Chronic Bronchitis and COPD – Causes, Signs and Treatment

Overview

Chronic bronchitis and COPD is a common pulmonary disorderamongst the Indian population. We see smokers, non-smokers and females, with prolonged complaints of dyspnoea on exertion, while walking into our outpatient department. A simple history and clinical examination can establish the diagnosis easily. What follows next are the facts, which a must for even anyone to know about this peculiar disorder.

Bronchitis can be called inflammation of the linings of bronchial tubes. These are the small tubes that pass air to your lungs and carry air from it. Individuals who have bronchitis frequently suffer from a cough along with the release of thick mucus. They are likely to suffer wheezing, chest pain and shortness of breath. There are two types of Bronchitis – acute and chronic.

Acute bronchitis may result from cold or other respiratory issues but improves within a couple of days without creating further discomfort. Chronic bronchitis is a more threatening condition, which develops progressively instead of striking all of a sudden. It can be described as recurrent episodes of bronchitis which tend to last for a long time. The constant inflammation of the airways results in an increased amount of sticky mucus present in the airways. And, this creates a hurdle when the air is passing in and out of the lungs. The blockage in the wind stream deteriorates after some time, bringing about breathing challenges and generates more mucus in the lungs.

Causes of Bronchitis

Chronic bronchitis disease occurs when the coating of the bronchial tubes become inflamed and irritated constantly. The constant disturbance and swelling can harm the airways and cause the development of sticky mucus, making it troublesome for air to travel through the lungs. This prompts breathing challenges that continuously escalate and cause discomfort. The inflammation is likely to harm the cilia, which are the hair-like structures that assist in keeping the air passage free of irritants. When the cilia don’t perform appropriately, the airways turn into a breeding ground for bacterial and viral contaminations.

Contaminations normally trigger the underlying aggravation and swelling that leads to acute bronchitis. Chronic bronchitis is, however, mostly caused by cigarette smoking. In reality, more than 90 percent of those with the infection may have been smokers or have a history of smoking. Breathing in tobacco smoke also temporarily affects the cilia, so continuous smoking for a long period of time can cause serious damage to the cilia. Chronic bronchitis may worsen over a period of time due to these habits.

Second-hand smoke can also add to the cause of chronic bronchitis. Other causes incorporate long term exposure to air pollution, chemical and industrial dust and toxins and dangerous gases. Chronic lung diseases may further harm the lungs and aggravate constant bronchitis symptoms.

Signs of a COPD Exacerbation

After an extensive period of aggravation and disturbance in the bronchial tubes, chronic bronchitis can result in several symptoms and it includes a relentless and heavy cough that releases mucus from the lungs. As time passes, the production of mucus increases gradually and it starts building up in the bronchial tubes creating discomfort in the air flow, which leads to causing more difficulty in breathing.

Being aware of the signs of a Chronic Obstructive Pulmonary Disease exacerbation can go a long way in preventing the disease from worsening, and can also decrease the life-threatening risks that occur with a sudden onset of COPD symptoms.

A lung infection caused by a virus or bacteria, such as a cold or some other illness, can lead to COPD exacerbations. COPD symptoms can also suddenly worsen due to constant exposure to these harmful pollutants.

Warning signs of a COPD exacerbation may include:

• Shortness of breath: A person experiencing a COPD exacerbation may feel breathlessness or shortage of air. If this feeling worsens even when at rest or with little physical activity, you may need to see a doctor.
• Noisy breathing: With a COPD exacerbation, wheezing, whistling, gurgling, or rattling sounds may accompany breathing. Wheezing suggests partial obstruction of the airways by mucous, pus, or other inflammatory material. Gurgling or rattling sounds during breathing may indicate an accumulation of fluid in the lungs or mucous being present in the airways.
• Increased anxiety: Oxygen is vital for everyone. If you feel like you are not getting enough oxygen and start to panic, being or becoming anxious can also aggravate your breathing ability as you may be anxiety.
• Chest breathing: During a COPD exacerbation, a person may breathe from the chest instead of the abdomen, which causes your breathing to become more irregular, which causes your chest to move up and down more quickly.
• A cough: A COPD exacerbation can result in a cough, which is more severe or frequent than usual. The coughing may increase while you are lying down or trying to sleep. Sitting in a chair instead of lying down, may help you breathe more comfortably, as lying down may aggravate it even further. A dry cough may also bring up phlegm that is bloody, green or yellow in colour.
• Changes in skin or nail colour: During an exacerbation, there may be noticeable changes in the colour around the lips, which may appear as a bluish tint. Nails may also become blue or purple, or the skin may take on a sallow or grey tone and appearance.
• Difficulty sleeping and lack of appetite: The increased symptoms with a COPD exacerbation may interfere with the ability to sleep or eat.
• Lack of speech: If a person experiences severe breathing difficulty, it might impair his ability to speak and tell others what is happening. He might be able to communicate only through hand gestures that he is in distress.
• Early morning headaches: COPD causes a build-up of carbon dioxide in the blood due to low levels of oxygen. This can result in morning headaches. If morning headaches are a new symptom, it could be a sign of a COPD exacerbation.
• Swelling in the ankles or legs or abdominal pain: Swelling and abdominal pain are common COPD symptoms. They are associated with heart complications or irregularities caused by damage to the lungs. If these symptoms are new, or if they increase suddenly, it could be a sign of an exacerbation.

