Chronic Bronchitis Diagnosis

  • Diagnosis

    Chronic bronchitis is a long-term, often irreversible respiratory illness. Those with chronic bronchitis have a daily mucus-producing cough that persists for at least 3 months a year, at least 2 years in a row.

    Bronchitis is an inflammation of the lining of the air passages. Bronchitis can be classified as acute or chronic. Acute bronchitis is a mild inflammation of the air passages of the lungs that clears up within a few days, often without treatment. Chronic bronchitis is a persistent, serious lung disease that requires ongoing medical care and can lead to gradual deterioration of the lungs. Many people with chronic bronchitis also develop another respiratory disease called emphysema.

    Chronic bronchitis involves restriction of airflow in the air passages that worsens over time. This causes increasing difficulty in breathing and more sputum (mucus) production in the lungs.

    Chronic bronchitis is a form of chronic obstructive pulmonary disease (COPD), a serious health condition.

    COPD is the fourth-leading cause of death in the United States. About 11 million American adults suffer from COPD.

    The diseases that fall under the COPD “umbrella” all lead to some type of long-term airflow problem in the lungs. The most common COPD conditions are chronic bronchitis, emphysema, and chronic asthmatic bronchitis. These may occur by themselves, but often a person has more than one condition occurring at the same time.

    Chronic bronchitis, like other COPD conditions, can have episodes where symptoms get worse very quickly. These episodes are called exacerbations, and they can vary in degree of severity.

    Exacerbations of chronic bronchitis can be triggered by upper- or lower-airway infections, such as colds or influenza. Exposure to environmental irritants, such as dust, fumes, or air pollution, may also exacerbate chronic bronchitis. Other medical conditions, such as heart problems or infection elsewhere in the body, can worsen chronic bronchitis symptoms. Exacerbations can be serious and even life threatening.

    Smoking is the major cause of chronic bronchitis and other chronic obstructive pulmonary diseases (COPDs).

    Cigarette smoking causes approximately 80%-90% of COPD cases. Inhaling smoke temporarily paralyzes the tiny, hair-like cells called cilia that line the air passages of the lungs. These cilia are important because they help to keep germs and irritants out of the lungs. The more you smoke, the more damage you do to the cilia.

    When the cilia do not work properly, mucus stays trapped in the lungs. This causes the walls of the bronchial tubes to become irritated, swell, and narrow. The bronchial tubes also become less able to expand when the body needs more oxygen. Mucus stuck in the smaller passages causes stale air to be trapped instead of exhaled. This leads to difficulty breathing that becomes progressively worse over time. The walls of the air sacs (alveoli) in the lungs also suffer damage as the disease progresses. As air sacs are destroyed, the lungs become less able to send oxygen to the bloodstream.

    Exposure to occupational or environmental irritants can cause chronic bronchitis.

    If you work around dust or fumes, know and follow the safety precautions recommended in the Material Safety Data Sheet(s) of the products or substances. Let your clinician know what you are exposed to in your work environment. If your bronchitis gets worse because of exposure to irritants in your workplace, you may need to change employment.

    Irritants may include:

    • Smoke
    • Air pollution irritants, such as ozone and nitrogen dioxide
    • Fumes from chemicals such as sulfur dioxide, hydrogen sulfide, bromine, strong acids, ammonia, some organic solvents, and chlorine
    • Dusts, such as coal dust or grain dust

    Chronic bronchitis can develop from repeated episodes of acute bronchitis or other repeated lung infections.

    The recurring cough from repeated episodes of acute bronchitis may damage the lining of the bronchial tubes, making it increasingly difficult to clear mucus from the lungs. The mucus then leads to further coughing and more scarring of the air passages in the lungs. Chronic bronchitis may develop over time because of this damage. Recurrent respiratory tract infections during infancy or early childhood can also lead to chronic bronchitis.

    The first noticeable symptom of chronic bronchitis is a persistent, mucus-producing cough.

