Smoking with Bronchitis

We may say smoking is like a silent killer or a friend that sneakily stabs you behind your back without you even realizing it.²⁸ It contributes to many diseases, including lung cancer, heart disease, and respiratory disease.²⁹ Despite that, more than 1 billion people smoke cigarettes regularly.²⁸ It also accounts for 8 million deaths worldwide. ²⁸ In other words, smoking is like opening Pandora's box of illnesses. 

Let's narrow our focus on how smoking can cause respiratory disease, specifically bronchitis. 

What is bronchitis?

Bronchitis is an infection that causes inflammation and irritation in the significant airways in the lungs.¹ People with bronchitis produce more mucus than usual, which they try to get rid of by coughing.¹ 

Types of bronchitis

There are two types of bronchitis: acute bronchitis and chronic bronchitis.¹

Acute bronchitis commonly arises due to viruses and is occasionally caused by bacterial infection. It commonly exists during the flu season and can be caused by allergens, irritants, and bacteria.² 

Examples of irritants: smoke inhalation, polluted air inhalation, and dust.³ If you have asthma, you are prone to bronchitis. The cough due to acute bronchitis can last 10 to 20 days. ² However, it may persist for four weeks.² Acute bronchitis is a self-limiting disease, meaning people with bronchitis can get better on their own with or without treatment. 

Meanwhile, chronic bronchitis is due to exposure to cigarette smoke by smoking or passively inhaling irritants.⁴ It is also a chronic obstructive pulmonary disease (COPD), an umbrella term for a group of lung diseases that cause breathing difficulties.^4,6 Examples of irritants include  smog, industrial pollutants and toxic chemicals. People with a history of respiratory conditions such as asthma, cystic fibrosis, or bronchiectasis have a higher risk of chronic bronchitis.⁴ Furthermore, people repeatedly exposed to environmental pollutants such as dust or airborne chemical (ammonia, sulfur dioxide) are more prone to chronic bronchitis.⁴ The cough due to chronic bronchitis can persist for over three months and occurs within two years. Unlike acute bronchitis, which tends to go away on its own, chronic bronchitis is a more severe condition that is persistent and can develop over time, according to the American Lung Association.⁵

Causes 

Role of cigarette smoking in the etiology of chronic bronchitis

The most common and major cause of chronic bronchitis, COPD, is cigarette smoking.^4,5,7 How does cigarette smoking cause chronic bronchitis? Cigarette smoking contains harmful chemicals such as nicotine, lead, and carbon monoxide, which harm your respiratory system.^8,9 Studies suggest long-term smoking can damage your alveolar and air duct walls.^9-12 

Smoking also causes an increase in the production of mucus, resulting in the obstruction of airflow to the lung.^9,13 Secondhand smoke, also called passive smoking, can also lead to chronic bronchitis.¹⁷ 

Symptoms (Brief)

Symptoms of both acute and chronic bronchitis include: ^2,4

1. Cough
2. Breathlessness
3. Wheezing
4. Fever (unusual)
5. Mucus (colours may vary)
6. Malaise or a general feeling of discomfort, pain, or uneasiness

Will smoking worsen bronchitis?

The link between smoking and chronic bronchitis

Experts have long demonstrated the link between smoking and chronic bronchitis. Older research in 1995 revealed that smokers are more susceptible to chronic bronchitis.¹⁴ Then, in 2006, a study that investigated the link between respiratory symptoms, COPD, and airflows for more than 30 years found that 40% of smokers develop bronchitis.¹⁶ A more recent research published in 2016 also suggested that smoking can increase the risk of developing chronic bronchitis.¹⁵ 

Does smoking increase the risk of acute respiratory infections?

Viruses and bacteria cause acute respiratory infections.¹⁸ They are usually grouped into upper and lower respiratory infections.¹⁹ Upper respiratory infections occur in the nose, sinuses and larynx.¹⁹ In contrast, lower respiratory illnesses occur in the airways and lungs. ^19,20 Acute bronchitis is a lower respiratory infection. 

