Acute bronchitis and copd

Chronic Bronchitis

Chronic bronchitis, along with emphysema, is one of the lung diseases that comprise COPD (chronic obstructive pulmonary disease). A chronic disease, such as chronic bronchitis, is a type of condition that goes on for a long time and does not go away but does have ups and downs in the symptoms that are present. Your symptoms may get better or worse over time and there are treatments available to help control your symptoms, so you feel better.

Chronic bronchitis should not be confused with acute bronchitis, which usually develops from a respiratory infection like a cold and goes away in a week or two. Individuals with chronic bronchitis can get an episode of acute bronchitis on top of their chronic condition. Symptoms may linger longer in this situation.

Key Facts about Chronic Bronchitis

  • Bronchitis is a condition in which the airways that move air to and from your lungs, also called bronchial tubes, become inflamed. This irritation causes symptoms such as cough with mucus production, shortness of breath, chest discomfort and fatigue and at times wheezing. In this situation, the term asthmatic bronchitis is often used.
  • To diagnose chronic (or long-lasting) bronchitis, your healthcare provider will look for a productive cough (producing mucus) that lasts at least three months and happens multiple times over the course of at least two years.
  • Cigarette smoking is the major cause of chronic bronchitis. Other factors that increase your risk of developing this disease include exposure to air pollution as well as dust or toxic gases in the workplace or environment. It may also occur more frequently in individuals who have a family history of bronchitis.
  • Chronic bronchitis is not curable but certainly varies in the number of symptoms that are present from individual to individual. There are treatments that can help you manage the symptoms of the disease.

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What is COPD?

Chronic obstructive pulmonary disease, or COPD, describes a group of lung conditions that make it difficult to empty air out of the lungs because the airways have become narrowed.

On this page:

  • What is COPD?
  • What causes COPD?
  • What are the symptoms of COPD?

What does COPD stand for?

Chronic = it’s a long-term condition and does not go away

Obstructive = your airways are narrowed, so it’s harder to breathe out quickly and air gets trapped in your chest

Pulmonary = it affects your lungs

Disease = it’s a medical condition

Two of these lung conditions are long-term (or chronic) bronchitis and emphysema, which can often occur together.

  • Bronchitis means the airways are inflamed and narrowed. People with bronchitis often produce sputum, or phlegm.
  • Emphysema affects the tiny air sacs at the end of the airways in your lungs, where oxygen is taken up into your bloodstream. They break down and the lungs become baggy and full of bigger holes which trap air.

These conditions narrow the airways. This makes it harder to move air in and out as you breathe, and your lungs are less able to take in oxygen and get rid of carbon dioxide.

The airways are lined by muscle and elastic tissue. In a healthy lung, the springy tissue between the airways acts as packing and pulls on the airways to keep them open.

With COPD, the airways are narrowed because:

  • the lung tissue is damaged so there is less pull on the airways
  • mucus blocks part of the airway
  • the airway lining becomes inflamed and swollen

There are treatments to help you breathe more easily and help you keep active, so it’s important to get an early diagnosis.

What causes COPD?

COPD usually develops because of long-term damage to your lungs from breathing in a harmful substance, usually cigarette smoke, as well as smoke from other sources and air pollution. Jobs where people are exposed to dust, fumes and chemicals can also contribute to developing COPD.

You’re most likely to develop COPD if you’re over 35 and are, or have been, a smoker or had chest problems as a child.

Some people are more affected than others by breathing in noxious materials. COPD does seem to run in families, so if your parents had chest problems then your own risk is higher.

A rare genetic condition called alpha-1-antitrypsin deficiency makes people very susceptible to developing COPD at a young age.

What’s the difference between COPD and asthma?

With COPD, your airways have become narrowed permanently – inhaled medication can help to open them up to some extent. With asthma, the narrowing of your airways comes and goes, often when you’re exposed to a trigger – something that irritates your airways – such as dust, pollen or tobacco smoke. Inhaled medication can open your airways fully, prevent symptoms and relieve symptoms by relaxing your airways.

So, if your breathlessness and other symptoms are much better on some days than others, or if you often wake up in the night feeling wheezy, it may be that you have asthma.

Because the symptoms are similar and because people who have asthma as children can develop COPD in later life, it is sometimes difficult to distinguish the two conditions. Some people have both COPD and asthma.

What are the symptoms of COPD?

Symptoms include:

  • getting short of breath easily when you do everyday things such as going for a walk or doing housework
  • having a cough that lasts a long time
  • wheezing in cold weather
  • producing more sputum or phlegm than usual

You might get these symptoms all the time, or they might appear or get worse when you have an infection or breathe in smoke or fumes.

If you have COPD that has a severe impact on your breathing, you can lose your appetite, lose weight and find that your ankles swell.

