work in an area that has heavy concentrations of dust or chemicals. Studies show that second-hand smoke can also make bronchitis worse, so others in your household may need to quit smoking.

Medication

Your doctor may prescribe medications that either are inhaled or taken by mouth. They include:

• Bronchodilators to open your airways. The two main classes of bronchodilators are beta-agonists (which relax the muscles surrounding the airways) and anticholinergics (which block the chemical our bodies use to contract the airways). The combination of these two classes of drugs may be more effective than either of them used alone.
• Corticosteroids are used to reduce inflammation, swelling and phlegm production. There also are a minority of people who respond to oral or inhaled corticosteroids. Your doctor may start a short trial to determine if you will respond to corticosteroids. A typical trial lasts two to three weeks.
• Expectorants are used to stop the cough that often accompanies chronic bronchitis. They also help make the phlegm more liquid and easier to get out of the lungs. The use of expectorants is controversial.
• Antibiotics are not usually used to treat the disease itself. However, since the thick phlegm that is usually seen with chronic bronchitis is a good breeding ground for bacteria, people with this disease are more likely to get lung infections that would require antibiotics.

Self-Care And Alternative Treatments

Treatments that you can try yourself include:

• Taking a hot shower or bath, draping a towel over your head and breathing the steam from a bowl of hot water, or running a humidifier in the bedroom during sleep. These can provide moisture that airways need to stay clear.
• Drinking eight 8-ounce glasses of water helps keep the secretions in the lungs liquid. Drinking hot liquids such as teas can also help remove phlegm from the lungs. Cold liquids tend to irritate the airways because of proximity of the esophagus to the trachea in the neck and upper chest.
• Respiratory therapists sometimes have their patients blow into a device with an adjustable valve that exercises the lungs in the same way as blowing up balloons.
• Some practitioners believe that red peppers, curry, and other spicy foods that make the eyes water or nose run can help to thin mucus secretions but this is very controversial.

Oxygen

As the disease progresses, it may become necessary to rely on supplemental oxygen supplied through portable or stationary tanks. However, simple bronchitis, i.e., bronchitis without emphysema, will rarely require chronic oxygen therapy.

• Some people may need continuous oxygen throughout the entire day.
• Others may only need supplemental oxygen at certain times, such as when exercising or during sleep.

Usually a combination of portable and stationary oxygen systems will be used. There are several options including: the concentrator, an electrical device that extracts oxygen from the air; lightweight compressed gas systems particularly with demand valves; and liquid oxygen.

Oxygen is usually administered to people in one of three ways:

• A nasal canula, which is a tube coming from the tank with small prongs that fit in the nose; this is by far the most common mode of administration.
• A transtracheal catheter, which is a tube that is surgically placed in the throat to deliver oxygen directly to the lungs
• An electronic device (flow demand valve) that senses the beginning of a breath and delivers a pulse of oxygen

How Can Bronchitis Be Prevented?

The easiest and most effective way to prevent bronchitis is to never smoke. If you do, quitting smoking at or, preferably, before the early signs of trouble can help keep damage to a minimum.

For those who work in certain environments, use of respiratory protection devices such as respirators or filter masks can help prevent the disease. In some cases, it may be necessary for a person to find other employment.

What Happens If I Get Another Respiratory Disease Along With My Bronchitis?

Because of the damage to the lungs, those with chronic bronchitis may more easily get other diseases along with their bronchitis. They may also be more sensitive to other irritating things such as dusts, chemicals, or allergies. When one of these causes a sudden increase or worsening of symptoms, the doctors call this an acute exacerbation of chronic bronchitis (AECB).

The symptoms of AECB include:

• An increased severity of cough
• Increased phlegm production
• Greenish or yellow colored sputum
• Chest congestion and discomfort
• Shortness of breath
• Fever
• Feeling of illness (malaise)
• Wheezing (which indicates a co-existing asthmatic tendency)

A wide variety of triggers can be responsible for the development of AECB. Bacterial infection, viral infection, allergy, and noninfectious irritants, including cigarette smoke, are common causes. When AECB is caused by a bacterial infection, slightly blood-streaked sputum is rarely seen. In addition, the person may have weakness, fever, and chills.

Many people with chronic bronchitis also have asthma. Although these are separate and distinct diseases, they do overlap and can produce symptoms of AECB.

For more information about asthma, go to Asthma.

