How to Prevent Chronic Bronchitis

Bronchitis is the inflammation of the bronchi, tubes in your lungs that allow air to pass in and out.  It can be classed as acute or chronic. Acute bronchitis is caused by a respiratory tract infection and lasts only a few days with no lasting ill effects. Chronic bronchitis is defined as a productive cough (one where you cough up mucus) that lasts for three months or more, for two consecutive years, and can lead to serious complications. Chronic bronchitis is a type of Chronic Obstructive Pulmonary Disease (COPD), and some of the advice given here is more general for all types of COPD.

What is Chronic Bronchitis?

Bronchitis is the medical term for inflammation of the breathing tubes in the lungs, known as the bronchi, and causes excess sticky mucus production and accumulation, leading to partial or total obstruction of the airways.  

It can be classed as acute or chronic; acute bronchitis is caused by a cold or respiratory tract infection and may only last a few days without any long-term effects.  In addition, acute bronchitis might be marked by cold symptoms, such as a headache or body aches. These symptoms usually improve within a week, but you may have a cough for several weeks.  

Chronic bronchitis is much more serious; you may experience daily bouts of severe, productive coughing lasting for months, over a period of years.  The resulting accumulation of sticky mucus due to chronic inflammation of the airways restricts the movement of air in and out of the lungs. This gets worse over time as the little hair-like projections (cilia) that move phlegm out of your lungs are damaged, resulting in increasingly severe breathing problems. 

To be classed with chronic bronchitis, you must be coughing up discoloured mucus every day for at least three months, in two consecutive years. Other possible causes of the cough, such as tuberculosis (TB), must also be ruled out.

According to healthline.com, many people who have chronic bronchitis go on to develop emphysema, a lung disease where the walls between the air sacs (known as alveoli) break down.  Together, chronic bronchitis and emphysema are the most common types of COPD.

Risk factors for chronic bronchitis include:

  • Smoking. It is known that smoking is responsible for 85-90% of COPD cases. It causes chronic bronchitis by irritating the lining of the lungs and causing inflammation. 
  • Occupational or prolonged exposure to lung irritants. This includes second-hand smoke, chemical fumes or dust and air pollution.  Irritants cause damage and inflammation which contribute to bronchitis.
  • Age.  Ageing, especially past the age of 50 years old, is a high-risk factor for chronic bronchitis. As a result of persistent mucus over-secretion, longer courses of productive cough are related to quicker reductions in the lung function.
  • Childhood history of respiratory tract infections. Lower respiratory tract infections before the age of 2 years are significantly associated with degraded lung function and COPD later in life.
  • Gender. The prevalence and severity of chronic bronchitis has been found to be less in men than women.  Women tend to experience a greater loss of lung function.
  • Genetics. Rarely, a genetic mutation that causes an alpha-1-antitrypsin (AAT) deficiency leads to chronic bronchitis by causing a shortage of a blood protein that helps protect the elastic structure of the lungs from inflammation damage.

Signs and Symptoms of Chronic Bronchitis

For either acute or chronic bronchitis, symptoms may include:

  • Cough
  • Production of mucus (sputum), which can be clear, white, yellowish, or green in colour — rarely, it may be streaked with blood
  • Fatigue
  • Fever and/or chills
  • Sinus congestion
  • Bad breath (halitosis)
  • Wheezing that worsens during physical activity
  • Shortness of breath/chest tightness

In chronic bronchitis, it’s likely that your cough and other symptoms may periodically worsen, so called flare-ups or exacerbations. You may have an acute respiratory tract infection on top of the bronchitis at these times, as these may be more common than usual.  

Severe chronic bronchitis can also result in weight loss, weakness in your lower muscles and swelling in your ankles, feet and legs. In addition, the fingernails, lips and skin may appear bluish (called cyanosis) because of low oxygen levels in the blood. Shortness of breath may only emerge after several years of bronchitis.

Can Chronic Bronchitis be Reversed?

A Chronic Obstructive Pulmonary Disease (COPD) like chronic bronchitis cannot currently be cured or reversed, but the impact of the disease can be reduced using treatment with combinations of drugs that open the airways (bronchodilators) such as umeclidinium and vilanterol or salmeterol, and with oral or inhaled steroids such as prednisolone or fluticasone. Also, it may be mitigated by some key lifestyle changes, including stopping smoking and eating well.