    In its early stages, chronic bronchitis has few symptoms. It often begins with a recurring morning cough that brings up mucus from the lungs (phlegm). Smokers often dismiss this cough as a “normal” smoker's cough. Many people also complain of postnasal drip or sinus congestion, a bad taste in their mouth, or bad breath (halitosis). As time passes, the amount of phlegm gradually increases and coughing continues throughout the day.

    Chronic bronchitis can cause wheezing and shortness of breath.

    Narrowing of the airways due to inflammation, coupled with increased mucus in the lungs, leads to shortness of breath that worsens over time. This shortness of breath may be accompanied by episodes of wheezing, which is a raspy, whistle-like sound heard with breathing. Wheezing occurs when air moves through the narrowed air passages in the lungs. The wheezing and shortness of breath of chronic bronchitis often occur or worsen with exertion.

    In the later stages of the disease, chronic bronchitis may cause the skin and lips to develop a bluish tinge due to a lack of oxygen in the blood. Lack of oxygen in the blood, coupled with the increased work it takes to breathe through obstructed air passages, can cause a person to tire easily with even small amounts of activity.

    Chronic bronchitis, and the heart problems it may cause, can lead to swelling (edema) in the legs and ankles.

    Swelling in the ankles and legs, and sometimes swelling in the abdomen, may occur in advanced chronic bronchitis. This happens because blood vessels narrow (constrict) to try and divert blood to less damaged areas of the lungs where more oxygen is available. This constriction can lead to high blood pressure in the lungs (pulmonary hypertension). Pulmonary hypertension causes the right side of the heart to work harder than it should. Eventually, that side of the heart may not be able to keep up with the workload. This is called right heart failure, or cor pulmonale. Right heart failure may cause blood to back up in the liver, intestines, and legs. This may cause swelling in the ankles, legs, and abdomen. High blood pressure and chest pain may also occur. It is important to see your clinician regularly so that any new problems with your heart or lungs can be caught early.

    A sudden worsening of chronic bronchitis is called an exacerbation. Symptoms of an exacerbation include coughing up more mucus or mucus that is a different color than usual, as well as increased shortness of breath.

    Viral infections are the most common trigger of an exacerbation of chronic bronchitis. When chronic bronchitis is in its later stages, even a mild cold can trigger a severe worsening of symptoms.

    Exacerbations of chronic bronchitis can make it hard for you to breathe. If you cannot get your breath, begin to wear out from the effort it takes to breathe, become confused, or have a new or worsening dusky tint of the skin of your fingers or mouth, seek medical attention immediately.

    Smoking tobacco products increases your risk for chronic bronchitis and chronic obstructive pulmonary disease (COPD).

    Cigarette smoking causes approximately 80%-90% of COPD cases. Even after you develop bronchitis or emphysema, your health could still benefit from quitting smoking. Your clinician can inform you of a number of medications and programs available to help you quit smoking.

    Children of heavy smokers also have an increased risk for developing chronic bronchitis, as do nonsmoking adults who are repeatedly exposed to the cigarette smoke of others (passive smoke).

    Being exposed to environmental pollutants, such as large amounts of dust or irritants, may increase your chance of developing chronic bronchitis.

    Chronic bronchitis is more common in urban areas that have air pollution. Exposure to emissions of sulfur dioxide (SO2, a chemical used in bleaching and as a refrigerant and preservative) in particular has been shown to increase the risk of chronic bronchitis. Workers exposed to dusts, such as coal miners, grain handlers, and metal molders, are also at an increased risk for developing chronic bronchitis.

    Frequent respiratory illnesses and infections can increase your chance of developing chronic bronchitis.

    People who have repeated episodes of acute bronchitis have an increased risk of developing the chronic form of the disease. Recurrent respiratory tract infections during infancy or early childhood can also lead to chronic bronchitis.

    Alpha1-antitrypsin (AAT) deficiency, an uncommon hereditary condition, can put you at greater risk of developing COPD and chronic bronchitis.

