What is chronic bronchitis and how is it treated?

Chronic bronchitis is an inflammatory disease of the bronchi caused by the extended irritation of the respiratory ways by the pollutants and/or damage induced by viral and bacterial agents. It is characterized by a morphological rearrangement of their mucous membrane, accompanied by excessive production of mucus, the violated cleansing function of the bronchi, which is manifested by constant or intermittent coughing and sputum production.Chronic bronchitis is an inflammatory disease of the bronchi caused by the extended irritation of the respiratory ways by the pollutants and/or damage induced by viral and bacterial agents. It is characterized by a morphological rearrangement of their mucous membrane, accompanied by excessive production of mucus, the violated cleansing function of the bronchi, which is manifested by constant or intermittent coughing and sputum production.

Short information about bronchitis

The disease is considered chronic if a patient coughs up sputum in the majority of days, for not less than three consecutive months for more than two consecutive years.The disease is considered chronic if a patient coughs up sputum in the majority of days, for not less than three consecutive months for more than two consecutive years.

Chronic bronchitis can be primary and secondary.

Primary bronchitis is an independent condition not related to any other bronchi and lung diseases or other systems of the body. It is characterized by the diffuse damage of the bronchial tree.

Secondary bronchitis develops on the basis of other diseases, for instance, lung diseases such as tuberculosis, other diseases such as uremia, congestive heart failure, etc.). Most often, secondary chronic bronchitis has a defined focus.

In this article, I am going to review only primary bronchitis that makes up around 30% of nonspecific lung diseases among the urban population.

Symptoms of chronic bronchitis

The symptoms of the disease include:

- Chronic coughing;
- Coughing up sputum (clear, white, yellow-gray or green colored);
- Fatigue;
- Shortness of breath;
- Mild fever and chills;
- General malaise.

Keep in mind that bronchitis is considered chronic only if the symptoms are persistent for more than three months a year for two years.

Chronic bronchitis is characterized by periods of remission, i.e. no symptoms, and relapses, i.e. when the symptoms are intense. Their frequency and duration are individual. The intensity of the symptoms in relapse is quite similar to the symptoms of acute bronchitis.

Chronic bronchitis can be also obstructive, its symptoms are:

- Rise of the body temperature to 37.5-39 C (99.5-102.2 F);
- Rapid and labored breathing;
- Dry/unproductive cough (without sputum);
- Shortness of breath with wheezing;
- Severe fatigue;
- Nasal congestion or runny nose with increased lacrimation.

Types of chronic bronchitis

There is no unique and uniform classification of chronic bronchitis.

The main parameter for the classification is the character of the course of the disease. It can be:

- Acute – lasts up to three weeks;
- Relapsing – recurring up to three times a year;
- Chronic – the symptoms are present for three consecutive months a year for two years.

Depending on the causative agent or factors causing the inflammatory process, the disease is classified into:

- Infections (bacterial, viral, fungal, protozoal);
- Allergic;
- Toxic.

In 85-95% of cases of acute bronchitis, the disease is caused by a viral infection.

There are three forms of the disease depending on the type of the inflammatory process: catarrhal, catarrhal-purulent and purulent.

By the nature of the course of chronic bronchitis, it can be divided into obstructive and non-obstructive.

- Non-obstructive bronchitis is when difficulty in breathing occurs only in an acute, exacerbation phase;
- Obstructive bronchitis is when breathing is generally impaired due to the spasm of the smooth muscles of the bronchi walls. In adults, this disorder progresses with time and is chronic. In children, it is typical only for acute period.

By the level of bronchial damage, it is divided into a primary lesion of large (proximal bronchitis) or small bronchi (distal bronchitis).

Any bronchitis can have a complicated or uncomplicated course. Particularly difficult is bronchitis with an asthmatic component. In a separate form, pulmonologists distinguish bronchiolitis, in which bronchioles are damaged.

What causes chronic bronchitis?

The disease develops due to the effect of external and internal factors.

External factors include:

- Irritating and damaging irritants: tobacco smoke, gases, dust, household or industrial chemicals;
- Air pollution;
- Viruses;
- Bacteria;
- Fungi;
- Allergens (pollen, animal dandruff);
- Overcooling or overheating of the body.

It is worth noting that in the exposure to the same factors, the disease develops only in some people. This is explained by the fact that some people have also internal factors/risk factors that make them more prone to disease development.

Internal factors that influence the development of chronic bronchitis:

- Pathology of the Nasopharynx;
-  Changes in breathing through the nose with impaired purification, moisturizing and warming of the inhaled air;
- Repeated acute respiratory infections;
- Acute bronchitis and focal infection of the upper respiratory tract;
- Impaired local immunity and metabolism (obesity).

