Everything You Should Know About Chronic Bronchitis, Causes, Symptoms And Therapy

Persistent coughing with sputum indicates chronic bronchitis. Smoking is the most important risk factor. Those who ignore the signs risk serious lung disease.

In short, what is chronic bronchitis?

Chronic bronchitis means that the bronchi are permanently inflamed. According to the World Health Organization (WHO), bronchitis is considered to be chronic if the symptoms of cough and sputum persist for two consecutive years for at least three months each year.

The bronchi are the continuation of the trachea. It divides into two main bronchi at the lower end. These lead the breathing air into the two lungs. There, the bronchi branch out ever finer until they end in the microscopic small alveoli, where the actual gas exchange, ie the vital intake of oxygen and release of carbon dioxide takes place.

Approximately ten percent of the population suffer from chronic bronchitis during their lifetime. Smoking is considered the biggest risk factor (colloquially “smoker’s cough”), but there are also many other triggers, which is why a reduction in smoking behavior falls short.

The most important therapy measure for smokers is the smoke stop. Various medications, adapted sports and special breathing techniques can help additionally.

Chronic bronchitis can lead to COPD – a chronic obstructive pulmonary disease. The airways are then permanently constricted and alveoli are broken down (emphysema). Read more about it in the COPD guidebook and in the guide to emphysema.

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Causes and risk factors: How does chronic bronchitis develop?

Risk of tobacco smoke: Smoking is the leading cause of chronic bronchitis. Tobacco smoke damages the respiratory tract in different ways: First, it destroys the cilia in the bronchial mucosa. These normally transport mucus and pollutant particles contained therein and thus exercise a cleaning function. On the other hand, tobacco smoke promotes inflammatory processes, weakens the immune system and causes more mucus to be formed in the bronchi. Especially at night while lying down secretions accumulate, which leads to morning cough with sputum. Passive smoking also increases the risk of chronic bronchitis.

Air pollutants: Certain gases, dusts and vapors pollute some people in the workplace. These pollutants can also cause lung problems and cause chronic bronchitis.

Common respiratory infections: Bacterial and viral infections are more common in chronic bronchitis. It often remains unclear whether they are the cause or the consequence of the respiratory disease.

Genetic causes: A certain genetic component can be identified in chronic bronchitis and its consequences. Alpha-1-antitrypsin deficiency, which increases the risk of pulmonary emphysema and may be associated with symptoms of chronic bronchitis, cystic fibrosis, where lung involvement often begins as chronic bronchitis, and ciliary disorder, in which mutations are either missing or defective, are well characterized Formation of the cilia on the bronchial mucosa leads.

Other underlying diseases: Certain diseases are associated with chronic bronchitis. It is usually hard to recognize cause and impact. Examples are asthma, chronic sinusitis and pulmonary tuberculosis. A hyperreactive bronchial system, as is typical in people with an allergy, may in rare cases favor chronic bronchitis.

Is chronic bronchitis contagious?

Chronic bronchitis is not intrinsically contagious – unlike acute bronchitis, which is often the case. If respiratory tract infections occur as part of chronic bronchitis, they can be contagious.

Symptoms: How is chronic bronchitis noticeable?

The classic symptom of chronic bronchitis is coughing with expectoration of viscous mucus. The cough occurs especially in the morning.

Chronic bronchitis often begins insidiously and may initially go unnoticed. Because a clogged cough that lasts for a long time, sufferers often lead back to a supposedly harmless, perhaps “abducted” cold. They do not take the symptom seriously.

Chronic bronchitis can be fluent in COPD. If there is shortness of breath and tightness of the chest during physical exertion, this is a possible sign that COPD has already developed. However, there may be other causes behind such symptoms, such as angina pectoris.

When is a bronchitis chronic?

According to the WHO definition, it is a chronic bronchitis if the symptoms of coughing and expectoration occur for two consecutive years for at least three months a year most days of the week.

What is an exacerbation?

Doctors speak of an exacerbation when the patient’s complaints suddenly worsen. This occurs especially in advanced disease and during the cold season. In the majority of cases respiratory infections are the trigger. If very severe COPD is present, an exacerbation can be life-threatening.

Important: Take respiratory symptoms seriously. See the doctor if symptoms persist like coughing persistently or if shortness of breath occurs.

Chronic bronchitis: What are the consequences of the disease?

