Brief overview
- Symptoms: Frequent coughing with sputum (increased mucus production); later shortness of breath on exertion or even without exertion, reduced performance; in case of complications, cardiac arrhythmia, bluish skin and nails due to lack of oxygen and oedema
- Treatment: Stop tobacco consumption, non-medicated by inhalation, tapping massages, respiratory gymnastics; medicated with bronchodilators or cortisone; antibiotics for secondary bacterial infection
- Causes: Primarily smoking, less frequently genetic factors or environmental influences such as pollutants
- Diagnosis: Medical history (anamnesis), physical examination with listening to the lungs, lung function test (spirometry), chest X-ray, computer tomography (CT), examination of sputum and blood gases, electrocardiography (ECG) and echocardiography (cardiac ultrasound) in case of complications if necessary
- Prognosis: Rarely curable, often good prognosis in the early stages with treatment; in advanced bronchitis (COPD) there is a risk of complications such as right heart failure or cardiac arrhythmia as well as shortness of breath, the prognosis is then significantly worse
- Prevention: Stop smoking, avoid contact with irritants, lead a healthy lifestyle with regular exercise; hereditary chronic bronchitis is almost impossible to prevent
What is chronic bronchitis?
Doctors distinguish between two forms of chronic bronchitis:
- Simple (non-obstructive) chronic bronchitis: Here the bronchial tubes are chronically inflamed. It is usually the milder of the two forms of the disease.
- Obstructive chronic bronchitis: Here, the chronically inflamed bronchial tubes are additionally constricted (obstruction = obstruction, blockage). Doctors also speak of chronic obstructive bronchitis (COB), which is often referred to as “smoker’s cough”.
Obstructive chronic bronchitis usually develops into chronic obstructive pulmonary disease (COPD). The alveoli are then also over-inflated (pulmonary emphysema). COPD is therefore chronic obstructive bronchitis in combination with emphysema. The disease is one of the most common causes of death worldwide.
Who is affected by chronic bronchitis?
In Germany, around 10 to 15 percent of adults have simple chronic bronchitis. Smoking is the biggest risk factor: every second smoker over the age of 40 has chronic bronchitis. Men contract the disease much more frequently than women.
Obstructive chronic bronchitis affects around two to three percent of women and four to six percent of men. Almost all patients have smoked or continue to do so even after being diagnosed.
Symptoms
If the chronically inflamed bronchial tubes are additionally irritated (e.g. by air pollutants, tobacco smoke, infections, etc.), the symptoms usually worsen.
Coughing with more or less sputum is also a typical sign of acute bronchitis. In chronic bronchitis, however, the symptoms are much less pronounced.
The patient’s general condition is usually good in chronic bronchitis. There are no or hardly any breathing problems.
As the disease progresses, simple chronic bronchitis often develops into chronic obstructive bronchitis, which means that the inflamed bronchial tubes become increasingly constricted. This impedes the flow of air when breathing in and out.
If the constriction is mild, shortness of breath only occurs under stress, for example when walking. However, as the disease progresses, the airways become increasingly narrow. This makes breathing increasingly difficult. Even with moderate exertion (such as climbing stairs), patients quickly become breathless. In the worst cases, obstructive chronic bronchitis causes shortness of breath even without physical exertion (i.e. at rest).
The difficulty in breathing costs patients a lot of energy. As a result, their performance is reduced.
In all stages of obstructive chronic bronchitis, there is a risk of symptoms of pulmonary emphysema: As pulmonary alveoli overstretch and perish and the respiratory capacity of the lungs decreases permanently. The lungs become over-inflated. Chronic bronchitis has then developed into COPD. The transition is fluid.
Chronic bronchitis impairs the lungs’ self-cleaning ability. Patients are therefore susceptible to additional bacterial respiratory infections. The risk of pneumonia is also increased.
Can chronic bronchitis be treated?
Smoking is the most important trigger for chronic bronchitis. Treatment is therefore only successful if those affected give up tobacco completely (“stop smoking”). Passive smoking should also be avoided. Other harmful substances that irritate the bronchial tubes should also be avoided wherever possible. If the patient comes into contact with such irritants at work, retraining may be advisable.
The further treatment of chronic bronchitis depends on the severity of the disease. In principle, there are non-pharmacological and pharmacological measures.
Non-pharmacological measures
Special breathing techniques are also useful. Doctors often recommend the “lip brake”, for example: the patient exhales through almost closed lips. This creates higher pressure in the bronchial tubes, which reduces their collapse. Breathing exercises are also helpful and support breathing. A physiotherapist will show the patient suitable exercises.
Chronic bronchitis encourages many patients to take it easy. This is particularly true if they also have constricted airways (obstructive chronic bronchitis). However, it is very important that patients remain physically active. Regular exercise and sport increase general resilience and quality of life. If the chronic bronchitis is already more advanced, it is best to exercise under medical supervision.
A healthy, balanced diet is also very important. It generally promotes good health. It is particularly important for underweight patients. Obstructive chronic bronchitis in particular can be so debilitating that patients lose a lot of weight. A higher-calorie diet is then advisable. Also make sure you drink enough fluids.
Medication for chronic bronchitis
Sometimes patients are given so-called glucocorticoids (“cortisone”). These inhibit the chronic inflammation in the bronchial tubes and have a decongestant effect on the mucous membrane. The active ingredients are usually inhaled.
If the chronic bronchitis is also accompanied by a bacterial infection, the doctor will prescribe antibiotics.
(Obstructive) chronic bronchitis sometimes worsens acutely (exacerbation). Possible triggers are, for example, acute infections with bacteria or viruses. This requires rapid and intensive treatment by a doctor, possibly in a hospital.