Next: How is COPD diagnosed? >

Chronic bronchitis

  • What is Chronic Bronchitis
  • Statistics on Chronic Bronchitis
  • Risk Factors for Chronic Bronchitis
  • Progression of Chronic Bronchitis
  • Symptoms of Chronic Bronchitis
  • Clinical Examination of Chronic Bronchitis
  • How is Chronic Bronchitis Diagnosed?
  • Prognosis of Chronic Bronchitis
  • How is Chronic Bronchitis Treated?
  • Chronic Bronchitis References

What is Chronic Bronchitis

Chronic bronchitis is a disease of the lung. The lungs consist of a series of folded membranes (the alveoli) which are located at the ends of very fine branching air passages (bronchioles).

Chronic bronchitis is a persisting infection and inflammation of the larger airways of the lungs – the bronchi. There are two main bronchi in the lungs (the right and left) which divide from the trachea, as seen in the figure to the right. Chronic bronchitis occurs as part of the disease complex known as chronic obstructive pulmonary disease (COPD) which also includes emphysema and small airways disease. Chronic bronchitis specifically refers to chronic cough and daily mucus production for at least three months of two or more consecutive years. Other causes of chronic cough must be excluded before making the diagnosis.

Statistics on Chronic Bronchitis

COPD (which includes chronic bronchitis and emphysema) is a common disease in Australia and a major cause of disability, hospital admissions, and mortality. It is considered to be ranked third in the overall burden of disease after heart disease and stroke. More than half a million Australians are estimated to suffer from moderate to severe disease, and COPD ranks fourth among the common causes of death in Australian men, and sixth in women. Rates are even significantly higher in the Australian Aboriginal population.

Chronic bronchitis is common among smokers. In Western countries it is estimated that chronic bronchitis occurs in approximately 18% of male and 14% of female smokers compared to 7% and 6% of non-smokers, respectively.

Risk Factors for Chronic Bronchitis

Chronic bronchitis can affect both males and females of all ages but it tends to be most common in middle-aged males. The following predisposing factors have been identified:

  • Cigarette smoke– This is by far the most important factor in the development of chronic bronchitis. The disease is 4 to 10 times more common in heavy smokers regardless of age, sex, occupation, and place of dwelling. There is a direct relationship between intensity of smoking and reductions in lung function and mortality from disease. Those who smoke 30 cigarettes per day are 20 times more likely to die from chronic bronchitis and COPD than non-smokers.
  • Pollution- Non-smokers exposed to heavy atmospheric pollution may occasionally develop chronic bronchitis. This results due to irritation of the airways from inhalation of toxins and fumes.
  • Family history- There is some role of family history in the development of COPD and chronic bronchitis.
  • Airway infections- Although infection is not considered responsible for the initiation of chronic bronchitis, it is important factor in maintaining disease and causing exacerbations.

Progression of Chronic Bronchitis

Early on in chronic bronchitis you usually will have symptoms of cough productive of significant amounts of sputum without any significant breathlessness. The excess mucus production is caused by enlargement of mucous glands and increased numbers of mucus-secreting goblet cells in the airways. The small airways themselves then become inflamed but at this stage the disease is considered largely reversible. Cessation of smoking will resolve the airway inflammation.

As the disease progresses there is progressive abnormal cell growth (called squamous metaplasia) and fibrosis (hardening) of the bronchial walls. This causes airflow limitation and symptoms of shortness of breath. Symptoms of breathlessness are usually present on exertion. You may develop other signs of COPD such as cyanosis (bluish discolouration of the lips and skin). Emphysema may also be present at this stage, causing more severe shortness of breath and chest tightness.

If your chronic bronchitis remains severe some other complications can develop including:

  • Secondary polycythaemia– This is an increase in the number of red blood cells in the blood to try to compensate for reduced oxygen levels. The blood subsequently becomes ‘thicker’ with sluggish flow which can lead to clotting.
  • Right heart failure.
  • Pneumothorax (punctured lung).
  • Respiratory failure– This is often caused by acute infective exacerbations. Death can sometimes occur from severe declines in respiratory function.

Symptoms of Chronic Bronchitis

Chronic bronchitis is defined clinically as cough productive of sputum for at least 3 months a year over 2 consecutive years. If airway limitation is also present you may experience symptoms of wheezing, chest tightness and breathlessness. Your doctor will ask you lots of questions about your symptoms including when they started, their duration and any triggering factors.

Symptoms may be worsened by factors such as cold, foggy weather and atmospheric pollution. In addition your doctor will take a detailed medical history and family history to exclude other causes of cough and sputum production. Smoking history is essential as this is the major cause of chronic bronchitis.

It can be difficult to distinguish symptoms of chronic bronchitis from emphysema and both conditions commonly occur together. Therefore if you have cough and breathlessness your doctor may diagnose COPD, rather than chronic bronchitis alone.