If chronic bronchitis progresses, this can have negative consequences:

Pulmonary emphysema: Pulmonary emphysema mainly affects the pulmonary alveoli of the lungs. They are indispensable for the absorption of oxygen. In pulmonary emphysema, they gradually merge into larger bubbles, the walls of the alveoli are degraded. Air remains trapped in the lungs. In addition, the inner surface of the lung continues to decrease. Although the respiratory muscles become more active, the gas exchange remains insufficient. This creates the feeling of shortness of breath or shortness of breath. Emphysema can not be undone. Read more in the guide Counselor Lungenemphysem.

Right heart failure (weakness of the right ventricle): In pulmonary emphysema, the blood vessels in the lungs are partly degraded, sometimes narrow. The blood must flow through fewer and narrower vessels. This is only possible by increased pressure, a pulmonary hypertension arises. The right ventricle of the heart needs to apply more force to pump the blood into the lungs. The heart enlarges, the muscle mass increases, it does not work more efficiently. This leads to right heart failure with symptoms such as shortness of breath and swollen legs.

Diagnosis: How to recognize a chronic bronchitis?

Information on complaints, medical history and lifestyle of the person concerned provide the doctor with first clues. Next, he listens and pats the patient’s chest. Under certain circumstances, a whistling or humming noise can be heard when exhaling, with secretion in the bronchi you can hear rattling breath sounds even during inhalation.

The diagnosis of chronic bronchitis is essentially based on the information provided by the patient. However, the doctor must rule out other diseases as a possible cause of the symptoms, for example, asthma, pneumonia, pulmonary embolism, lung cancer, tuberculosis or heart disease. Different investigations may be required. Chronic cough can also be a side effect of certain medications (antihypertensive drugs: ACE inhibitors) and is often associated with heartburn and reflux. More in the guidebook gastroesophageal reflux disease.

It is important to recognize the onset of bronchoconstriction as early as possible so that the disease is still treatable. Therefore, the doctor checks the lung function with a lung function test, spirometry. The patient blows with maximum force into a meter, after he has inhaled deeply. Among other things, this method is used to determine the characteristic value “FEV1”: the forced exhaled (exhaled) volume in the first second. The FEV1 value in relation to the total exhaled air (so-called expiratory, forced vital capacity, FVC) provides information on whether the airways are narrowed or how much the breathing is impaired. Read more in the text Spirometry. With the help of whole-body plethysmography, the bronchial constriction and the extent of pulmonary hyperinflation can be recorded more accurately and also during quiet, normal breathing. A whole body plethysmography is usually performed only by the lung specialist.

A blood gas analysis can be used by the doctor to check the oxygenation of the organism and the exhalation of the carbon dioxide.

Exercise tests (bicycle or treadmill ergometry, spiroergometry) often show changes in lung function more clearly and earlier than at rest.

If an infection is suspected, the doctor can also have a sample of the morning sputum (sputum sample) examined for germs and make an X-ray of the lung – the latter can also make a bronchial carcinoma visible.

Furthermore, if necessary, diagnostic procedures such as a blood sample, a bronchoscopy (lung reflection) or an ECG (electrocardiogram) are eligible.

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Therapy: What helps with chronic bronchitis?

Stop Smoking / Exposure Stop: Anyone who stops smoking can slow the progression of chronic bronchitis. Already three days after the last cigarette, the lung function improves. Over time, coughing subsides, the bronchi make less mucus. The lung cancer risk is reduced significantly. Those exposed to other pollutants in the air should try to avoid them in the future.

Medications: They do not fight the cause of chronic bronchitis. But they can alleviate symptoms and improve well-being. The exact therapy depends, among other things, on the severity of the disease. With a low severity of COPD, the doctor prescribes short-acting bronchodilating drugs (beta-sympathomimetics or anticholinergics). The patient can take them if necessary when he feels a need for air. If the disease progresses, usually long-acting bronchial dilating sprays are added, which the patient uses regularly. In addition, the doctor may prescribe a cortisone preparation. Cortisone has anti-inflammatory effects. You can read more about the treatment of COPD in the guidebook COPD.

Further measures

Respiratory Physiotherapy: Special breathing techniques (such as the so-called “lip brake”) and a posture that facilitates breathing contribute to maintaining quality of life and resilience despite impaired lung function.

Exercise: Physical training is a central part of the therapy. Anyone who practices adapted sport – for example in a lung sports group – can best maintain the resilience and functionality of their body. Regular physical activity also reduces the risk of exacerbation, ie a sudden worsening of bronchitis symptoms. The sport should take place under medical supervision, so that the patient is not overwhelmed.