    AAT is a protein that is made in the liver and released into the blood. It plays a role in protecting the lungs. AAT deficiency is an inherited disorder in which there is not enough AAT in the blood. This may leave the lungs less protected against damage. AAT deficiency is uncommon, but if you have it, your risk of developing COPD can be significantly increased. If you have this hereditary deficiency, your clinician may recommend AAT-replacement therapy.

    Pneumococcal and influenza vaccines may reduce your risk of having an acute exacerbation (sudden worsening) of your chronic bronchitis.

    Any lung infection can make the symptoms of your bronchitis worse. Preventing pneumonia and influenza can help you decrease the risk of bronchitis exacerbations. Ask your clinician about whether you should receive the pneumococcal and influenza vaccines. Both vaccines are usually recommended for people who are over the age of 65, have a chronic illness, or have a weak immune system. The pneumococcal vaccine is effective for 5 years in people who receive it before age 65 for the first time. But people who receive it for the first time who are over 65 only need to get it one time. The influenza vaccine must be taken yearly, because it protects against only that year's strains of influenza viruses.

    Smoking increases your risk of developing lung cancer. If you begin to cough up blood, notify your clinician right away. This may be a sign of lung cancer.

    Your clinician will take a thorough medical history.

    Your clinician will also ask about your past and current smoking habits and if you live with someone who smokes. Any history of on-the-job exposure to airborne irritants is important to your clinician. You should tell your clinician about any family history of respiratory diseases, such as cystic fibrosis or emphysema.

    Your clinician will ask about your cough: how long you've had it, whether it produces mucus, and how frequently you've had it within the past 2 years. You will be asked about the color, consistency, and amount of phlegm you cough up in a typical day. It's important that you answer these questions fully and report any breathing problems that you have.

    Your clinician will use a stethoscope to listen to your lungs.

    Your clinician will be listening for wheezes (high-pitched sounds that occur when air is pushed out through constricted airways) and rales (small rattling sounds that result when air moves through airways filled with fluid). The clinician may also percuss your lungs, which involves placing one hand on your chest and thumping it with the fingers of the other hand. The vibration from the chest percussion helps the clinician determine the size and condition of the lungs.

    You may need a chest x-ray to rule out pneumonia or other diseases that may mimic or contribute to chronic bronchitis Table 01.

    Sometimes an x-ray is taken to rule out the possibility of other illnesses or diseases. An x-ray cannot be used to diagnose early chronic bronchitis because an x-ray taken during the beginning stages of the disease is often normal Table 01.

    You may need to take lung function tests.

    Lung function tests (also called pulmonary function tests) measure how well the lungs can take in, hold, and use air. Spirometry is the most important of these tests for diagnosing chronic bronchitis and chronic obstructive pulmonary disease (COPD).

    Lung function tests are simple to take. You breathe into a mouthpiece attached to special monitoring equipment. The test results will help your clinician find out how well your lungs are working and determine the severity of your bronchitis. These tests may need to be repeated over time so your clinician can keep track of whether the disease is getting worse and whether your treatment is helping.

    You may need various laboratory tests.

    Laboratory tests may include a complete blood cell count (CBC), to see if an infection is causing (or worsening) your bronchitis symptoms. Your clinician may take a sample of the phlegm (mucus) you are coughing up to determine if your symptoms are caused by a virus or a bacterium.

    Another laboratory test you may need is an arterial blood gases (ABG) test. An ABG test includes measurement of the levels of oxygen and carbon dioxide in your blood. For this test, blood must be drawn from an artery in the wrist, arm, or groin. Your clinician uses the results of this test to see how advanced your disease is and if you need oxygen therapy. You may need ABG testing more than once, especially during a severe episode of difficulty breathing.

    If you are around the age of 45 or younger, are a nonsmoker, or have a strong family history of COPD, your clinician may do a blood test to see if you have enough alpha1-antitrypsin (AAT).