Clinical Examination of Chronic Bronchitis

Your doctor will perform a detailed examination of your respiratory system. This will include undressing your top, inspecting your chest, measuring your chest expansion and listening to your breath sounds. Important signs your doctor will be looking for include:

  • Productive cough.
  • Cyanosis (bluish discolouration).
  • Tachypnoea- An increased respiratory rate.
  • Use of accessory muscles.
  • Hyper-expansion of the chest- In advanced disease the chest wall can become barrel shaped.
  • Reduced chest expansion.
  • Reduced breath sounds, wheeze and crackles.
  • Signs of heart failure such as peripheral oedema (swelling) may be present in advanced disease.

Patients with chronic bronchitis are classically described as “blue bloaters” due to the presence of cyanosis and oedema. They have reduced levels of ventilation and are not very breathless. There are low levels of oxygen in the blood and high levels of carbon dioxide which can cause other signs such as bounding pulse, asterixis (flapping of the hands), and in severe cases, confusion and progressive drowsiness.

Patients with predominantly emphysema on the other hand are described as “pink puffers” as they are very breathless and hyperventilating (with pursed lips) but have near normal levels of oxygen and carbon dioxide in the blood. However, these clinical signs aren’t always reliable and do not always correlate with pathology.

How is Chronic Bronchitis Diagnosed?

Your doctor may perform number of tests to confirm the diagnosis of chronic bronchitis and to detect the associated airway limitation. Tests may include:

  • Blood tests- Specifically looking at the concentration of red blood cells which may be increased due to the chronic lack of oxygen in the body.
  • Chest x-ray– This helps to show hyper-expansion of the lungs associated with chronic bronchitis and COPD. The lung fields will look enlarged and empty and may flatted out the diaphragm.
  • ECG– This can detect signs of right heart failure (a complication of chronic bronchitis and COPD).
  • Pulmonary/Lung Function tests– Spirometry is the best test to detect airflow limitation and obstruction. Unlike asthma, the airflow limitation is not reversible.
  • Blood gases- These may also be normal but in the later stages of disease you may have low oxygen and high carbon dioxide levels.
  • High resolution CT– This is sometimes used in patients with COPD. It is best for detecting emphysema and bullae (big dilated air spaces).

Prognosis of Chronic Bronchitis

Chronic bronchitis itself does not cause an increase in mortality unless there is an associated decline in lung function. Your overall prognosis therefore depends on:

  • Whether you continue to smoke- Stopping smoking will improve symptoms in 90% of patients. Even if you have severe disease, studies have shown that stopping smoking increases survival.
  • Your current lung function.
  • Presence of other complications such as heart failure and respiratory failure.
  • Frequency of exacerbations.

Chronic bronchitis with severe breathlessness carries a poor prognosis with approximately 50% of patients dying by 5 years. Death is usually caused by a decline in lung function from infective exacerbations.

How is Chronic Bronchitis Treated?

Chronic bronchitis should be treated if airway limitation is present. Treatment follows the same general principals as treatment of COPD. The majority of treatments only control and improve symptoms.

Only smoking cessation and oxygen therapy (in those with advanced disease) actually alter the course of disease. Stopping smoking is the best thing you can do as quitting smoking, regardless of the stage and severity of disease, will slow down the rate of progression and prolong life. Other treatments are outlined below.

Drug therapy

Drugs can be used for long-term suppression of symptoms or for treatment of acute exacerbations. Bronchodilators (such as Ventolin, Seretide and Atrovent via puffer or nebuliser) and corticosteroids are used for symptom control. Your doctor will usually give you a trial of oral steroids to see if you respond before using long-term inhaled steroids. Antibiotics are taken for short-term exacerbations of disease. Your doctor may also prescribe agents to reduce the thickness of your sputum (called mucolytics, for example acetylcysteine). Studies have shown these agents may reduce the frequency of exacerbations.

Pulmonary rehabilitation

Chest physiotherapy has been shown to help remove secretions in the airways. Various techniques are available which assist sputum removal and improve your ventilation for patients. Your doctor will also enter you into exercise or pulmonary rehabilitation programs which have been shown to increase exercise tolerance, relieve symptoms and improve quality of life.

Oxygen therapy

If you have severe airflow limitation you may require home oxygen therapy, sometimes for up to 19 hours per day. Oxygen ca be administered via nasal prongs or mask. This treatment has been shown to prolong life in patients with severe COPD who have stopped smoking.

Other

  • Vaccinations- It is important that you have your yearly influenza vaccination, and pneumococcal vaccine. This will help reduce effective exacerbations from these agents.
  • Diuretics– If your chronic bronchitis is complicated by right heart failure, you may be treated with tablets to remove the excess fluid.

For more health information on chronic bronchitis and appropriate treatment for yourself, please consult your local doctor.

