What is chronic bronchitis?
Bronchitis is inflammation of the breathing tubes. These are the airways called bronchi. This
inflammation causes too much mucus production and other changes. There are different types of
bronchitis. But the most common are acute and chronic.
Chronic bronchitis is long-term inflammation of the bronchi. It is common among smokers. People
with chronic bronchitis tend to get lung infections more easily. They also have episodes of acute
bronchitis, when symptoms are worse.
To be classified as chronic bronchitis:
You must have a cough and mucus most days for at least 3 months a year, for 2 years in a row.
Other causes of symptoms, such as tuberculosis or other lung diseases, must be ruled out.
People with chronic bronchitis have chronic obstructive pulmonary disease (COPD). This is a large
group of lung diseases that includes chronic bronchitis. These diseases can block air flow in the lungs
and cause breathing problems. The 2 most common conditions of COPD are chronic bronchitis and
emphysema.
What causes chronic bronchitis?
Chronic bronchitis is not caused by a virus or bacteria. Most experts agree that the main cause of
chronic bronchitis is cigarette smoking. Air pollution and your work environment may also play a role.
This is especially true if you also smoke.
Bronchitis symptoms often happen with other lung diseases, such as:
Asthma
Pulmonary emphysema
Scarring of the lungs (pulmonary fibrosis)
Sinusitis
Tuberculosis
Upper respiratory infections
What are the symptoms of chronic bronchitis?
Below are the most common symptoms of chronic bronchitis. But each person may have slightly
different symptoms.
Symptoms may include:
Cough, often called smoker’s cough
Coughing up mucus (expectoration)
Wheezing
Chest discomfort
People with chronic bronchitis often have a cough and make mucus for many years before they have
shortness of breath.
Chronic bronchitis may cause:
Disability
Frequent and severe infections that affect your airways
Narrowing and plugging of your breathing tubes (bronchi)
Trouble breathing
Other symptoms may include:
Bluish fingernails, lips, and skin because of lower oxygen levels
Wheezing and crackling sounds with breathing
Swollen feet
Heart failure
The symptoms of chronic bronchitis may look like other lung conditions or health problems. See your
healthcare provider for a diagnosis.
Definition/Description
Chronic Bronchitis (CB) is defined as a chronic cough
and sputum production for at least 3 months a year for 2 consecutive
years. [1]
It is covered under the umbrella term of Chronic Obstructive
Pulmonary Disease (COPD). The COPD spectrum ranges
from Emphysema to Chronic Bronchitis. Many patients have
characteristics of both, putting them somewhere along the spectrum. [1]
CB is the inflammation and excessive mucus build-up in the bronchi.
[2]
Emphysema occurs when the alveolar membrane breaks down .
The overall prognosis for most patients is poor, with many patients
being disabled from the progressive shortness of breath [3]. The
prevalence of the disease has a great impact on society and on health
care systems around the world.
Epidemiology
The occurrence of Chronic bronchitis
In the general population has been documented to vary between 3%
to 7% of healthy adults.
It is estimated to be as high as 74% among those diagnosed to have
COPD.
Subjects under the age of 50 years who are otherwise healthy and have
chronic bronchitis are at a higher risk of morbidity and mortality when
compared to healthy subjects.
The increasing prevalence of chronic bronchitis is thought to be
associated with increasing age, tobacco smoking, occupational
exposure, and socioeconomic status. [3]
Etiology
There are many known causes of chronic bronchitis.
The most important causative factor is exposure to cigarette smoke
either due to active smoking or passive inhalation. Other causes
include:
Inhaled irritants to the respiratory tract eg smog, industrial
pollutants, airborne chemicals (eg ammonia and sulfur) can cause
chronic bronchitis.
Repeated exposure to viral infections can cause chronic bronchitis.
People with an associated background in respiratory
diseases eg asthma, cystic fibrosis, or bronchiectasis have a higher
predisposition to develop chronic bronchitis.
Chronic gastroesophageal reflux is a well documented but less
frequent cause of chronic bronchitis[3].
There is also a genetic factor associated with COPD, it is a deficiency
in alpha-1-antitrypsin. This genetic marker is indicative of
Emphysema, but many patients on the COPD spectrum have
characteristics of both Emphysema and CB.[2]
Pathophysiology
Chronic bronchitis is thought to be caused by overproduction and
hypersecretion of mucus by goblet cells. Epithelial cells lining the
airway response to toxic, infectious stimuli by releasing inflammatory
mediators and eg pro-inflammatory cytokines. During an acute
exacerbation of chronic bronchitis, the bronchial mucous membrane
becomes hyperemic and edematous with diminished bronchial
mucociliary function. This, in turn, leads to airflow impediment because
of luminal obstruction to small airways. The airways become clogged by
debris and this further increases the irritation. The characteristic cough
of bronchitis is caused by the copious secretion of mucus in chronic
bronchitis. [3]
Image 2: Pseudostratified epithelium, highlighting the pseudostratified
epithelial cells, goblets cells (shown in blue), then
underlying connective tissue
Smokers with moderate COPD and CB had a greater number of
goblet cells in their peripheral airways [1], which increases the
potential of mucus in the lungs (a greater number of small airways
were blocked with mucus increases the severity of the disease). [1]
Mucus hypersecretion is one of the risks associated with cigarette
smoke exposure, viral infections, bacterial infections, or
inflammatory cell activation. When combined with poor ciliary
function, distal airway occlusion, ineffective cough, respiratory
muscle weakness, and reduced peak expiratory flow clearing
secretions is extremely difficult and requires high energy
consumption. [1]