Is bronchitis contagious?

The answer to this question about whether bronchitis is transmitted from a sick person to a healthy one worries not only the parents of young children but also many adults. It is impossible to answer it unequivocally. Bronchitis is a lesion of the tissues (mucous membranes and walls) of the bronchial tree, which is accompanied by increased secretion of mucus and cough and is provoked by various factors. That is why, not knowing the cause and form of the disease, it cannot be unequivocally stated that bronchitis is contagious.

Bronchitis is contagious if it is provoked by infectious agents. Chronic bronchitis, in most cases, is not contagious unless it is secondary bronchitis developed due to tuberculosis.

The risk of contracting bronchitis increases in:

- There are chronic foci of infection in the upper respiratory tract;
- Age under 2 years old or over 65 years old;
- There are abnormalities in the development of the chest or respiratory system;
- There are chronic diseases (COPD, diabetes, AIDS, etc.);
- Adverse working and/or living conditions (low temperatures and high humidity, inhalation of dust or air contaminated with chemicals);
- Transplantation of organs or autoimmune diseases that require the use of medications to suppress the immune system;
- There is a history of such addictions as tobacco smoking, smoking or inhalation of drugs and other substances.

An important role in the likelihood of contracting bronchitis is played by the state of immunity and the degree of infectiousness of the pathogen. The weaker the defense system and the greater the contagiousness of the microorganism, the higher the chances of getting sick after communicating with the patient.

Infection pathways

In infectious bronchitis, in most cases, infection occurs by airborne droplets. If hygiene rules are not followed and there is no habit of washing hands, the pathogen provoking inflammation can be transmitted by contact-household means.

The duration of the period in which a patient with infectious bronchitis is contagious depends on the type of pathogen. Usually, the risk of infection remains throughout the entire period of the disease (including in the presence of residual cough).

The occurrence, course, and outcome of the disease

With infection, the mucous membranes of the nasal passages are first affected and sinusitis develops. After the infection descends into the lower parts of the respiratory system and, as a result, reaches the bronchial tree. The inflammatory process develops from several hours to several days, after which a characteristic cough appears with the expectoration of a large amount of sputum.

In prolonged bronchitis, the inner surface of the bronchi hypertrophies or atrophies. Subsequently, both of these conditions can lead to the development of serious consequences of bronchitis.

Peculiarities of the disease course during pregnancy

Cough with bronchitis creates an additional load and is usually difficult to tolerate by pregnant women. To prevent possible complications for the expectant mother and baby, treatment should begin as early as possible.

For diagnosis, if possible, it is recommended to undergo a CT scan. Drug therapy should be prescribed only by a doctor, taking into account contraindications to the use of drugs in a particular trimester.

Peculiarities of the disease in children

Most often, bronchitis develops in children under 2 years of age or in those who have a history of predisposing factors. Also, experts note that bronchiolitis often occurs in babies up to a year. Bronchitis is especially severe if it develops as a complication of infections such as mumps, chickenpox and measles.

Complications of bronchitis

The most likely complications of bronchitis are:

- Bronchial obstruction development;
- Transformation into a chronic form;
- Pneumonia;
- Asthmatic component (asthma attacks);
- Disorders in the work of the heart;
- Chronic obstructive pulmonary disease (COPD);
- Deformation of the walls of the bronchi;
- Emphysema;
- Pulmonary failure;
- Pulmonary hypertension;
- Bronchial asthma;
- Diffuse pneumosclerosis.

Particularly dangerous is the complicated course of bronchiolitis (inflammation and congestion in the small airways (bronchioles) in small children), in which a fatal outcome is possible.

The most common causes of complications of bronchitis are fast-developing or severe course, aggressive infection in lowered immunity, lack of proper therapy or preexisting pathologies.

First aid for bronchitis

For first aid for bronchitis it is necessary:

- To provide access to fresh air;
- Humidify indoor air;
- Rinse the nasal passages with warm saline solution and use vasoconstrictor nasal drops/sprays.
After that, you must call an ambulance or deliver the patient to the hospital yourself.

Diagnostics of bronchitis

First, a doctor can suspect bronchitis based on the patient’s complaints. Then, laboratory and instrumental methods for diagnosing bronchitis are appointed to clarify data on the form and type of bronchitis and make a differential diagnosis, i.e. exclude other lung diseases.

Diagnosis of bronchitis may include:

- Listening and tapping the chest;
- X-ray;
- Sputum, blood, and urine laboratory tests.

In complicated cases, spirography, bronchoscopy, and CT can be prescribed.

