Chronic bronchitis. Symptoms, causes and treatment

Bronchitis Chronic is a persistent inflammation of the mucous membrane that lines the bronchi. It is mainly related to the inhalation of irritating and harmful substancessuch as cigarette smoke, gases and air pollutants.

The pathology usually manifests itself with productive cough (ie, with expectoration of mucus). Sometimes it is associated with respiratory distress.

What is meant by Chronic Bronchitis?

Chronic bronchitis is a persistent inflammation of the bronchi, that is, the branches of the respiratory tree that start from the trachea and reach the interior of the lungs.

The factor that most predisposes to chronic bronchitis is the smoke of the cigarette, But also the air pollution and prolonged exposure to inhalation irritants, chemicals or physical, which favor the maintenance of inflammation.

Chronic and acute bronchitis: what are the differences?

Chronic bronchitis differs from the acute form for several reasons. First of all, to be defined as chronic, the symptoms of bronchial inflammation must be present for at least three months in two years. It doesn't have to be months in a row.

It's more:

• Chronic bronchitis:
  • It results from repeated exposure to irritants, the most important of which is tobacco.
  • If not treated properly, over the years it can evolve into more serious forms, such as COPD.
• Acute bronchitis:
  • It is an inflammation mainly of infectious origin (generally, it is a complication of the common cold or flu).
  • If handled correctly, it tends to heal in a short time, leaving no sequelae.

Causes and risk factors

What happens in the presence of Chronic Bronchitis

The inflammatory process at the origin of chronic bronchitis predisposes to hypertrophy (that is, to further pathological development) of the mucus-secreting glands, located in the wall of the bronchi, from which two effects are derived:

1. Mucus hypersecretion: by increasing the volume and activity of the cells that produce mucous secretions, the latter is more difficult to eliminate and tends to stagnate, becoming more viscous.
2. Thickening of the walls of the bronchi by contraction of the small muscle cells that surround them or by excessive accumulation of mucus, with:
   • Reduction of the vibrating cilia that line airway mucosa, in numerical and functional terms. (Note: these structures, with their undulating movement, favor the expulsion of foreign bodies from the bronchial tree).
   • Limitation of airflow: in the presence of chronic bronchitis, it is difficult to get air in and out of the narrowed airways.

Chronic bronchitis: what are the main causes?

Chronic bronchitis is the result of a combination of several factors environmental y of behavior.

The most important cause of chronic bronchitis is the smoke of tobacco, especially that of cigarettes, which accelerates and accentuates the natural deterioration of respiratory function.

Other factors also make chronic inflammation of the bronchi more likely, such as:

• Passive smoke (promotes the inhalation of gases and particles).
• Exposure to irritating particles, fumes and vapors, dusts and chemicals, both at home and in the workplace (for example: silica or cadmium, gases and combustion products from fuels for cooking or heating).
• Air pollution (smog and fine environmental particles, emissions from motor vehicles, stoves, air conditioning systems, etc.).

Some people also seem to have a natural predisposition to chronic bronchitis, such as:

• Immunosuppression.
• Respiratory tract infections acquired in early childhood (especially if they are recurrent, especially severe and/or capable of negatively influencing the development of the respiratory tree), such as:
  • bronchiolitis;
  • acute bronchitis;
  • pneumonia;
  • pleuritis.
• Positive personal history or familiarity with:
  • allergies;
  • asthma;
  • other respiratory pathologies.

Symptoms of chronic bronchitis

Clinically, chronic bronchitis is defined by the presence of productive cough (accompanied by excessive production of mucus and expectoration of the same), for at least 3 or more months of the year, for 2 consecutive years.

Persistent cough may be associated with dyspnoea, described as increased effort to breathe or wheezing during even modest physical exertion (eg, walking). In chronic bronchitis, the sputum can be extremely thick and difficult to pass.

Inflammatory episodes

In the setting of chronic bronchitis, recurrence of inflammatory episodes is a sudden event, usually caused by inhaled irritants or an infectious cause. Flare-ups of bronchial inflammation cause a rapid worsening of respiratory symptoms (wheezing, tightness in the chest, chest pain, fatigue, and malaise). In some cases, this condition can be a medical emergency.

Chronic Bronchitis: Forms

simple chronic bronchitis

Simple chronic bronchitis is manifested only by coughing and excessive secretion of mucus.

