From the Guidelines
Chronic bronchitis is diagnosed when a patient has a productive cough that occurs for at least three consecutive months in two consecutive years, after other causes of cough have been excluded, as stated in the 2006 ACCP evidence-based clinical practice guidelines 1. This definition is clinically important as it distinguishes chronic bronchitis from acute bronchitis or other respiratory conditions. The diagnosis is primarily clinical, based on patient history rather than specific laboratory tests or imaging studies.
- Chronic bronchitis is typically a component of Chronic Obstructive Pulmonary Disease (COPD), characterized by airflow limitation and inflammation of the airways.
- The condition results from long-term exposure to respiratory irritants, with cigarette smoking being the most significant risk factor, accounting for about 80-90% of cases.
- Other contributing factors include air pollution, occupational dusts and chemicals, and genetic factors like alpha-1 antitrypsin deficiency.
- The chronic inflammation leads to increased mucus production, ciliary dysfunction, and airway narrowing, causing the characteristic productive cough, dyspnea, and recurrent respiratory infections. Management focuses on smoking cessation, bronchodilators, inhaled corticosteroids, pulmonary rehabilitation, and preventing exacerbations through vaccinations and prompt treatment of infections, as recommended in the 2018 GOLD report 1.
- It is essential to consider the patient's history, including exposure to respiratory irritants and symptoms, to make an accurate diagnosis and develop an effective treatment plan.
- The evaluation of patients with chronic cough should include a complete history regarding exposures to respiratory irritants, including cigarette, cigar, and pipe smoke; passive smoke exposures; and hazardous environments in the home and workplace, as suggested by the 2006 ACCP guidelines 1.
- A chest roentgenogram may be obtained, and if the findings are abnormal, further investigation is necessary to determine the cause of the cough, as outlined in the 2006 empiric integrative approach to the management of cough guidelines 1.
From the Research
Chronic Bronchitis Criteria
The criteria for chronic bronchitis include:
- A cough productive of sputum for over three months' duration during two consecutive years 2
- The presence of airflow obstruction 2 Chronic bronchitis is a clinical diagnosis, and pulmonary function testing can aid in the diagnosis by documenting the extent of reversibility of airflow obstruction 2.
Diagnosis and Management
The diagnosis of chronic bronchitis involves:
- Clinical evaluation
- Pulmonary function testing to assess airflow obstruction and its reversibility 2 Management of chronic bronchitis includes:
- Inhaled ipratropium bromide and sympathomimetic agents as the mainstays of treatment 2
- Oral steroid therapy for patients with demonstrated improvement in airflow not achievable with inhaled agents 2
- Antibiotics for acute exacerbations, although they may only lead to modest airflow improvement 2
- Strengthening of the respiratory muscles, smoking cessation, supplemental oxygen, hydration, and nutritional support for long-term management 2
Treatment Options
Other treatment options for chronic bronchitis include:
- Inhaled corticosteroids, such as fluticasone propionate/salmeterol, which can help decrease symptoms, improve lung function, and prevent exacerbations 3, 4
- Combination therapies, such as budesonide/formoterol, which may be more effective than fluticasone/salmeterol in preventing exacerbations 5
- Fluticasone/formoterol combination therapy, which has a more rapid onset of action compared to fluticasone/salmeterol 6