Some patients report that expectorants (such as acetylcysteine or ambroxol) do them good. However, the effectiveness of these medications has not been clearly proven scientifically.
What causes chronic bronchitis?
Chronic bronchitis is primarily a “smoker’s disease”: tobacco smoke directly damages the mucous membrane of the airways. It becomes inflamed and produces more viscous mucus.
Tobacco smoke also inhibits the movement of the cilia in the bronchial tubes. These normally transport mucus, germs and other foreign substances towards the exit (windpipe and throat). In smokers, however, they are no longer able to do this sufficiently.
Rarer causes of chronic bronchitis
Pollutants in the environment and at the workplace are less common causes of chronic bronchitis. These are, for example, gases, dusts and vapors that irritate the respiratory tract. Examples include sulphur dioxide, nitrogen oxides, ozone, cadmium, silicates, wood, paper, grain and textile dusts.
Chronic bronchitis is also rarely caused by so-called endogenous factors. These are factors that lie with the patient themselves, for example genetic factors. In some cases, a congenital deficiency of the enzyme alpha-1-antitrypsin triggers chronic bronchitis. A so-called antibody deficiency syndrome is also a possible cause. Other people suffer from a congenital disorder of the cilia in the airways. They often develop obstructive chronic bronchitis in childhood.
In some patients, a severe acute respiratory infection has developed into chronic bronchitis. This risk exists in particular if those affected do not have the infection treated or have it treated late – in other words, if an infection is carried over. Repeated respiratory tract infections also contribute to the development of chronic bronchitis.
How can chronic bronchitis be diagnosed?
If chronic bronchitis is suspected, an experienced family doctor or a pulmonologist is the right person to contact.
The doctor will first talk to the patient in detail to obtain their medical history (medical history interview). Possible questions include:
- What exactly are your symptoms? How long have you had the symptoms?
- Are you a smoker?
- Since when and how much do you smoke?
- Have you been/are you exposed to any particular pollutants, for example at work?
- Do you have any pre-existing or underlying conditions?
This is followed by a physical examination. Among other things, the doctor will listen to your lungs with a stethoscope. He or she will usually hear rales. If obstructive chronic bronchitis is present, a so-called wheezing sound can generally be heard. This is a whistling sound when exhaling. It indicates constricted airways.
Pulmonary function test
The doctor uses a lung function test to check how well the patient’s lungs are working. This is particularly important in the case of obstructive chronic bronchitis. Various methods are available, such as spirometry. Lung function can be tested even more precisely with a so-called body plethysmography.
X-ray examination of the chest
X-rays of the chest (chest X-ray) are primarily used to rule out other causes for the symptoms. For example, lung cancer and pulmonary tuberculosis cause similar symptoms to chronic bronchitis. The same applies to foreign bodies in the lungs and so-called bronchiectasis (bulging of the bronchial tubes).
Chronic bronchitis leaves irregular, diffuse streaks or band shadows on the X-ray image. Doctors refer to this as squamous atelectasis or “dirty chest”. The shadows are caused by there being too little or no air in the alveoli. As a result, the corresponding lung area is reduced or not expanded at all.
Further examinations
Computed tomography (CT) is sometimes used to visualize the chest. This allows bronchiectasis to be ruled out, for example.
The doctor sometimes examines a sample of the coughed up sputum in more detail. This can be used, for example, to determine whether a bacterial infection has also spread in the airways.
Doctors often measure the blood gases, i.e. the oxygen and carbon dioxide content as well as the pH value of the blood. The results can be used to estimate how advanced chronic bronchitis is. This is particularly important in the case of obstructive chronic bronchitis.
Chronic bronchitis usually only develops at an advanced age. However, if the patient is younger than 45 and/or has a family history of COPD, the cause is often a hereditary deficiency of alpha-1-antitrypsin (antitrypsin deficiency). A congenital deficiency of certain antibodies (antibody deficiency syndrome) may also be the cause. A blood test will provide the relevant information.
What is the success of treatment for chronic bronchitis?
Chronic bronchitis can rarely be cured – provided it is still at a very early stage and the trigger (smoking, other harmful substances, etc.) is strictly avoided. But even simple chronic bronchitis usually lasts a lifetime. With appropriate treatment, life expectancy is generally very high and those affected live to a ripe old age – simple chronic bronchitis does not shorten life expectancy.
However, in just under 20 percent of patients, simple chronic bronchitis develops into obstructive chronic bronchitis over time. The airways are then permanently constricted. Medication (such as sympathomimetics) can only partially reverse this narrowing or at least alleviate the symptoms.
Another dreaded complication is right heart failure (cor pulmonale).
In addition, chronic bronchitis generally makes patients more susceptible to infections such as influenza and pneumonia. Such complications usually significantly worsen a patient’s condition. Doctors therefore recommend that people who have obstructive chronic bronchitis are regularly vaccinated against influenza and pneumococci (common causes of pneumonia).
Can chronic bronchitis be prevented?
As smoking is the main cause of chronic bronchitis, the best way to prevent the disease is to greatly reduce or completely stop smoking. Only “quitting smoking” prevents excessive irritation of the mucous membranes in the airways, especially the bronchial tubes.
Avoid irritants that are possible triggers. Talk to your employer if you suspect that there are substances in your professional environment (at work) that irritate your airways. It may be necessary to restructure or change jobs.
If there are hereditary risk factors, chronic bronchitis can hardly or not at all be prevented. Lead as healthy a lifestyle as possible and exercise regularly to prevent complications.
