At first, you had an extended bout of coughing and throat clearing every morning. Then the coughing, wheezing and shortness of breath started taking up a good part of each day. You call it your smoker’s cough and decide that you’re just going to live with it.
If those are your symptoms and you’ve had them for awhile, you probably have chronic bronchitis. It is indeed a smoker’s cough, and you most certainly should not try to live with it.
Bronchitis is an inflammation of the bronchial tubes that carry air to and from your lungs. Acute bronchitis, often occurring after a cold, is common, and it often lasts much longer than the cold itself. It does eventually pass, however, while chronic bronchitis does not. It’s officially defined as a daily cough that lasts at least three months for two consecutive years. The cough is wet or “productive,” bringing up sputum.
Acute bronchitis is usually caused by a virus and, as a result, does not respond to antibiotics. Chronic bronchitis is usually caused by cigarette smoking, although air pollution, dust, chemical fumes, toxic gases or second-hand smoke can be either a primary cause or a contributing factor.
Since there is often a co-existing bacterial infection, antibiotics can sometimes be helpful in treating chronic bronchitis.
Usually after about 10 years of smoking, but sometimes earlier, about 50 percent of smokers start to notice a chronic cough with sputum but no other severe symptoms. If smoking cessation occurs at this point, the cough and sputum production clears within about a year and a half.
Progressive, Irreversible
About 10 to 20 percent of those who continue to smoke go on to develop chronic obstructive pulmonary disease (COPD), with progressive and irreversible damage to the lungs and airways.
Chronic bronchitis is one of two major types of COPD. The other is emphysema. The two are linked, and both are life threatening.
Whereas chronic bronchitis involves mostly the airways, emphysema affects the air sacs in the lungs that are crucial for the exchange of oxygen and carbon dioxide. A person with emphysema may not have the chronic cough or it might not be as severe, but the damage is occurring nevertheless. In both diseases, the end game is gradual loss of air supply...and death.
Coughing occurs as the body’s way of clearing the airways of the mucus that is accumulating due to chronic inflammation. As more mucus occurs, coughing gets worse. And the coughing itself inflames the airways even more and leads to greater mucus production.
The chronic cough becomes worse during colds, and these take longer to resolve in a person who is developing COPD. The sputum turns a greenish color at such times.
Eventually, the bronchial tubes lose their elasticity, swell and become thickened, narrowing the airways even more. The patient finds it increasingly difficult to keep the airways free even with frequent coughing. And that’s one reason for the breathlessness.
In the early stages, the patient may get winded easily during exercise or while climbing stairs. The coughing is worse during the day than at night.
Eventually, the breathlessness begins to interfere with every day activities and even occurs during rest. At this stage, coughing becomes worse at night, and the patient may have to sleep sitting up.
Starved of oxygen, the body compensates by raising heart rate and blood pressure to pump more blood. Heart failure may occur, causing the body to swell from fluid buildup.
The skin develops a bluish tint, known as cyanosis, usually appearing on the lips, fingers and toes. And some patients develop a hyper-inflated “barrel” chest.
Aside from the risks of lung damage, cancer and pneumonia, persons with chronic bronchitis have a 50 percent higher risk of dying from coronary artery disease.
The ideal treatment is to catch the smoker’s cough early, before it becomes chronic bronchitis, and to stop smoking. Even when irreversible damage has occurred, smoking cessation lessens inflammation, reduces coughing and makes breathing easier. It also lowers the risk of death by heart disease. Exposure to passive smoke, chemical fumes, dust and pollution should also be avoided.
Doctors determine the stages of COPD and treatment through an FEV1 test that measures forced expiratory volume in one second. The test shows how well you are able to exhale or breathe air out of the lungs–the major problem in COPD.
Mere cough suppression is rarely the solution even in the very early stages. The inflammation that’s causing the cough must be stopped as well. Inhaled bronchodilators, corticosteroids, beta2 agonists and anticholinergic agents are among the medications prescribed. One goal is to reduce the inflammation.
In many cases, at least some of the airway obstruction can be reversed, leading to improvement of lung function. In the later stages, however, a gradual deterioration occurs over a four- to five-year period.
Treatment in the later stages usually involves managing associated medical conditions such as pulmonary hypertension and congestive heart failure.
Patients with chronic bronchitis tend to be obese while many with emphysema waste away, losing muscle mass and bone density. Good nutrition is important for both.
Exercise is also an important lifestyle change although it becomes very difficult to move when you’re having shortness of breath with even routine daily activities.
Breathing exercises, making use of pursed lips and the diaphragm, can make breathing easier. Nevertheless, many patients need to rely on supplemental oxygen through portable or stationary tanks.
Four of five Americans with chronic obstructive pulmonary disease are present or former smokers. The longer a person smokes and the larger the number of cigarettes, the greater the risk of either chronic bronchitis or emphysema.
A Swedish study using data on 40,000 twins concluded that 40 percent of the risk for chronic bronchitis could be attributed to inherited genes. Unfortunately, about 14 percent of subjects with this inherited risk also inherited a predisposition to smoke.
Not all smokers get COPD, but for those who do, the toll of disability and suffering is substantial. If you’re just now beginning to notice the daily cough, or if you’ve never experienced it, it’s time to quit.
REFERENCES:
American Lung Association, “Understanding chronic bronchitis.”
William T. Basco, Jr., M.D., “Chronic bacterial bronchitis in kids–really?” Medscape Pediatrics, 2012,
“Chronic bronchitis/overview,” FamilyDoctor.org.
Charles Patrick Davis, M.D., Ph.D., “Chronic Bronchitis,” MedicineNet.com, 2013.
“Chronic obstructive pulmonary disease,” Patient.com.uk, Dr. Colin Tidy, last checked October 12, 2010.
“COPD, “Chronic obstructive pulmonary disease–symptoms,” WebMD Medical Reference, last updated May 4, 2011.
“COPD in-depth report,” New York Times.
“Course of chronic obstructive pulmonary disease,” About.com Senior Health, updated October 21, 2004.
Deborah Leader, R.N., “Chronic bronchitis: complete guide to chronic bronchitis,” About.com COPD, updated October 29, 2011.
Marc Miravitlles, et al, “Characterisation of exacerbations of chronic bronchitis and COPD in Europe: the GIANT study,” Therapeutic Advances in Respiratory Diseases, 2009;3(6):267-277.
Katja Radon, Ph.D., et al, “Passive smoking exposure: a risk factor for chronic bronchitis and asthma in adults?” Chest, 2002;122(3).
Jaclyn Smith and Ashley Woodcock, “Cough and its importance in COPD,” International Journal of COPD, 2006;1(3):305-314.
“Study suggests genetic factors in smoking may increase risk of chronic bronchitis,” Expert Reviews in Respiratory Medicine, 2008;2(2):145-147.
09/16/2013
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