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Chronic bronchitis  

What is chronic bronchitis?

It is a persisting inflammation of the bronchial tree (air passages) of the lungs. It is a potentially dangerous problem because it starts so quietly that many people do not realise that they have it. Repeated irritation thickens and damages the delicate lining of these important tubes. This leads to lots of mucus and thus narrowing of the tubes.

What are the symptoms?

The main symptom is a morning cough with sputum (phlegm). Smokers may consider this to be a normal smokers' cough, but there is nothing normal about it. As time goes by, this productive cough increases.

Later on, wheezing and breathlessness become a problem. If you are breathless when you exert yourself, you probably have significant lung damage.

What are the causes?

• Smoking is the main cause.
• People who work in dusty atmospheres are also at risk. Air pollution is a minor factor.

At first the bronchitis gets worse with bad colds or influenza, but eventually even a mild cold can bring on a nasty flare-up. Colds or other infections can cause deterioration, especially in winter. However, chronic bronchitis is not caused by chronic infection. It is usually caused by chronic irritation from smoke.

What are the risks?

• Once bronchitis is chronic, a vicious cycle is established so that increasing infections and lung damage occur.
• The end result is severe permanent lung damage and then heart failure.

How common is the problem?

In Australia about 4500 people die of chronic bronchitis each year.

What is the treatment?

Self-help

If you smoke, you should stop. This is the vital first step-it will stop further damage. The lungs may return to normal. Avoid smoke-filled rooms.

If you work in a polluted or dusty atmosphere, it would be wise to change your job. A warm, dry climate is preferable to a cold, damp place: it may make you feel more comfortable and may make you less susceptible to winter colds and 'flu'.

Avoid close contact with people with colds, since any viral respiratory infection is a problem to your lungs.

Medical help

Prevention of more infections is important. This may be achieved by giving high doses of vitamin C, anti-influenza injections and antibiotics. Your doctor may prescribe small doses of antibiotics throughout the winter months or may advise you to take a full dose at the first sign of a flare-up. The reason for this is that bacterial infection soon complicates the viral infection.

See your doctor as soon as possible if you notice your sputum changing to a yellow or green colour.

If you have wheezing and breathlessness, an aerosol inhaler will be prescribed if tests show that your breathing capacity is reduced.

Your doctor can help you with techniques to stop smoking.

Physiotherapy can help if you have difficulty coughing up sputum.

Copyright 1995: John Murtagh, Professor of General Practice
Monash University, Melbourne, Australia