Chronic Bronchitis Treatment

  • Treatment

    If you are having significant difficulty breathing, are confused or less alert, or have chest pain, seek medical attention immediately.

    It is important to seek medical care if your chronic bronchitis is getting worse. Sometimes, emergency care is necessary.

    Dial 9-1-1 or 0 for an ambulance if:

    • You get confused or become less alert to what is going on around you
    • You cannot get your breath
    • You have to work so hard to breathe that you become very tired
    • You notice a blue or gray tint to the skin of your fingers and around your mouth or if an existing tint gets worse
    • You become dizzy or develop heart palpitations or chest pain

    The goal of chronic bronchitis treatment is to help you live more comfortably and slow the progression of your disease Table 02. Quitting smoking is the single most important thing you can do to help your chronic bronchitis.

    The only effective way to significantly slow the downhill course of chronic bronchitis is to quit smoking. It is never too late to quit smoking. Quitting smoking will help you feel better, slow progression of the disease, and help you live longer. Medical research has shown that quitting smoking is helpful, even for people with advanced chronic obstructive pulmonary disease (COPD).

    A variety of options are available to help you stop smoking, such as nicotine-containing patches, gum, and nasal spray. Support groups can also be very helpful when you are trying to quit smoking. Certain antidepressants have been shown to increase the success rate in people who try to quit smoking. Remember that concerned professionals and other people are available to help you through this tough change.

    Table 2.  Ways to Be As Healthy As Possible When Living With Chronic Bronchitis

    Maintain a healthy environment
    Avoid respiratory irritants, such as smoke, air pollution, and marked variations in temperature and humidity.
    Consider major lifestyle changes, such as getting a new job (if needed to avoid irritant exposure) or moving to a lower altitude or a less polluted area.
    Avoid exposure to people with colds or flu.
    Ensure good nutrition and fluid intake
    Eat nutritious foods from a variety of food groups.
    If you are underweight, eat frequent high-calorie small meals and snacks.
    Drink at least 6 to 8 large glasses of water a day, unless instructed otherwise by your clinician. This helps to keep the mucus in your lungs thin, making it easier to cough up.
    Exercise your lungs
    Be as physically active as you can. Participate in a regular program of exercise (such as walking or riding a stationary bicycle several times a day for a total of at least 20 to 30 minutes every day). Consult your clinician before beginning any exercise program.
    Learn to use breathing exercises, such as pursed-lip breathing.
    Work with your clinician to find the treatment that is best for you
    Take any prescribed medication as directed by your clinician. If it does not seem to help or you have side effects, contact your clinician before stopping the medication.
    Use only over-the-counter or alternative medications that are approved by your clinician. Medications that are otherwise safe could worsen chronic obstructive pulmonary disease (COPD) symptoms or have bad interactions with your prescribed medications.
    Make certain that you get an influenza vaccine every year, and a pneumococcal (pneumonia) vaccine when recommended by your clinician.
    If your breathing, coughing, or other symptoms suddenly get worse, seek medical attention right away.
    Ask your clinician whether a pulmonary rehabilitation program may be right for you.

    If you have chronic bronchitis, avoid people who are ill and wash your hands frequently to prevent exposure to germs that may cause an infection in your lungs. Immediately seek treatment whenever you get a respiratory infection.

    Washing your hands frequently is a good way to decrease your risk of falling ill with many different kinds of infection. Be sure to wash your hands before eating, before touching your eyes or nose, and after going outside. Also wash your hands after caring for a sick person or handling items used by a sick person. If you do become ill with a respiratory tract infection, see your clinician right away.

    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 avoid bronchitis exacerbations. Ask your clinician whether you should receive 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 given once to people over age 65. Someone who gets their first influenza vaccine before age 65 will need a repeat vaccine in 10 years. The influenza vaccine must be taken yearly, because it protects against only that year's strains of influenza viruses.

    Your clinician can help you plan an exercise routine. Regular exercise can help you increase your energy and endurance.

    Establishing a general exercise regimen, such as a walking program, under your clinician's supervision can help you build strength and improve your overall well-being. It is important to use your inhalers as directed by your clinician before you exercise. Start your exercise with a warm-up period, and stop if you become too winded.

    Certain breathing exercises and techniques can be helpful.

    A 10-minute exercise called pursed-lip breathing can improve your breathing, especially before beginning an activity.

    • Lie flat on a bed with your head on a pillow and inhale through your nose. Be sure you are using your abdominal muscles to help your lungs fill with air.
    • Slowly exhale through your mouth with your lips pursed (slightly puckered, as if blowing out a candle), so that you make a quiet hissing sound.
    • Try to prolong the exhalation to get rid of as much “used” air from your lungs as possible. It should take you twice as long to breathe out as it did to breathe in.
    • Repeat this exercise several times. Once you are used to the pursed-lip breathing technique you can perform it anytime you need more air, even while standing.

    Exercises to strengthen your diaphragm and abdominal muscles can also help you breathe easier. Diaphragmatic breathing requires a bit more concentration than pursed-lip breathing, but it becomes easier with practice.

    • Place one hand on your stomach just below your ribs. Place your other hand in the middle of your chest over your breastbone.
    • Breathe in slowly through your nose, as deeply as you can.
    • Breathe out slowly through pursed lips, while concentrating on tightening the muscles in your stomach. Use your hand to gently push in and up. Repeat this for a few minutes.
    • You may need to practice this many times a day. Slowly increase the amount of time you spend during each practice session.

    Learning special positions for sleeping and lying down can help you breathe easier.

    In moderate to advanced chronic bronchitis, you may find it easier to breathe when sitting up. Foam wedges used to elevate the upper body while in bed may be useful in helping you breathe more comfortably during sleep.

