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Chronic Bronchitis
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Original Editors - Students from Glasgow Caledonian University's Cardiorespiratory Therapeutics Project.

Top Contributors - Lindsey Chisholm, Kelly D'Autremont, Lucinda hampton, Kim Jackson, Esraa Mohamed Abdullzaher,
Uchechukwu Chukwuemeka, Admin, Evan Thomas, Michelle Lee, WikiSysop and Fasuba Ayobami

Contents
1 Definition/Description
2 Epidemiology
3 Etiology
4 Pathophysiology
5 Clinical Manifestations
6 Evaluation
6.1 Treatment / Management
7 Nonpharmacological interventions.
8 Physiotherapy
9 Education
10 Exercise
10.1 Physical Fitness
11 Prevention
11.1 Avoiding Irritants
11.2 Practice Proper Hygiene
12 References
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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]

Clinical Manifestations
The clinical presentation can be an increased exacerbation rate, accelerated
decline in lung function, worse health-related quality of life and an increase in
mortality.[1] Common symptoms outlined by the British Lung Foundation include[2]:

Wheezing, particularly breathing out

Breathlessness when resting or active
Tight chest
Cough
 Producing more mucus or phlegm than usual

These symptoms would be persistent for at least 3 months a year for 2 consecutive years
to be considered Chronic Bronchitis.[1]

Evaluation
The most critical factor in the diagnosis of chronic bronchitis is a typical history to exclude
other possible diseases of the lower respiratory tract.

The investigations which assist in confirming the diagnosis of chronic bronchitis are:

Blood test: This is to see if your symptoms could be due to anemia, or to see if the
symptoms are due to the genetic marker alpha-1-antitrypsin deficiency.[4]
A chest x-ray in the elderly and when physical findings suggest pneumonia is
important.
A culture of the sputum when a bacterial infection is suspected is indicated.
The additional investigations which are a helpful measurement of oxygen saturation, and pulmonary function tests eg
spirometry[3]

Spirometry: how to take a lung function test

[5]

Treatment / Management
The primary aim of treatment for chronic bronchitis is to relieve symptoms, prevent complication and slow the progression of the
disease. The primary goals of therapy are aimed at reducing the overproduction of mucus, controlling inflammation and lowering
cough. These are achieved by pharmacological as well as nonpharmacological interventions.

The mainstay of pharmacological interventions are the following:

1. Bronchodilators: Short and long-acting β-Adrenergic receptor Agonists as well as Anticholinergic help by increasing the airway
lumen, increasing ciliary function and by increasing mucous hydration.
2. Glucocorticoids: Reduce inflammation and mucus production.Inhaled corticosteroids reduce exacerbation and improve quality of
 life.However, it is administered under medical supervision and for short
periods of time as long-term usage can induce osteoporosis, diabetes,
and hypertension.
3. Antibiotic therapy: is not indicated in the treatment of chronic bronchitis
however macrolide therapy has been shown to have anti-inflammatory
property and hence may have a role in the treatment of chronic
bronchitis.
4. Phosphodiesterase-4 inhibitors: decrease inflammation and promote
airway smooth muscle relaxation by preventing the hydrolysis of cyclic
adenosine monophosphate a substance when degraded leads to the
release of inflammatory mediators.

Nonpharmacological interventions.
Physiotherapy
The goal of the physiotherapist should involve education, improve exercise tolerance,
reduce exacerbations and hospitalization, assist in sputum clearance, and increase
thoracic mobility and lung volume.

Pulmonary rehabilitation and Respiratory Physiotherapyare important parts of treatment

for chronic bronchitis. See links for fantastic detail..

Education
Chronic bronchitis has a significant impact on morbidity and quality of life. Education of
the individual with CB by the treating clinical staff in terms of the presenting condition,
medication use, treatment options, and self-management may help the psychological
effects associated with having a chronic condition and promote a proactive approach to management.

The most critical nonpharmacological intervention is smoking cessation. Smoking cessation improves mucociliary function and
decreases goblet cell hyperplasia. Smoking cessation has also been shown to reduce airway injury resulting in lower levels of
exfoliated mucus in tracheobronchial cells.

Exercise
Regular exercise can have positive effects on the management, treatment, and prevention of CB and COPD. Aerobic exercise and
upper & lower limb resistance training have shown positive changes in the reduction of airflow obstruction, clearing of airways,
improved functional capabilities increased energy levels, and sputum expectoration. Exercise programs should be under the
supervision of the treating clinical team (eg physiotherpist) and a discussion with the general practitioner should be had before
taking part in any exercise program.[6]

Physical Fitness
Aerobic exercise and upper & lower limb resistance training have the ability to increase physical fitness, functional tolerance, energy
levels, and decrease concern over the shortness of breath, exacerbations, and hospital visits. Specific guidelines are put in place in
concern to exercise for individuals with chronic bronchitis and COPD. The Discussion should be held with the treating clinical team
before participation in any exercise program begins.

Prevention
There is presently no cure for CB. However, with lifestyle changes, education, and proper management it is possible to prevent
exacerbations of the condition.

