Diagnosis is usually possible on the basis of the clinical picture. However, some investigations are required to assess the severity and to exclude other diseases.
Diagnostic investigations in the setting of bronchitis
- Microbiological and cytological examination of the sputum.
- Blood count examination
- X-ray of the chest
- Pulmonary function test
- Blood gas analysis (BGA) in the late stage
The detailed collection of medical history (anamnesis) can already bring directional clues to the disease. If the combination of cough, years of smoking, dust exposure and chemical irritants at work is found so the diagnosis of chronic bronchitis can be considered certain. Physical examination often reveals a so-called “barrel chest“. Listening to the lungs (auscultation) may reveal “rales” during inhalation and occasionally “wheezes” during exhalation. In chest x-rays (thoracic radiographs), pulmonary hyperinflation can be readily identified by markedly increased radiolucency. In addition, the diaphragm is pushed downward toward the abdomen by the pulmonary hyperinflation (diaphragmatic depression). On pulmonary function testing, both spirometry and whole-body plethysmography demonstrate the presence of chronic bronchitis and/or emphysema. Bronchoscopy is only useful when a mucus plug is obstructing the airways and cannot be expelled naturally by coughing. During bronchoscopy, the mucus plug is removed. Blood gas analysis is used to determine the oxygen level in the blood. Only in the advanced stage of the disease can a clear lack of oxygen in the blood be detected. Microbiological and cytological examination of the sputum detects colonization of the mucus with bacteria. Once the type of bacteria has been determined, targeted treatment with the correct antibiotic can be started if necessary.
Treatment of chronic bronchitis
Chronic bronchitis requires vigorous, persistent treatment, otherwise the sequelae already listed above will occur. If emphysema has already occurred, chronic bronchitis is particularly difficult to treat because the two conditions exacerbate each other. Smoking and spending time in smoky rooms or polluted air are particularly harmful to a sick person and significantly impair the chances of recovery. Special care must be taken to avoid hypothermia. Even a mild cold, which does little harm to a healthy person, can threateningly aggravate chronic bronchitis. The general treatment is the same as for acute bronchitis – strict ban on smoking, plenty of exercise in fresh air, regular inhalation over a long period of time. It is best to inhale with an inhaler Emser salt, chamomile decoctions and essential oils such as eucalyptus oil or also spruce needle extract. Physiotherapy with breathing exercises generally has a very beneficial effect and is recommended.
Treatment with medications
In addition, bronchodilator medications help. Various drugs (anticholinergics, short- and long-acting beta-2 agonists, and theophyllines) are suitable for dilating the bronchi. Depending on the severity of the disease, these substances can be administered individually or in combination. Cough suppressants should not usually be given because they prevent secretions from being cleared from the airways. If they cannot be dispensed with, they should never be given together with expectorants. Bacterial infections are treated with antibiotics. Once the chronic inflammatory process has begun, complete cure is hardly possible. However, giving up tobacco smoking can reduce the symptoms and halt the progression of the disease. Passive smoking is also unfavorable. Other harmful influences are cold (including cold drinks) or fog, as this increases the obstruction. Disregarding the doctor’s recommendation to stop smoking inevitably leads to pulmonary obstruction. Abundant fluid intake promotes mucus clearance. In elderly patients, care must be taken to prevent previously latent heart failure from becoming more severe. Other measures may include:
- Instructing the patient on proper medication use, especially metered dose inhalers.
- Gymnastic exercises to maintain or improve chest mobility.
- Endurance training (e.g., walking and cycling on level ground) with overall low to moderate exertion.
- In advanced stages oxygen administration according to the order
Prevention of chronic bronchitis
Since smoking is the main cause of the development of chronic bronchitis, not smoking is the most useful (and only) preventive measure.
