Chronic Bronchitis – The Smoker’s Cough

What is chronic bronchitis?

Chronic bronchitis is defined as a persistent cough with sputum production for at least three months in at least two consecutive years in the absence of any other identifiable causes.

Chronic bronchitis is also commonly known as the smoker’s cough. This is due to the fact that chronic bronchitis is so common among the smokers.  

If chronic bronchitis persists for years and years it can lead to three outcomes:

1. It can progress on to Chronic Obstructive Pulmonary Disease (COPD).
2. It can lead to cor pulmonale (The enlargement of the right heart as a result of pathology in the lungs) and eventually heart failure.
3. It can result in changes in the lining cells of the respiratory tract (metaplasia and dysplasia) providing a good environment for cancerous lesions to grow.

How does one develop chronic bronchitis?

As mentioned earlier, chronic bronchitis is a common condition among the habitual smokers. The primary factor that initiates the origin of chronic bronchitis is long term exposure to inhaled irritants such as the chemicals in tobacco smoke, dust, cotton, and silica.

This causes the glands in your airways to increase in size (hypertrophy) and number (hyperplasia). The glands found in the airways are mucous secreting cells. As these glands increase in size and number, the amount of mucous secreted also increases. Due to the hypersecretion of mucus, the body develops a reflex to get rid of this mucus containing the irritants out of your body. This results in a cough with a sputum production. This excessive mucus production will eventually lead to obstruction of the airways.

The ongoing inflammation continuously damages your airways, causing scarring and thickening of the bronchial walls. This results in fibrosis of your airways, which also contributes to the narrowing of the airways and limitation of airflow.

At the same time, the excessive mucus lying in your airways predisposes you to catch recurrent respiratory tract infections. Cigarette smoke also interferes with the action of the cilia on your respiratory tract mucosa (The function of cilia is to sweep away the germs out of your body.), and inhibits the action of the cells in your bodies to fight against the bacteria. These factors predispose you to develop recurrent respiratory tract infections leading to acute exacerbations of bronchitis.

What are the clinical features?

The cardinal symptom of chronic bronchitis is a persistent cough with sputum production. With progression of the disease, difficulty in breathing on exertion develops.

Chronic bronchitis can also result in a low grade fever with chills.

Other symptoms of chronic bronchitis include:

• Sore throat
• Runny nose
• Body aches and pains
• Generalized body weakness

Treating chronic bronchitis

• The first step in treating bronchitis is to stop smoking.
• Paracetamol or Ibuprofen – To treat the fever, body pains, and headaches.
• Mucolytic – These reduce the thickness of the mucus and make it easy for you to cough out this mucus. These are often prescribed to patients with chronic bronchitis and chronic obstructive pulmonary disease. They reduce the acute exacerbations and the number of missed working days.
• Inhalers – Salbutamol and Albuterol can help to dilate the bronchi and bronchioles to ease the air flow through them. It helps you in your breathing.
• Cough suppressant – The cough of chronic bronchitis is troublesome and may disturb your sleep. If it does, your doctor may prescribe you some cough suppressants to be taken at night before bed time to reduce the cough and help you have a good night’s sleep.