Chronic Bronchitis References

  1. Cotran R, Kumar V, Collins T. Robbins Pathological Basis of Disease Sixth Ed. WB Saunders Company 1999.
  2. Ekberg-Jansson A, Larsson S, Löfdahl C. Preventing exacerbations of chronic bronchitis and COPD: Two recent Cochrane reviews report effective regimens, BMJ 2001;322:1259-1261
  3. Kerstijens H. Stable chronic obstructive pulmonary disease, BMJ 1999;319:495-500.
  4. Kumar, Clark. Clinical Medicine. 5th Edition. Saunders. 2002.
  5. Longmore, Wilkinson, Rajagopalan. Oxford Handbook of Clinical Medicine. 6th Edition. Oxford University Press. 2004.
  6. McKenzie D, Frith P, Burdon J, Town G. The COPDX Plan: Australian and New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease 2003, MJA 2003; 178: S1-S40. Available at URL: http://www.mja.com.au/public/issues/178_06_170303/tho10508_all.html
  7. Murtagh J. General Practice, 3rd Edition, McGraw-Hill, Sydney, 2003.
  8. Reilly J, Silverman E, Shapiro S. ‘Chronic Obstructive Pulmonary Disease,’ in Kasper et al. Harrison’s Principle of Internal Medicine, 16th Edition (Chapter 242), McGraw-Hill, 2006.
  9. Talley NJ, O’Connor S. Clinical examination- A Systematic Guide to Physical Diagnosis, 4th Edition. MacClennan & Petty, Sydney 2001.

Chronic Bronchitis

Bronchitis is an inflammation of the bronchial tubes, the airways that carry air to your lungs. It causes a cough that often brings up mucus. It can also cause shortness of breath, wheezing, a low fever, and chest tightness. There are two main types of bronchitis: acute and chronic.

Chronic bronchitis is one type of COPD (chronic obstructive pulmonary disease). The inflamed bronchial tubes produce a lot of mucus. This leads to coughing and difficulty breathing. Cigarette smoking is the most common cause. Breathing in air pollution, fumes, or dust over a long period of time may also cause it.

To diagnose chronic bronchitis, your doctor will look at your signs and symptoms and listen to your breathing. You may also have other tests.

Chronic bronchitis is a long-term condition that keeps coming back or never goes away completely. If you smoke, it is important to quit. Treatment can help with your symptoms. It often includes medicines to open your airways and help clear away mucus. You may also need oxygen therapy. Pulmonary rehabilitation may help you manage better in daily life.

NIH: National Heart, Lung, and Blood Institute

Understanding the Difference Between Bronchiectasis and COPD

For many people living with impaired breathing, bronchiectasis and Chronic Obstructive Pulmonary Disease (COPD) may seem like similar terms. They each affect an individual’s ability to release air from the lungs and cause frequent coughing, breathlessness, and wheezing. In fact, it is not unusual for a person to experience symptoms of both bronchiectasis and COPD simultaneously. To find the best treatment to help manage your bronchiectasis or COPD symptoms, it is important that you understand the differences between the two lung conditions.

Bronchiectasis (brong-kee-EK-tuh-sis) is an irreversible, chronic condition where the airways in your lungs (bronchi) become damaged and abnormally widened from recurring inflammation or infection.

Common Signs and Symptoms of Bronchiectasis Include:

  • Chronic cough that produces mucus
  • Recurrent respiratory infections (e.g. tonsillitis, sinusitis, bronchitis, etc.)
  • Breathlessness and wheezing
  • General fatigue

COPD is similar to bronchiectasis in that it causes frequent pneumonias, inflammation, and permanent damage to your lungs. However, COPD is used as an umbrella term to describe other impaired breathing conditions, such as emphysema, chronic bronchitis, or asthma.

Differences Between Bronchiectasis and COPD

Bronchiectasis is caused by consistent inflammation and/or infection in the lungs whereas most COPD conditions result from smoking, allergies, or pollution.

Bronchiectasis causes airways to slowly lose their ability to clear out mucus, which makes your respiratory system more vulnerable to infection. COPD can cause tightening in the chest and shortness of breath, but certain conditions that fall under the category of COPD do not necessarily create excess mucus.

Bronchiectasis treatment and management involves a combination of antibiotics and airway clearance techniques to clear mucus from the lungs. COPD treatment can include the use of anti-inflammatory medications or inhalers.

There are many diseases and conditions that can hinder your ability to clear your airways and cause permanent lung damage. Understanding the signs and symptoms of bronchiectasis and COPD will allow you to start treatment early, so you live longer and breathe healthier for years. Learn more about the effects and treatment options for managing your bronchiectasis or COPD condition.

Discover how SmartVest helps to clear the airways of those living with bronchiectasis or other impaired breathing conditions, and find out whether the SmartVest Airway Clearance System is right for you!

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