When to See a Doctor?

Many individuals do not bother about the symptoms of chronic bronchitis and misunderstand by thinking it as smoker’s cough. Nonetheless, it’s essential to contact your specialist immediately on the off chance that you have even the slightest doubt about having bronchitis. Neglecting the symptoms and treatment for chronic bronchitis significantly raises the danger of serious lung damage, which can prompt respiratory issues or heart failure.

• Visit your doctor right away if you are persistently coughing
• If a cough still persists for more than three weeks
• Cough is not letting you sleep or is causing disturbance
• If you still have a high fever above 100.4 (degree F) and continuous cough
• Releasing discoloured mucus or blood
• Causing shortness of breath

Treatment of Chronic Bronchitis

COPD treatments may vary, but no matter your stage, the goal of COPD treatment is to:

• Relieve symptoms
• Prevent complications and worsening of an illness
• Improve health and exercise tolerance

Guidelines for treating COPD are set out in the Global Initiative for Chronic Interstitial Lung Disorder (GOLD).  COPD treatment includes:  

• Smoking cessation: Stopping smoking can help slow down the decline in lung function.
• Oxygen therapy: When the lungs cannot function well, inhaled oxygen is still insufficient to provide the right amount of oxygen into the blood to meet the body’s needs.
• Nutrition: COPD can make a person lose weight and subsequently lead to loss of muscle mass. An underweight person with COPD usually experiences greater difficulty and discomfort while trying to breathe.
• Bronchodilators: These medications relieve symptoms, and improve airway obstructions and exercise capacity. They work by opening up the air passages while making it easier to breathe. There are many different kinds of bronchodilators. Atrovent, for example, is short-acting, so it’s used for the immediate relief of symptoms.  Spiriva, by contrast, is long-acting, and its used to keep airways open day to day.
• Corticosteroids: These drugs, such as prednisone or budesonide, are used to reduce inflammation and to treat symptoms, especially symptoms of an exacerbation. These medications may help slow the progression of occupational lung disease.
• Vaccines: COPD can flare up and worsen when you get sick, so it’s important to get the flu shot and the pneumonia shot.
• Surgery: When medications prove ineffective, several surgeries, including lung transplantation, can reduce symptoms and hence improve a person’s quality of life.
• Antibiotics: Antibiotics treat bacterial infections and are used primarily during an exacerbation.

According to Schechter, oxygen therapy is effective in prolonging life. Patients with COPD need to monitor levels at home, especially at night, and not solely rely on a test at the doctor’s office to determine if they may require oxygen therapy.

Understanding and Treating COPD

Rehabilitation is beneficial: People with COPD can also benefit from rehabilitation therapy, which includes being aware of COPD and the right diet to follow. Schechter says rehabilitation therapy should also involve physical activity and exercise training

“The physical conditioning is geared to people who have lung disease, and it can improve the patient’s endurance. Even though lung function may not improve, the person with COPD is able to be more physically active,” says Schechter.

Depression and denial are common: “Some patients may be embarrassed about having COPD, which leads to depression and denial,” says Schechter. “Many feel duped by cigarette companies and feel that they brought the problem (COPD) on themselves.”

Schechter urges patients with COPD who smoked to stop worrying. “Smokers are not self-destructive, lazy or unmotivated.”  People smoke because they are addicted to nicotine, he says.

It is important to keep in mind that the more you know about COPD, the easier it is to control it.