Lifestyle Factors

The following lifestyle factors have the greatest impact on increasing your risk of this chronic health condition.  We will also look at what you can do to reduce your risk from today.

  1. Smoking.  According to Medical News Today, giving up smoking is the number one change you can make to mitigate the effects of a COPD. It is known that smoking causes about 85-90% of COPD cases. Advice and support from the NHS on how to do this can be found here. Support with quitting can take the form of support groups, counselling, medicines, and nicotine replacement therapy, e.g., patches, gum, etc. Giving up tobacco won’t reverse the disease but may slow its progression and improve the effectiveness of some treatments.  It may also give the immune system a boost, reducing the impact of recurrent chest infections. You should also avoid second-hand smoke if you can, as this will have much of the same impact on chronic bronchitis flare-ups as smoking.
  2. Alcohol.  People with alcohol dependence are three times more likely to be smokers, and as we’ve established, smoking is very bad in patients with chronic bronchitis. According to Healthline, drinking alcohol regularly may increase your risk of COPD, but the evidence isn’t clear cut. Alcohol impairs the clearance of mucus and other debris from the lungs by hair-like projection (cilia) in your airways. Also, heavy alcohol consumption depletes the body’s levels of a substance called glutathione, which helps to protect the lungs from damage by smoke and other irritants. People with COPD who drink are 25% more likely to experience sleep apnoea, and quality of sleep is usually poorer in those that drink alcohol.  Those with allergies, which are common in COPD, may also have a sensitivity or allergy to alcohol that may cause a flare-up.
  3. Nutrition. According to the American Lung Association, if you have chronic bronchitis or other COPD, you should limit your intake of simple carbohydrates (sugar, sweets, soft drinks, etc.) and focus on complex carbohydrates such as those found in whole-grain pasta and bread, fresh fruit, and vegetables. It is recommended that you eat 20-30g of dietary fibre each day, from sources such as bread, pasta, nuts, seeds, fruits, and vegetables. You should also eat a good source of protein at least twice a day, such as lean meat, fish, milk, or eggs.  Foods containing saturated or trans fats should be eaten in only small amounts, such as in fried or processed foods.  It is important to maintain your intake of vitamins and minerals, consider multivitamin tablets as well as calcium supplements as prolonged steroid use can increase your body’s need for calcium. You should maintain adequate levels of hydration by drinking plenty of water (6-8 glasses a day), as this helps to thin the mucus and make it easier to clear from the lungs.  Lastly, be careful not to have too much sodium in your diet as this may increase blood pressure.  More advice on nutrition and COPD can be found here.
  4. Physical Activity. Exercise cannot cure or reverse chronic bronchitis, but it can improve some of its symptoms, e.g. shortness of breath. This can make exercise, and ordinary daily activities, a challenge but it is important to keep the muscles of the chest and heart as strong as possible to maximise their tolerance to physical activity.  Pulmonary rehabilitation can be very useful in improving exercise tolerance in COPD, starting slowly and gradually building up the exercise under medical supervision. An exercise programme should always include proper warmup and mobility/stretching exercises, cardiovascular exercise such as walking or cycling and strength exercises such as with free weights. Exercise helps with weight control in concert with good nutritional practices, and can improve mental health and wellbeing.
  5. Overweight/Obesity. According to a recent editorial, more than 1 in 3 patients with COPD are obese. However, it has also been shown that obese patients have less frequent and severe flare-ups and are less likely to die from COPD complications than their lean counterparts.  This “obesity paradox” is borne out by many studies, but at first sight seems to fly in the face of other evidence showing that elevated BMI (body mass index, a measure of body weight and obesity) is associated with increased risk of chronic bronchitis, and poorer outcomes in mild to moderate COPD. The relationship between body mass and COPD is clearly complex but the maintenance of as healthy a lifestyle as possible is often recommended by doctors, focussing on a combination of abstinence, nutrition, and exercise.
  6. Sleep. According to the Sleep Foundation, 75% of people with COPD report having trouble sleeping and have overall lower sleep quality. This can be due to oxygen desaturation or reduced oxygen levels in the blood (hypoxaemia), which particularly affects rapid eye movement sleep. Discomfort from coughing and wheezing  also makes falling asleep very difficult when lying down, and those with COPD frequently also suffer from gastroesophageal reflux (GERD), the pain and discomfort of which impairs sleep. COPD patients frequently have obstructive sleep apnoea (OSA), which are gaps in breathing rhythm during sleep. Sleep apnoea causes frequent night-time awakenings, oxygen desaturation and spikes in blood carbon dioxide levels (hypercapnia). When COPD and OSA happen together, this is called “overlap syndrome”, associated with even more severe hypoxaemia episodes than COPD alone. A continuous positive airway pressure (CPAP) machine is the first line treatment for those with overlap syndrome. Signs of a sleep disorder might include snoring, gasping, or choking during the night, headache, and daytime sleepiness.
  7. Mental Health. According to WebMD and the American Lung Association,  chronic illnesses, including COPD, negatively impact mood and cause increased depression and anxiety.  You may feel sad, fearful, or worried about your illness.  You may be an ex-smoker, and blame yourself for your COPD, or you might feel distanced and isolated because you can’t participate in your usual social or physical activities. Shortness of breath can cause anxiety and even panic attacks. Mental health issues can affect the course of your COPD.  For example, if you have depression, you may be more likely to neglect your treatment plan or your general fitness and wellbeing, leading to more frequent flare-ups. Pumar et al (2014) suggested that anxiety, depression, and COPD could even share a common cause.  Fortunately, there are things you can do to get help with these mental health issues. Speak up, talk to your care team and they’ll be able to signpost dedicated specialists, or join a support group - there will be one near you. Look after your physical health and stay active, this will benefit your mental health, and make time for social activities with family and friends.
  8. Wellness. Keeping your emotional health balanced is necessary for your physical health. Self-care is important for overall good health. Improving your mental and physical wellness will help you manage your chronic bronchitis/COPD.  Staying active, going for walks, and doing exercises, eating a good diet, and sleeping as well as you can all contribute to wellness.  Mental wellness can be improved by giving yourself time for your own pursuits, such as an absorbing hobby or social activities with family and friends. Try practising mindfulness, breathing exercises or relaxation techniques. These are great for managing anxiety and depression and will have a knock-on effect on your physical wellbeing, especially the breathing exercises, which will help you when you’re short of breath.