AECB can be treated with:

• Acetaminophen (such as Tylenol) or aspirin for fever or general aches and pains; be sure that package directions are followed as overdosing may lead to serious liver problems.
• Antibiotics for bacterial infections

Living With Bronchitis

If you have bronchitis, there are steps you can take to help yourself:

• Smoking cessation
• Protecting against respiratory infections
• Breathing exercises
• Home environment
• Other tips

Smoking Cessation

Quitting smoking is the first and most essential step in treating chronic bronchitis. Once you stop smoking, your lung function may stabilize and even improve slightly, eventually declining at only about the same rate as nonsmokers in the same age group. No one with bronchitis should smoke, and smokers who live or work around a person with chronic bronchitis should make every effort to quit.

Since nicotine is very addictive, smoking cessation may prove to be the hardest part of living with bronchitis. Studies have shown that use of nicotine-containing products, such as chewing gum or the patch, can help reduce cravings for a cigarette. These are even more helpful if combined with behavior modification and support groups.

Buproprion (Zyban, Wellbutrin) is an antidepressant medication that has been found to decrease cravings for cigarettes. It has been shown to be of benefit to individuals who want to quit smoking.

For more information about smoking cessation, go to Smoking: How To Stop.

Protecting Against Respiratory Infections

Protection against other respiratory infections is also important. Since most AECBs are caused by carrying viruses from the infected persons hands to an object like a paper, a plate or a cup, both avoidance of such objects when handled by someone with a cold and hand washing thoroughly and often is a simple way to avoid infections.

People with chronic bronchitis should ask their doctor about yearly flu shots. Another important vaccination is the pneumococcal vaccine, which protects against the major bacterium that causes pneumonia. The vaccine remains effective for years.

Flu and pneumococcal vaccines can safely be given at the same time.

Breathing Exercises

Breathing exercises can be important. A technique called pursed-lip breathing can help improve lung function in patients with severe (usually combined with emphysema) bronchitis during or immediately after starting activities.

• Exhale slowly and completely utilizing a count of two to inhale and six to exhale
• The next breath will be larger because your lungs are much emptier at the end of the slow exhalation.

Some practitioners believe that the use of an incentive spirometer for 15 minutes twice a day may also be helpful in strengthening breathing muscles and loosening sputum but this is quite controversial. This is a small hand-held device that contains a breathing gauge. The user exhales forcefully through the tube, using the pressure of the exhalation to raise the gauge to the highest level possible.

The Home Environment

To minimize the amount of contaminants in the home:

• Ventilate by keeping windows open (weather and air pollution permitting)
• Use exhaust fans for stoves and vents for furnaces
• Keep fireplace flues open
• If a wood-burning stove or fireplace is in use, make sure it is well-ventilated and meets the Environmental Protection Agency’s safety standards
• Burn pressed wood products labeled “exterior grade” since they contain the least amount of pollutants from resins
• Have furnaces and chimneys inspected and cleaned yearly if used heavily
• Eliminate molds and mildews stemming from household water damage

Other Tips

Other measures you can take include:

• Try to stay out of very hot or cold weather. When it’s very cold or windy, cover your nose with a scarf. When it’s humid, try to stay in air-conditioned places. This can make breathing easier.
• Avoid taking tranquilizers, sedatives, or other drugs that may slow down breathing without your physician’s approval.
• As much as possible, avoid exposure to air-borne irritants such as hair sprays and any aerosol products, paint sprayers, and insecticides.

When Should I Contact My Doctor?

Because chronic bronchitis is a long-term disease, it is very important to see a doctor regularly. You should call your doctor:

• Whenever you have a persistent cough, with or without phlegm, especially if you are a smoker
• If you have a fever, since this can be a sign of infection
• If you have shortness of breath or trouble breathing

Frequently Asked Questions: Bronchitis

Here are some frequently asked questions related to bronchitis.

Q: What other diseases resemble chronic bronchitis?

A: There usually are no symptoms of lung cancer until the disease is well established. Frequent bouts of pneumonia or lung infection in a seemingly healthy adult that does not clear up normally may be the first sign of lung cancer. Also, bronchiectasis is an irreversible lung disease in which the airways in the lung are always dilated. This condition is usually preceded by serious, frequent respiratory infections, often starting in childhood.

Q: Is there a genetic component to this disease that I can pass down to my kids?

A: Gene-linked deficiencies in a specific protein have been linked to emphysema, which often exists along with chronic bronchitis. However, studies have yet to link a lack of the protein to chronic bronchitis. Research into this is continuing.