Avoiding Irritants
Being aware of possible irritants within the household, workplace, and places of recreation can help reduce risk factors associated
with chronic bronchitis and reduce exacerbations. Irritants to be aware of can include dust, chemicals, vapors, air pollution, and
smoke. Proper respiratory protective equipment should be made readily available if contact with irritants in the workplace commonly
occurs. [7]

Practice Proper Hygiene

Practicing good hygiene can reduce the spread of germs, bacteria, and infections. This can help reduce the risk factors associated
with bronchitis and help reduce exacerbations of chronic bronchitis.[8]
Practical Assessment and Treatment of Cervicogenic Headaches
An online course by Ari Kaplan

Learn more on this topic

Related articles

Chronic Bronchitis - Physiopedia

Definition/Description Error creating thumbnail: Unable to save thumbnail to destination 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
Bronchitis
to Chronic Bronchitis - Physiopedia and it occurs when the airways become inflamed and the air sacs in your lungs are damaged. Emphysema occurs when your alveolar membrane breaks down
whereas CB is the inflammation and excessive mucus build-up in your bronchi.[2] Many patients have characteristics of both, putting them somewhere along the spectrum.[1] Normal
Condition Bronchitis can be defined as an inflammation of the bronchi. It is also noted to be an infection of the lower respiratory tract which, in general, will follow an upper respiratory
Lung Function and Anatomy The two lungs are organs responsible for respiration, air enters and leaves the lungs via main the bronchi, which are branches of the trachea. The lungs
tract infection. Acute bronchitis is an illness characterised by fever and cough which may or may not be productive(may or may not have mucus) and is found to be wheezy in nature.
supply the body with by oxygenated blood, infection.which allows us to live. lastThe pulmonary arteries thedeliver
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immediately. Statistics)
property
[8] is achieved
[9] Prognosis[edit ( Extrapolated editisPrevalence
by |bursts and turbulent
source] Acute --- Population
expiratoryis
bronchitis Estimated
airflow
self-limiting due toand theAngolaopening
resolves -- 488,384
and closing --- 10,978,5522
of the treatment Botswana
conjunction
managing COPD.with postural
There isdrainage.
a high The
level -- of theory
evidence behind the
the use
for44,448,4702 benefits of percussions
of pulmonary and vibrations
rehabilitation thatpeople
for it will assist
with COPD[5] --with the Strength
clearing of sputum stuck exerciseonwith the symptomatic
airways. ---There is
forlittle
in
-- 72,921
valve.
most of the
---
Oscillations 1,639,2312
instances. during South
expiration
Secondary
Africa decreases
pneumonia
1,977,303
is the ---
viscoelasticity
possible. Rare cases
Swaziland
properties
of acute of--respiratory
52,014
mucus, --- 1,169,2412
effecting
distress its syndrome Zambia
movement which
and
490,481 depends
respiratory on and
--- 11,025,6902
failure thehave endurance
oscillatingZimbabwe
been frequency.
reported
-- 163,343
in
areOscPEP
the
endorsed 1,2671,8602
is equally
literature.[1]
people as
Prevention
evidence
with COPD.[6]
Diagnosis of thisUse effect however,
of protein some
supplements, clientsin do believe it helps
combination withand withwith
exercise, sputum could expectoration.
also ofbe thebeneficial,Percussion refer is the
to all rhythmic
dietician. Musclesclapping that on are the chest orfor
required backarmof the
exercise client arewith also a involved
loose wrist in
effective
Of Paediatric asJust other like any
Airway
Bronchitis[edit
respiratory
Clearance
| editshould
disorder,
Technique
source]
the
Insoothing
diagnosis
(ACT)
paediatric
will
asbronchitis
PEP start Active
as well
theCycle
as
history
other Breathing
medical
patient,
Technique including
(ACBT)[8]. details
Different pertainingPEP to the
devices[edit disorder | Hands
edit (exposure
source] !.tobe irritants,
OscPEP - including
applied being
with to a
and cupped hands.
movement Thewall clapping be and therelaxing tobreathe
the client, each client conditions,
may have prevention
their own personal is always better
preference. than cure.
Vibrations consist should of while washed
the therapist's regularly hands
exposed to of
threshold-dependent
the chest
second-hand mechanism
during
smoke), respiration
lung
with a exam
high andandphysical
density
thus
steel
need to
examination.
"movable ball" Oxygen
that
often
is
compromises
saturation
interposed is
on a
the individual’s
important
funnel in circular
or evaluating ability
cone
to undertake
the severity the
between ofdailythe activities,
disease
exhalation along
tract
therefore
of with
the the exercise
device pulse prescription
rate,
causing a vibration
avoid the arm
are against
involving spreading
theexercise
client's of any
chest
needs viruses
ortoback and
beVarious otherprescribed.[7]
performing
carefully infections.[10]
fine movements A hand
Promote of should
the hands,
Effective be Inhaled
placed
down and overinwards,
the mouth while during the coughing,
client Inispeople andwith
exhaling theafterwashing a large ones' breath.hands [7]after a cough will
[11] breathless
Education aid
Education in theof the
temperature, and respiratory rate. tests can be used to diagnose bronchitis in Therapy[edit
patients who|present edit source] with prolonged coughing stable COPD
and shortnesswho remain
of breath. Chest or X-ray have This test is
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