Smoking increases the risk of acute respiratory infections. The respiratory epithelium consists of vital cells that are crucial in protecting us against inhaled pollutants and pathogens.¹⁸ Cigarette smoke can hurt and damage these cells, given its harmful substances.²¹ In addition, the substances in cigarette smoke can impair the function of cilia, hair-like structures that helps clean the airways.²² When it is impaired, it results in an overproduction of mucus and slowing mucus clearance.²³ This can encourage the reproduction of pathogens.²⁴ A study in 2010 also suggested that smoking reduces the sensitivity to cough, which will prevent the elimination of pathogens from our body.²⁵ Moreover, nitrogen found in cigarette smoke can damage our respiratory tract, leading to an increased susceptibility to infection.¹⁸ 

Diagnosis and Treatment

How is bronchitis diagnosed? Your healthcare provider will do a physical examination and take your past medical history.^2,4 They might conduct a blood test or a chest x-ray to check any abnormalities in your lungs and to rule out pneumonia.^{2, 4}

Acute bronchitis can go away on its own. However, if you want to get better, plenty of treatments are available: ²

1. Hot tea, honey, and ginger for cough relief
2. Beta-agonist for patients with wheezing and cough
3. Analgesic and antipyretic agents to treat malaise and fever
4. Prednisone or otter steroids to reduce inflammation

ACCP does not recommend healthy adults with simple acute bronchitis take antibiotics. ²

On the other hand, treatments for chronic bronchitis are: ⁴

1. Bronchodilators: these can improve cilia function and increase mucous hydration
2. Glucocorticoids: It reduces inflammation and prevents the overproduction of mucus. However, it should be administered under medical supervision and for a short period of time. Longer usage of it can lead to other diseases such as diabetes, hypertension, and osteoporosis
3. Antibiotic therapy: the anti-inflammatory property of macrolide property might treat chronic bronchitis
4. Phosphodiesterase-4 inhibitor: Can help to reduce inflammation

Does the efficacy of treatment differ between smokers and non-smokers?

There are conflicting findings regarding the efficacy of the treatment between smokers and non-smokers. 

A review in 2002 investigated the efficacy of antibiotics for smokers with acute bronchitis.²⁶ The review explained that in one trial, the use of antibiotics did reduce the number of times they were coughing but not among smokers. However, the review concluded that the effect of antibiotics was the same for smokers and non-smokers with acute bronchitis.²⁶

Another review in 2020 concluded that lighter or ex-smokers with COPD symptoms would benefit more from inhaled corticosteroids than smokers. Experts suggested that smokers might develop resistance against steroids, and thus it is less effective on smokers.²⁷ 

Ways to quit smoking

Smoking seems like a really bad guy here. And, it is never easy to quit smoking. 

Rest assured because there are several ways that smokers can try to quit smoking:

Behavioral interventions³⁰

In-person counseling, telephone counseling and self-help materials were found to be effective in helping adults quit smoking. These interventions increase the number of smoking cessation in intervention groups. There are minor and intensive in-person interventions that people can try. Both interventions are effective in making people quit smoking for good. Public Health Service suggested individuals undergo at least four in-person counseling sessions because more or longer sessions successfully improve smoking cessation rates. 

Nicotine Replacement Therapy (NRT)³⁰ 

Nicotine replacement might help to reduce cravings for smoking. There are several types of NRT, such as slow-nicotine releasing (nicotine patch) and rapid-delivery forms of NRT (chewing gums, lozenges, nasal spray and inhalers). The effectiveness of using NRT has been demonstrated. Using two types of NRT rather than just one is more effective in helping individuals stop smoking. 

Bupropion SR³⁰: The use of bupropion SR is much more effective when used in combination with NRT

Will quitting smoking help reduce risks?

Smoking cessation is the most effective way to reduce the risk of developing bronchitis^{2, 4} 

An older study in 2004 suggested that when individuals with chronic bronchitis stop smoking, their lung function will improve, and their chronic cough will be less frequent.³¹ 

Smoking cessation also prevents further damage to lung function.³¹ Similar findings in 2006 also documented the improvement in the respiratory system after the individuals quit smoking. The study explained that by stopping smoking, the number of cells that helps to kill germs increased, reducing the risk of respiratory infection.³² 

Summary

Smoking or passively smoking a cigarette could jeopardize our health. It can cause or increase the risk of developing bronchitis and further worsen bronchitis. Although several treatments can help treat both acute and chronic bronchitis, it is best to prevent ourselves from getting the disease. The best way to do this is by quitting smoking or avoiding places full of people smoking.