Diet: Overweight influences the course of the disease as well as underweight. Especially the latter is accompanied by an unfavorable prognosis. An adapted diet should be done in collaboration with a nutrition expert.

Healing chances: is a chronic bronchitis curable?

Chronic bronchitis can completely recede in the early stages. Thus a cure is possible in principle. The decisive factor is that those affected eliminate smoking or other inhaled pollutants. However, if the bronchi are already constricted, so that a COPD has developed, the disease can no longer be completely cured. However, the course and the life expectancy can be positively influenced – by a consistent therapy.

How Does The Doctor Diagnose Pulmonary Edema?

Pulmonary Edema can be manifested by sudden onset of severe breathlessness, rattling breath and coughing attacks.

Causes: What causes pulmonary edema?

The cause of pulmonary edema is either an increase in pressure within the pulmonary vessels or an increase in the permeability of the pulmonary vascular walls. Sometimes combinations of both causes are present.

Cardiac Pulmonary Edema

When the pressure within the vessels increases, it is mostly due to heart disease. One speaks of a cardial pulmonary edema. For example, a heart attack, an inflammation of the heart muscle, a disease of the coronary vessels or too high a blood pressure in pre-existing heart failure underlying.

These diseases weaken the left ventricle. As a result, they can not pump the oxygen-rich blood provided by the lungs fast enough into the body. The blood builds up in the pulmonary vein. The congestion increases the pressure on the blood vessels. As a result, blood fluid escapes from the vessels and is forced into the lung tissue. The walls of the blood vessels work like filters and allow only the liquid to pass.

The remaining blood components, such as red blood cells or other cells, are held back. The fluid first accumulates in the interstices of the cells and can then penetrate into the interior of the alveoli. As a result, they can perform their task increasingly poorly and oxygen uptake is becoming increasingly difficult.

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Altitude Pulmonary Edema

A special feature of the pulmonary edema was the so-called high-altitude edema. It is triggered in mountain climbing at high altitude in the first two to three days by a combination of oxygen deficiency and low air pressure. The vessels contract and cause an increase in blood pressure, which overloads the left ventricle and creates a backlog.

Non-cardiac pulmonary edema

In non-cardiac pulmonary edema, the most common cause is damage to the membranes of the fine pulmonary capillaries. As a result, they lose part of their barrier function; blood fluid, together with smaller cell components, can penetrate into the tissue of the lung. The more effective the lymphatic vessels can initially remove the excess fluid, the slower the development of symptoms.

In most cases, ARDS (Acute Respiratory Distress Syndrome) is the cause of membrane damage. In this case, the lungs react to massive damage, for example from infections with viruses, inhalation of toxic gases, medication, severe burns, serious cardiovascular shock or blood poisoning. Rarely, pulmonary embolism, overdose in anesthesia, or stroke can increase membrane permeability.

“Another cause is damage to the liver and kidneys, which leads to a drop in albumin in the blood – a specific blood protein,” says K√∂hler. Due to the lack of protein, the blood fluid can not be kept in the necessary amount in the blood vessels and thus reaches the cell gap to the outside.

Diagnosis

For diagnosis, the doctor asks questions about the underlying and concomitant diseases of the heart, lungs and other organs. When listening to the lungs with the stethoscope rattling noises fall on, which sometimes are already audible with the naked ear. An x-ray examination can be used to determine whether water is actually in the lungs. Important indications for pulmonary edema include accelerated breathing, increased heart rate and blueing of the skin and mucous membranes. An ECG, echocardiography and other examinations target the underlying cause.

Therapy: How is pulmonary edema treated?

Pulmonary edema is a serious, potentially life-threatening condition requiring intensive medical treatment. Patients should be transported to the hospital as soon as possible. As a first measure, an upper body and lower legs are helpful. As a result, the blood flows back to the heart slower, so this is relieved.

Breathing can be assisted by the delivery of oxygen via a nasogastric tube or a mask. In an advanced stage, positive pressure ventilation, in some cases artificial respiration is necessary. Most patients are supplied with painkillers and tranquillizers.

Dehydrating medications (diuretics) ensure that the water drains from the tissue. This not only improves the oxygen exchange at the alveoli, but also relieves the blood pressure by reducing the volume of fluid and thus reduces the burden on the heart. Drugs that dilate the vessels lower the pressure on the heart, improving the oxygen supply.

All other measures depend on the underlying cause. In case of height elevation edema sufferers should descend as soon as possible. In addition, oxygen delivery, vasodilating drugs, and positive pressure ventilation may help.