The primary take-home message of all these lifestyle factors is to care for yourself as well as possible, eating properly, getting lots of exercise, and following your treatment regime. Be mindful of your mental health and seek help if you need it. Sometimes, only other people will notice if you’re struggling, so it’s important to keep talking to people and maintain social contacts.  

Diagnostic Testing

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Useful Links

The Mayo Clinic

Healthline

Johns Hopkins Medicine

WebMD

Medline Plus

References:

  1. Beeh, K.M. (2016)  The Role of Bronchodilators in Preventing Exacerbations of Chronic Obstructive Pulmonary Disease.  Tuberc Respir Dis (Seoul). 79(4), pp. 241–247.
  2. Iyer, A.S. and Dransfield, M.T. (2017) The “Obesity Paradox” in Chronic Obstructive Pulmonary Disease: Can It Be Resolved? Annals American Thoracic Society 15(2) pp. 158-159.
  3. Lee, Y.L., Chen, Y-C. and Chen, Y-A. (2013) Obesity and the Occurrence of Bronchitis in Adolescents. Obesity 21, pp. E149-E153.
  4. Pumar, M.I., Gray, C.R., Walsh, J.R., Yang, I.A., Rolls, T.A. and Ward, D.L. (2014) Anxiety and depression—Important psychological comorbidities of COPD. J Thorac Dis. 6(11), pp. 1615–1631.
  5. Verberne, L.D.M., Leemrijse, C.J., Swinkels, I.C.S., van Dijk, C.E., de Bakker, D.H. and Nielen, M.M.J. (2017)  Overweight in patients with chronic obstructive pulmonary disease needs more attention: a cross-sectional study in general practice. NPJ Prim Care Respir Med. 27 pp. 63-68.

Author: Dr. Richard Stephens

Doctor of Philosophy (PhD), Physiology/Child Health
St George's, University of London


Richard has an extensive background in bioscience and bioinformatics with a PhD in membrane transport physiology and 28 years of experience in scientific publishing, bioscience research and computational biology.
On moving to Cambridge, UK, in 2015, Richard took the opportunity to broaden the application of his scientific background as well as to explore new avenues of interest. Among other things he mentored students at the Disability Resource Centre at the University of Cambridge and is currently working as an educator, pro bono for the Illuminate charity whilst further developing his writing and presentation skills.

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