Q: I don’t smoke. Can I still get chronic bronchitis?

A: Yes. While smoking is the leading cause for this disease, environmental pollution and some kinds of occupational exposures to chemicals have also been shown to lead to chronic bronchitis. In addition, there are some early studies showing that those exposed to high enough levels of second-hand smoke may be more likely to get chronic bronchitis. Finally, there is a set of people with no know risk factors who still get the disease.

Q: What is chronic asthmatic bronchitis?

A: Chronic asthmatic bronchitis is the condition in which the airways in the lungs are obstructed due to both persistent asthma and chronic bronchitis. People with this disease generally also have a persistent cough that brings up phlegm. Chronic asthmatic bronchitis, which also may involve emphysema, is usually classified under the more general category of chronic obstructive pulmonary disease (COPD).

Q: What is the Better Breathers Program?

A: It is a program for those with chronic respiratory diseases like bronchitis, emphysema, or asthma. Sponsored by the American Lung Association, BBP combines education with social opportunities designed to create a better understanding of chronic respiratory disease and how to live with it. The program features education through films, literature, and demonstrations, as well as lectures by doctors and other health care professionals specializing in lung disease. You can find out about these programs by contacting your local chapter of the American Lung Association (see their listing in the your local telephone book) or by going to the ALA’s Web site.

Putting It All Together: Bronchitis

Here is a summary of the important facts and information related to bronchitis.

• Bronchitis is an inflammation of the bronchial tubes (or bronchi), which are the air passages that extend from the windpipe into the lungs.
• No matter what their occupation or lifestyle, people who smoke cigarettes are most likely to develop chronic bronchitis.
• The symptoms of chronic bronchitis include coughing and/or sputum production for three or more years, yellow or green sputum, shortness of breath, and increased cough.
• There is currently no cure for chronic bronchitis. Treatment is focused on making the symptoms less and trying to prevent further damage.
• Quitting smoking is the most essential step in treating chronic bronchitis.

Glossary: Bronchitis

Here are definitions of medical terms related to bronchitis.

Alveoli: Tiny sac-like airspaces in the lungs where carbon dioxide from the body is exchanged for oxygen from outside the body.

Bronchial tubes, bronchi: Larger air passages in the lung, usually closer to the throat

Bronchioles: Smaller air passages in the lung

Bronchoconstriction: Tightening of the muscles of the surrounding the bronchi which causes the air passageways to get smaller

Bronchodilator: A medication or other substance that causes the muscles to loosen or dilate

Cilia: Tiny hairs in the nose, bronchi and lungs that filter air and trap particles such as dust for removal.

Cyanosis: The bluish color of the skin associated with too little oxygen in the body

Dyspnea: Shortness of breath or hard, labored breathing

Macrophages: Defensive cells in the body that are capable of consuming foreign objects

Phlegm: Abnormal amounts of mucus; phlegm coughed up through the mouth is called sputum

Vaccination: Giving a killed or weakened virus or bacteria in order to stimulate the immune system to protect the person from that organism at next exposure.

Ventilation: The process of exchanging air between the lungs and the atmosphere leading to an exchange of gases in the blood.

Spirometry : A test performed by breathing into an instrument called a spirometer that records the amount of air and the rate of air that is breathed in over a specified time.

Some of the test measurements are obtained by normal breathing, and other tests require forced inhalation and/or exhalation.

Sputum: Phlegm that is coughed up from the lungs

Wheezing: Whistling sound heard when someone breaths out or in due to secretions in the larger airways or airways narrowed by mucus, bronchospasm or tumor.

Additional Sources Of Information: Bronchitis

Here are some reliable sources that can provide more information on bronchitis.

American Lung Association 
Phone: (800) 586-4872
http://www.lungusa.org

National Heart, Lung & Blood Institute Information Center 
Phone: (301) 251-1222
http://www.nhlbi.nih.gov/index.htm

The American Academy of Family Physicians 
http://familydoctor.org/

The professional association for the family practice doctors in the U.S. They have a good selection of consumer brochures on lung diseases, many of which are available on their website.

National Jewish Medical and Research Center 
Phone: 303/388-4461
Phone: 800/222-LUNG (5864)
http://www.njc.org/PRhtml/%21k_bronc.htm

One of the major hospitals and research centers in the U.S. that concentrates mainly on lung and similar diseases. Has good brochures and other information available on the website and through their phone hotline.