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Chronic Bronchitis

Brief Overview: Per UpToDate, “Chronic bronchitis is defined as a chronic productive cough over a defined period, classically for at least three months in each of two successive years, in a patient in whom other causes of chronic cough (eg, bronchiectasis) have been excluded. It may precede or follow development of airflow limitation. This definition has been used in many studies, despite the arbitrarily selected symptom duration. By age 35 to 40 years, cigarette smokers may develop chronic bronchitis and start to have intermittent exacerbations of their symptoms even in the absence of airflow obstruction.”

Prevalence: According to Pulmonary Advisor, “Chronic bronchitis affects an estimated 10 million people in the United States.3,4 It most often develops in individuals age 44 to 65 years.4 Women are more likely to develop chronic bronchitis than men. The prevalence of chronic bronchitis is 56.8 cases per 1000 women, compared with 28.8 cases per 1000 men.”

Etiology:

  • Cigarette smoking is the most common cause.
  • Long-term exposure to inhaled irritants causes airway inflammation and mucus gland hypertrophy.
  • Environmental factors such as air pollution, occupational dusts, and fumes contribute.
  • Recurrent respiratory infections may worsen disease progression.

Risk Factors:

  • Current or former smoking
  • Secondhand smoke exposure
  • Occupational exposure to dust, chemicals, or fumes
  • Air pollution or biomass fuel exposure
  • Older age
  • History of asthma or recurrent childhood respiratory infections

Commonly Associated Conditions:

  • Asthma
  • Pulmonary emphysema (COPD overlap)
  • Pulmonary fibrosis
  • Pulmonary HTN
  • Right-sided heart failure (cor pulmonale)
  • Anxiety, depression
  • OSA
  • GERD
  • Lung cancer
  • TB

Common Medications:

Medications aim to improve airflow, reduce mucus and inflammation, and prevent exacerbations.

  • Bronchodilators:
    • Short-acting beta-agonists (SABA): albuterol
    • Short-acting muscarinic antagonists (SAMA): ipratropium
    • Long-acting beta-agonists (LABA): salmeterol, formoterol
    • Long-acting muscarinic antagonists (LAMA): tiotropium, umeclidinium
  • Combination inhalers:
    • LABA/LAMA combinations
    • ICS/LABA or ICS/LABA/LAMA (for patients with frequent exacerbations or elevated eosinophils)
  • Other medications (selected patients):
    • Roflumilast (chronic bronchitis phenotype with frequent exacerbations)
    • Chronic macrolide therapy (e.g., azithromycin; specialist-directed)
    • Systemic corticosteroids and antibiotics during acute exacerbations

Common Labs, Imaging, and Tests:

  • Pulmonary function tests/spirometry
  • Chest x-ray
  • Chest CT
  • Pulse oximetry and arterial blood gases may be indicated
  • Alpha-1 antitrypsin testing
  • Additional blood tests may be indicated

Common Symptoms:

  • Chronic productive cough (often daily)
  • Thick sputum production
  • Shortness of breath with exertion
  • Wheezing or chest tightness
  • Fatigue
  • Frequent respiratory infections or exacerbations

Common Treatments:

  • Medication (see above)
  • Smoking cessation (most effective intervention)
  • Stepwise inhaler therapy based on symptoms and exacerbation risk
  • Pulmonary rehabilitation
  • Vaccinations (influenza, pneumococcal, COVID-19) as directed by healthcare provider
  • Supplemental oxygen therapy when indicated
  • Exacerbation action plans and early treatment strategies
    • Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.  

Physical Findings:

  • Wheezing or rhonchi
  • Prolonged expiratory phase
  • Decreased breath sounds
  • Cyanosis in advanced disease (“blue bloater” phenotype)
  • Signs of right heart strain in severe cases

Potential Complications and Contraindications:

  • Potential complications:
    • Recurrent COPD exacerbations
    • Acute respiratory failure
    • Pulmonary hypertension and cor pulmonale
    • Decreased exercise tolerance and frailty
    • Reduced quality of life
  • Contraindications / cautions:
    • Overuse of systemic corticosteroids (osteoporosis, diabetes, infection risk)
    • Increased pneumonia risk with inhaled corticosteroids
    • Sedatives and opioids may worsen respiratory drive
    • Medication adherence and inhaler technique are critical

General Health and Lifestyle Guidance:

  • Reinforce smoking cessation at every interaction
  • Encourage proper inhaler technique and adherence
  • Avoid respiratory irritants and poor air quality
  • Encourage gradual physical activity and pulmonary rehab
  • Maintain hydration to help thin secretions
  • Monitor sputum changes and seek care early for exacerbations
    • Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.  

Suggested Questions to Ask Patients:

  1. How often do you have cough and sputum production?
  2. Has the color or amount of sputum changed recently?
  3. How far can you walk before becoming short of breath?
  4. Any recent flare-ups, ER visits, or hospitalizations?
  5. Are you using your inhalers daily, and correctly?
  6. Do you currently smoke or have exposure to smoke or fumes?
  7. Are symptoms affecting sleep or daily activities?

Suggested Talking Points:

  • Chronic bronchitis is a form of COPD that causes ongoing mucus and cough.
  • Stopping smoking is the most important step to slow progression.
  • Daily inhalers help open airways and reduce flare-ups.
  • Recognizing flare-ups early can prevent hospitalizations.
  • Pulmonary rehab improves breathing and stamina.
  • Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.  

Sources:

This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.