Mucopurulent chronic bronchitis

Mucopurulent chronic bronchitis is characterized by the recurrence of respiratory infectious episodes, favored by the persistence of thick and viscous mucus (ideal substrate for the colonization of pathogens), at the level of the bronchi. In this form of the pathology, the sputum appears purulent.

Complications and associated disorders

Possible complications of chronic bronchitis

In some cases, if neglected and prolonged over time, chronic bronchitis tends to evolve progressively, giving rise to airflow limitation, which becomes increasingly marked and makes breathing difficult, even after small efforts.

This clinical picture is aggravated by the increased susceptibility to respiratory infections of viral, bacterial or fungal origin. These tend to heal slowly and can cause relapses accompanied by aggravated symptoms. As chronic bronchitis progresses, these episodes tend to become more frequent and may induce a significant inflammatory response.

Inflammation can also affect the lung, predisposing to the appearance of other pathological conditions, which are not entirely reversible, such as:

• bronchopneumonia;
• emphysema;
• chronic obstructive pulmonary disease (COPD).

Diagnosis

How is the diagnosis of Chronic Bronchitis made?

The diagnosis of chronic bronchitis is established by the general practitioner or referral pulmonologist based on:

• History: involves the collection of data and information that may be useful in formulating the final diagnosis (for example, smoking habit or presence of other risk factors, quality of respiration, frequency of symptomatic inflammatory episodes, etc.);
• objective examination: auscultation of the bronchi and lungs with the stethoscope confirms the presence of some characteristic signs of the clinical picture.

Instrumental investigations and other evidence.

In addition to the medical examination, it may be necessary to perform a chest x-ray, which shows the inflammatory state of the bronchi. This last situation can also be evaluated with a bronchoscopy.

Spirometry allows to determine the damage to the function respiratory secondary to chronic bronchitis. In fact, the test makes it possible to measure the amount of air that reaches the lungs with each inspiration and how much is expelled with expiration, in addition to establishing the time it takes to complete the entire act of breathing.

Treatment and Remedies

The goal of treatment for chronic bronchitis is limit exacerbations And what is more important, prevent the disease from progressing. In the case of COPD, there is currently no effective cure that allows the restoration of lost respiratory function.

In any case, the most appropriate therapeutic strategy must always take into account the individual indications established by the doctor, formulated in relation to the extent of the disorder, the symptoms and the personal needs of the patient.

Chronic bronchitis: what treatment is foreseen?

In the first place, the correct approach to chronic bronchitis involves remove the causes that cause it, such as smoking and exposure to pollutants.

To relieve symptoms and facilitate healing, supportive therapy includes a hydration suitable combined with repose. Drinking a lot favors the fluidization of mucous secretions.

Regarding medications for chronic bronchitis, the doctor may prescribe bronchodilators inhaled. These medications help the muscles of the bronchi to relax and promote the passage of air, improving respiratory capacity. The greatest effectiveness is obtained with early intervention and regular follow-up of therapy.

Other drugs that might be indicated are expectorant, which thin the mucus, facilitating its removal, in case it is difficult to expel it with a cough.

In some cases, chronic bronchitis may require hospitalization, to manage any problems, for example, with oxygen therapy, non-invasive mechanical ventilation (with face mask) and parenteral nutrition. Medications used primarily at the hospital level may include systemic corticosteroids (tablets or intravenously), antibiotics (if necessary, ie in the presence of concurrent bacterial infections), and mucolytics.

Prevention

Chronic bronchitis: some tips

• To prevent the onset and evolution of chronic bronchitis, It is of fundamental importance to reduce global exposure to tobacco smoke, dust in the workplace, and indoor and outdoor pollution.
• To prevent exacerbations, patients with chronic bronchitis are recommended to get regular vaccinations against influenza and pneumococcal pneumonia. In fact, these infectious diseases could aggravate already compromised respiratory function.

In everyday life, patients with chronic bronchitis may benefit from a few precautions:

• keep room in which we are well ventilated (on days when the air is highly polluted, instead, it is advisable to stay indoors, with the windows closed).
• Avoid active and passive cigarette smoke.
• Control the weight, so as not to force the respiratory system further.
• Practice a series of specific exercises to keep the respiratory muscles active and improve effort tolerance.