Chronic bronchitis is a permanent inflammation of the respiratory tract that mainly affects smokers and former smokers. In Germany, about 20 percent of all adult men are affected by chronic bronchitis, which can severely limit the quality of life, especially in advanced stages.
When is bronchitis chronic?
Chronic bronchitis presents the same symptoms as acute bronchitis. However, according to the World Health Organization (WHO), it is called chronic bronchitis only when there are at least three months of cough or other bronchitis signs over the period of two years (one year for children). Smokers are much more affected by this disease than non-smokers. Men are two to three times more likely to develop the disease than women. The incidence of disease increases with age and peaks in the 7th decade of life.
Chronic bronchitis is classified into three degrees of severity:
- Simple chronic bronchitis: mucous white sputum without bronchial obstruction (so-called smoker’s cough).
- Chronic obstructive bronchitis: sputum with obstruction due to viscous sputum (dyscrinia) and mucosal swelling.
- Obstructive emphysema: Like chronic obstructive bronchitis, but additionally with increased residual volume and decreased gas exchange area.
Causes of chronic bronchitis
Repeated occurrence of acute bronchitis can lead to chronic bronchitis. But chronic bronchitis can also develop over time after other diseases, for example, whooping cough, as well as through chronic damage (tobacco smoke, dusty air in quarries, grinding mills, spinning mills, weaving mills, bakeries, mills, etc.).
Chronic bronchitis also develops more frequently in cases of congestion in the pulmonary circulation, chronic heart and kidney diseases, hunched backs and pleural adhesions. In the elderly, it is not uncommon to develop pulmonary hyperinflation, which in turn is a frequent cause of chronic bronchitis.
Symptoms of chronic bronchitis
Typically, the affected person initially has hardly any symptoms for years. The cough with mucous-white sputum, which appears mainly in the morning, is not taken seriously by most. The excessive mucus production obstructs the small airways (bronchioli), makes exhalation difficult and provokes coughing. Persistent severe coughing can cause the alveoli to become over-expanded.
Over the years, the constant irritation and inflammation of the airways promotes the remodeling of the lung tissue. This process promotes the overinflation of the alveoli and enables the development of a flatulent lung. The pathologically altered lung tissue cannot sufficiently ensure normal gas exchange. Those affected therefore complain of shortness of breath, which initially occurs only under exertion, but later also at rest.
In addition, people with chronic bronchitis are much more prone to bacterial infections, which are accompanied by high fever, a deterioration in general condition and purulent sputum. This bacterial infection of the pre-damaged tissue is called an exacerbation of infection.
End-stage chronic bronchitis
Chronic bronchitis develops as a result of this hyperinflation and the narrowing of the airways by the mucus. After years of being free of symptoms, the patient slowly develops seizure-like shortness of breath on exertion. Acute, infection-related exacerbations of chronic bronchitis due to bacterial colonization of the pre-damaged tissue occur more and more frequently.
In the final stage of the disease, oxygen deficiency, carbon dioxide accumulation, right heart strain and later right heart weakness (cor pulmonale) are added. Focal pneumonia occurs when bronchial inflammation spreads to the surrounding lungs. Pulmonary abscesses and pulmonary gangrene may occur in the dilated alveoli.
