What is chronic bronchitis?

Bronchitis is a respiratory disease that is broadly divided based on its duration of symptoms into two types - acute and chronic. Chronic bronchitis is characterised by a daily persistent cough that lasts for three months in a year and consecutively for at least two years. It is one of several lung diseases defined as a part of chronic obstructive pulmonary disease (COPD). According to the World Health Organisation, 3.23 million people died from chronic obstructive pulmonary disease (COPD), making it the third largest cause of mortality globally in 2019. Studies suggest that around 3% to 7% of healthy individuals in the general population have chronic bronchitis. However, for people with COPD, it may reach 74%.² The average age of onset of chronic bronchitis is after the age of 45.¹  Chronic bronchitis is recognised to be primarily caused by ongoing cigarette smoke inhalation. Environmental substances such as air pollution and toxic fumes are also known to be its risk factors. People with history of respiratory conditions such as cystic fibrosis, bronchiectasis, or asthma are more likely to develop chronic bronchitis. People frequently exposed to airborne contaminants like ammonia and sulphur dioxide or dust have an increased chance of getting chronic bronchitis. The tubes in the lungs, known as the bronchi, become inflamed, resulting in the overproduction of mucus and other alterations. Chronic bronchitis also leads to persistent cough, frequently referred to as smoker's cough. This causes chest discomfort, expectoration of mucus, and wheezing.² This could worsen over time and could cause life-threatening breathing issues.

Signs of chronic bronchitis

The main symptoms of chronic bronchitis include:

• Coughing up mucus - the NHS states that this is due to a repetitive cough that lasts three months of the year for at least two years.
• Chest discomfort.
• A cough commonly known as smoker’s cough due to the condition mainly affecting smokers.
• Shortness of breath.
• Wheezing.

How does chronic bronchitis affect mental health?

The symptoms of depression and anxiety frequently coincide with those of COPD, making it difficult to diagnose and treat. Behavioural, social, and biological variables are among the many causes of depression and anxiety symptoms. Only one-third of COPD patients who also experience comorbid depression or anxiety symptoms get the proper care.³ Most COPD patients occasionally experience feelings of unhappiness and fear. This is a common symptom when coping with a debilitating illness like COPD.

Common co-morbid mental health conditions when dealing with chronic health problems:

• Depression - a persistently low mood that lasts for several weeks or months and is characterised by feelings of unhappiness and lack of pleasure in activities (anhedonia). A study found that around 40% of COPD patients displayed symptoms of depression, making it the highest prevalence comorbidity compared with many other chronic disease groups that were identified.⁴ 
• Anxiety (fear of breathing problems) - can include feelings of distress, worry, and fear. Shortness of breath for those with COPD can lead to anxiety and even panic attacks. Anxiety can worsen chronic bronchitis symptoms as you start to breathe faster when anxious. Additionally, research has demonstrated that the severity of anxiety is associated with the severity of COPD and decreased partial pressure of oxygen in the blood, which is an indicator of chronic bronchitis severity.⁵ It is recommended to stay active as this can strengthen the lungs of patients with chronic bronchitis and positively impact anxiety and depression.⁵ 
• Social anxiety (fear of having breathing problems in public) - according to Eisner, anxiety is linked to poor quality of life, flare-ups, improper medication use, and continued smoking as a coping mechanism.^6,7 Patients with COPD who experience anxiety avoid social situations and daily activities and tend to feel alone.⁸ 
• Trauma from past acute breathing events - there is evidence to suggest that post-traumatic stress disorder (PTSD) is a significant comorbidity affecting COPD management.⁹ 

If you or someone close to you is struggling with mental health

Mind - 0300 123 3393 (Infoline) - Mind is a charity that offers support and advice to those with mental health problems.

Anxiety UK  - 03444 775 774 (helpline) or 07537 416 905 (text) -  this charity provides support and advice for anyone who is suffering from anxiety.

NHS Improving Access to Psychological Therapies (IAPT) - nhs.uk/service-search/find-a-psychological-therapies-service (UK only) - the NHS provides counselling and therapy services. You can self-refer these services if needed.

Samaritans -116 123 - a charity that provides emotional support for those struggling to cope, having suicidal thoughts, or feeling distressed.

Conclusion

Chronic bronchitis is a debilitating disease grouped under COPD (chronic obstructive pulmonary disease). The main cause of chronic bronchitis is cigarette smoking. Chronic bronchitis is also thought to be caused by exposure to air pollution or toxic gases. To diagnose chronic bronchitis, your doctor will identify symptoms such as a continuous cough that produces mucus that lasts at least three months in a year over a two-year course. If you believe you may have chronic bronchitis, it is important to visit a doctor to get a diagnosis and suitable treatment. While there is no known cure for chronic bronchitis, some treatments can help you manage your symptoms.