Chronic Bronchitis

Chronic Bronchitis Definition

Chronic bronchitis is a disease characterized by coughing and expectoration during the course of three months per year, at least two years in a row.

Classification of the disease

According to the clinical picture, respectively the symptoms, chronic bronchitis is divided into the chronic un-obstructive bronchitis, chronic obstructive bronchitis, and chronic bronchitis with secondarily developed lung emphysema.

Epidemiology

Chronic bronchitis is a relatively frequent disease. 10-15% of the world’s global population suffers from it. It is important to stress that this disease is mostly related to smoking, and there are only few long-term smokers who do not have chronic bronchitis.

Cause of the disease

Factors that cause the occurrence of this disease can be divided into two main groups: external and internal factors.

External factors
The most important external factors that influence the occurrence of bronchitis are polluted air, smoking, and the respiratory tract infections.

Internal factors
The hereditary weakness of the respiratory mucosa, increased sensitivity to the environmental factors, disturbed regulation of the expansion and narrowing of the bronchi, as well as some other factors that are still unknown.

Pathology

The damage to the ciliated epithelium, whose function is the “hygiene“ maintenance of the respiratory airways, occurs and leads to the increase in the number of goblet cells that secrete mucus. This further leads to the increased mucus secretion, which can be clear, or thick and pussy. The corks of hardened mucus can be present in the smaller bronchi and obstruct the air flow.

An increase in the mass and numbers of the goblet cells that excrete the mucus is a characteristic sign for chronic bronchitis.

Chronic Bronchitis Symptoms

The main symptom of bronchitis is the cough and the content that is being expectorated. At the initial stages of the disease, the cough is rarer and usually occurs in the morning hours, right after waking up. Over time, the cough becomes more frequent, intensive, and the expectorated content is no longer clear.

The signs of a respiratory tract obstruction are the shortness of breath and wheezing. At the initial stages of the disease, these two signs only occur in cases of the acute worsening of the disease (acute infection), but when it comes to the progression of the disease into a chronic phase, shortness of breath and wheezing become more frequent, especially during greater physical efforts.

The final progression of the disease leads to the development of a secondary emphysema. The development of the emphysema, in combination with an already present bronchitis, leads to a permanently present shortness of breath, which indicates the respiratory system’s insufficiency, and is also accompanied by a permanent cough with expectoration.

Temporary worsening of this disease is followed by increased coughing and body temperature. Occasional complications and deteriorations lead to the accelerated development of the disease. Finally, chronic bronchitis leads to the respiratory insufficiency, which causes a permanent feeling of sleepiness, fatigue, and confusion.

Due to the decreased blood oxygenation, patients can also be cyanotic. In the advanced stage of the disease, patients usually have a digestive constitution and are edematous. The appearance characterized by a digestive constitution is a purple-blue skin tone, facial puffiness, bulging eyes, which is why they are usually referred to as the “blue bloaters”.

Complications of the disease

The development of a chronic pulmonary heart and a secondary pulmonary hypertension is possible.

Diagnosis of the disease

It is very important to carefully research the history of the disease, where very important data related to its inception, cough duration, the appearance of the expectorated content, and shortness of breath are revealed. In addition, it is important to ask the patient whether he or she is a smoker, how long has he or she been smoking, and how many cigarettes a day does he or she smoke. Workplace can also be a source of harmful substances.

The lung auscultation is certainly the most important part of a patient’s physical exam. Due to the respiratory tract obstruction, bronchial wheezing occurs during the exhalation. In addition, rattling occurs during the exhalation and inhalation. The exhalation is usually prolonged.

The tests of the lung function are very important in the diagnostics of a chronic bronchitis. Also, these tests help doctors to determine which bronchi are obstructed (large or small).

Chronic Bronchitis Treatment

For a successful treatment of this disease, it is necessary to stop exposing the lungs to the harmful factors, such as smoking and unfavorable climate. To the persons who suffer from this disease, it is recommended to go to areas with pleasant coastal climate as often as possible, especially in the winter.

In addition, an eventual, more prominent constriction of the bronchi needs to be treated with special medications – muscarinic receptor antagonists, beta-2 receptor antagonists.

If the disease worsens, which usually refers to the bacterial infection, it is necessary to take antibiotics.
There are special medications for the facilitated expectoration of the contents, which have doubtful efficacy. Today, most doctors recommend an increased intake of liquids (hydration), which has been shown as an effective way of facilitating the expectoration of the contents from the bronchi without any undesirable side-effects.

When it comes to the more serious conditions, which involve a drop in blood oxygen, the patients need to be given oxygen and their acid-based status and blood oxygenation must be measured on regular basis.