    AAT is a protein that is made in the liver and released into the blood. It plays a role in protecting the lungs. AAT deficiency is an inherited disorder in which there is not enough AAT in the blood and the lungs are not protected. AAT deficiency is a major (but uncommon) risk factor for COPD. If you have this hereditary deficiency, your clinician may recommend AAT-replacement therapy.

    AAT-replacement therapy in those with AAT deficiency cannot reverse any lung damage that has already occurred. However, it can slow the progression of lung disease. This therapy must be continued for the rest of your life.

    Your clinician may need to perform an electrocardiogram (ECG).

    An ECG records the electrical activity of your heart as a tracing on paper that your clinician can examine. The results of your ECG can help your clinician determine if your bronchitis symptoms are caused by, or worsened by, a heart problem. It may also show if your heart is having trouble tolerating your illness. Since chronic bronchitis can cause heart problems over time, your clinician may perform an ECG more than once.

    Table 1.  Common Tests Done to Diagnose Chronic Bronchitis

    Test Why it is done
    Spirometry This simple test is the most important test in diagnosing chronic obstructive pulmonary disease (COPD). You will breathe into a tube, and readings will be taken. Your clinician may use this test to diagnose chronic bronchitis, track the progression of the disease, and see how well any treatments are working.
    Arterial blood gases (ABG) test This test measures the amount of oxygen and carbon dioxide in your blood. It is helpful in diagnosing more advanced stages of the disease and can help your clinician determine whether you require oxygen therapy.
    Pulse oximetry This test uses a probe that gently warms the skin to take indirect readings on the amount of oxygen in your small blood vessels. Pulse oximetry is comfortable and easy to perform; however, it does not give as much information to your clinician as an ABG test does.
    Complete blood count (CBC) Your clinician can see if you have an infection and can monitor your blood for changes that may occur due to lack of oxygen.
    Serum alpha1-antitrypsin Your clinician may perform this test if you get chronic bronchitis but don't smoke, are young, or have many family members with COPD.
    Electrocardiogram (ECG) An ECG can help rule out a cardiac cause of your bronchitis symptoms. As your disease progresses, an ECG can help your clinician see how your heart is tolerating your illness. Since chronic bronchitis can cause heart problems as the disease advances, ECGs done on a regular basis may help your clinician catch problems early.
    Chest x-ray A chest x-ray often cannot be used to diagnose early chronic bronchitis, since lung changes often are not visible until later in the disease. However, a chest x-ray can help your clinician rule out some other causes of your bronchitis symptoms.

    The best way to keep from getting chronic bronchitis and other lung problems is not to smoke.

    Smoking can cause a variety of lung diseases, including chronic obstructive pulmonary disease (COPD) and cancer. Smoking can also make your chronic bronchitis get worse more quickly, increase your susceptibility to other illnesses, and shorten your life. People who are exposed to your secondhand smoke are also at greater risk of illness and disease. It is never too late to quit smoking. Ask your clinician for information about medications and programs to help you quit smoking.

    Avoid inhaled irritants, such as air pollution or workplace dust or fumes.

    If you live in a polluted area, limit your exposure to potentially damaging chemical irritants by staying indoors as much as possible on days when pollutant levels are high. Also, limit your exposure to indoor pollutants by using fewer aerosol deodorants, insecticides, and hair sprays.

  • Prevention and Screening

    The best way to keep from getting chronic bronchitis and other lung problems is not to smoke.

    Smoking can cause a variety of lung diseases, including chronic obstructive pulmonary disease (COPD) and cancer. Smoking can also make your chronic bronchitis get worse more quickly, increase your susceptibility to other illnesses, and shorten your life. People who are exposed to your secondhand smoke are also at greater risk of illness and disease. It is never too late to quit smoking. Ask your clinician for information about medications and programs to help you quit smoking.

    Avoid inhaled irritants, such as air pollution or workplace dust or fumes.

    If you live in a polluted area, limit your exposure to potentially damaging chemical irritants by staying indoors as much as possible on days when pollutant levels are high. Also, limit your exposure to indoor pollutants by using fewer aerosol deodorants, insecticides, and hair sprays.

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