Treatment of bronchitis

The tactics of treating bronchitis is determined by the clinical case and the stage of development of the pathology. In severe cases, hospitalization is recommended. Different methods may be included in the treatment plan for bronchitis.

Drug therapy

The patient may be assigned:

- Antibiotics (in confirmed bacterial infection);
- Antiviral drugs (in severe viral infection or in immunocompromised patients);
- Antifungal agents (in confirmed fungal infection);
- Expectorant (in almost any type of bronchitis to facilitate coughing up of sputum);
- Bronchodilators (they are used in obstructive chronic bronchitis when bronchospasms can develop. For acute suffocation attacks such inhalers as Proventil (Albuterol) are used;
- Antitussive drugs (in severe exhausting coughing);
- Antipyretic medicines (in fever);
- Antihistamines (in allergic bronchitis or as an additional treatment in other types of bronchitis).

The treatment of bronchitis lasts until the symptoms disappear completely and its duration is determined individually.

Non-drug treatment and normalization of lifestyle

To accelerate recovery and prevent complications, it is recommended to observe bed rest during the acute stage of bronchitis including acute exacerbations in chronic bronchitis.

In case of allergic and toxic damage to the bronchi, it is necessary to identify and eliminate the effect of irritating factors. The patient should spit out sputum, drink large volumes of warm liquid, increase the humidity level in the room, often ventilate the room and prevent drafts.

Physiotherapy in bronchitis

Physiotherapy also helps to improve the results of treatment, and for young patients, there is special children's physiotherapy, which takes into account all the features of the child's body.

For bronchitis, it is recommended:

- Taking medications with a nebulizer;
- Inhalation;
- Therapeutic massage;
- Compresses;
- Breathing exercises;
- Physiotherapy exercises, etc.

Surgery for bronchitis treatment

Surgical treatment for bronchitis is usually not required. Sometimes, to eliminate foreign bodies that cause bronchitis, or to treat severe forms of chronic bronchitis, a sanitation minimally invasive procedure such as bronchoscopy is performed.

Diet for the treatment of bronchitis

Following a diet and the rules of good nutrition for bronchitis is extremely important to eliminate protein starvation and lack of vitamins.

The main principles of the diet for inflammation of the bronchi are:

- Eating fresh fruits and vegetables, chicken stock, fatty fish, meat (not fried), and whole grains;
- Eating foods high in protein and vitamins;
- Eating 4-5 times a day;
- Elimination of allergens (if there are known allergens for the patient or generally common allergic foods);
- Heavy drinking (it is better to drink natural juices, herbal teas, whey, kefir).

Adhering to the principles of good nutrition is recommended for both chronic and acute forms of bronchitis.

Healing control

With the right approach, in most cases, all uncomplicated forms of bronchitis respond to successful treatment. To control the quality of treatment, such studies as x-ray, CT, bronchoscopy, sputum culture, etc. are made.

Prevention of bronchitis

For the prevention of bronchitis, a patient should comply with the following rules:

- Exclude of factors provoking the development of inflammation, i.e. exposure to allergens, move to the less polluted area, quit smoking, etc.;
- Ensure sufficient humidification of indoor air – open the windows, use a humidifier in heating season;
- Perform frequent cleaning to eliminate/minimize dust at home and in the workplace;
- Comply with the rules of good nutrition, i.e. follow a generally healthy diet and lower the consumption of “empty” fast food and junk food;
- Undergo a general health checkup once a year;
- Timely treat any diseases (especially pathologies of ENT organs);
- Do regular walks in the fresh air, preferably, in nature and not the streets of the city where air pollution is high;
- Engage in sufficient physical activity – do physical exercises suitable for your form at least thrice a week;
- Avoid visiting crowded places (especially during flu and SARS epidemics) or wear a mask.
- Eliminate of the influence or minimize the factors causing an allergic or toxic reaction (change of work, wearing respirators, smoking cessation, etc.);
- Comply with hygiene rules, i.e. wash your hands when you get home, when you eat, before touching your face when you are outside of your home. If you have no possibility to wash your hands, use antiseptic spray.

What doctor treats bronchitis?

Usually, bronchitis is treated by a family physician or pediatrician. However, in the case of frequently recurring or complicated forms, it is highly advised to seek the help of a pulmonologist, i.e. lung specialist.

Where you can buy medicines to treat chronic bronchitis?

To save on the therapy, especially if you suffer from chronic obstructive bronchitis and need permanent use of certain medications, you can buy generic medicines online. However, do not try to choose the drugs on your own. Consult a doctor and undergo all needed tests and then order only those medicines that your doctor prescribed.

Post by: Jacob Hansen, General healthcare practitioner, National health centre, Stavanger, Norway