    Take care of yourself to keep your immune system healthy. Eat a balanced diet, drink enough fluids, and get plenty of rest Table 02.

    Your body will be better able to defend itself against respiratory infections if you lead a healthy lifestyle. Be sure to get enough rest every day. Eat foods that are rich in beta-carotene and the antioxidant vitamins C and E, such as dark green leafy vegetables (broccoli, spinach) and orange or yellow fruits and vegetables (carrots, oranges, mangos, apricots).

    Drink plenty of fluids throughout the day (preferably water). This helps to keep your mucus membranes hydrated (moist), which can help your body stop bacteria and viruses from entering Table 02.

    Eating extra snacks and dietary supplements can help you maintain your weight and nutritional balance if you are becoming too thin.

    People with advanced chronic bronchitis may have trouble maintaining their weight and getting the proper nutrition. Underweight people should eat frequent high-calorie small meals and snacks. Products such as nutrition shakes may also be necessary. Your clinician can recommend nutritional guidelines that are right for you.

    You may be given a prescription for a bronchodilator. A bronchodilator can help you breathe easier Table 03.

    Bronchodilators help to relax and open your airways to help you breathe easier. Some bronchodilators are taken regularly, and some can be taken when needed for trouble breathing. Bronchodilators come in pill, liquid, or inhalation form.

    For chronic bronchitis, bronchodilators are most often given by inhalation. The medicine may be inhaled through a metered-dose inhaler Table 03 or through a nebulizer (a device that delivers the medication in droplet form, using moistened oxygen or air).

    Different inhalers may have different purposes and work in different ways. It is important to follow directions from your pharmacist and clinician and not overuse your inhaler(s).

    You won't get the full benefit of your inhaled medications unless you take the time to learn proper inhaler use. Even people who have been using inhalers for a long time may be using them incorrectly without even knowing it. Take your inhaler with you to medical appointments so your clinician can evaluate your technique Table 03. Your clinician may recommend you use a spacer or chamber with your inhaler. This is a device that goes between the inhaler and your mouth. A spacer can help you inhale more medicine and make inhaling your medicine easier.

    Table 3.  How to Use a Metered-Dose Inhaler (MDI)

    Shake the inhaler thoroughly to be sure you get the correct amount of medicine per puff.
    Exhale (breathe out) as much air from your lungs as you can.
    Inhale at a slow and steady rate, as you depress the inhaler once to release the puff of medicine. Keep breathing in slowly and deeply as you inhale the medicine.
    Hold your breath for 10 full seconds. Then, breathe out slowly.
    Wait about 1 minute between puffs, if you are supposed to take more than one.
    At night, take the canister of medicine out of the mouthpiece, and rinse the mouthpiece and cap with warm water. Let the pieces dry overnight.

    Adapted from: Facts About Controlling Asthma, National Asthma Education and Prevention Program, National Heart, Lung, and Blood Institute, NIH Publication No. 97-2339 - A reproducible handout. Available online at: http://www.nhlbi.nih.gov/health/public/lung/asthma/asth_fs.htm. Accessed April 14, 2003.

    Check with your clinician before taking any over-the-counter or alternative therapies.

    Common medications that are generally considered safe may not be safe for people with chronic bronchitis. Over-the-counter medications and some alternative therapies may worsen your COPD symptoms or have bad interactions with your prescribed medications. Use only over-the-counter and alternative medications that are approved by your clinician.

    Your doctor is the best source of information on the drug treatment choices available to you.

    People with advanced chronic bronchitis who have low blood oxygen levels may require oxygen replacement therapy.

    Signs that you may have low oxygen levels in your blood include being tired all of the time and being unable to do even simple things without becoming short of breath. You also may be irritable, have a harder time thinking than usual, or have headaches.

    Your clinician may need to perform certain tests (such as pulse oximetry or arterial blood gases tests) to see if you need extra oxygen. Round-the-clock oxygen therapy is usually recommended for people who have low blood oxygen levels at rest or after minimal activity. Occasional (or, “as needed”) oxygen therapy is useful for people whose oxygen level drops while they are exercising or sleeping. Sometimes, extra oxygen is necessary for only a short time, such as when you are recovering from an illness, riding on an airplane, or traveling to high altitudes.

    Several different oxygen delivery devices are available for home use, including tanks of compressed oxygen and devices that concentrate oxygen from the air in the room. Oxygen is usually delivered through a nasal cannula, which is a plastic tube that has small, flexible prongs that fit just inside your nostrils. This oxygen may need to be humidified (moistened) to keep your nose from drying out. Humidified oxygen is also important to help keep the secretions in your lungs loose, so you can cough them up more easily.

    Oxygen canisters should be kept away from any open flame, such as a pilot flame on a stove or a burning cigarette. Since oxygen increases fire danger, you should never smoke or allow anyone around you to smoke when you are using oxygen.

    Certain postures, methods of coughing, and ways of striking the chest and back can help keep air passages clear of mucus.

    Certain techniques can help people with bronchitis to keep their airways clear of mucus. Your clinician or physical or respiratory therapist may be able to teach these techniques to you (and a family member or caregiver):

    • Postural drainage - prescribed positions that allow gravity to assist in draining secretions from different areas of the lungs, making secretions easier to cough out
    • Chest percussion - lightly clapping your chest and back to help dislodge secretions
    • Controlled coughing - techniques that help you cough up mucus

    Sometimes, bland aerosols - inhaled solutions of salt or baking soda that thin and loosen secretions - are used along with these treatments.

    Lung transplants and lung reduction surgery are used only rarely to treat chronic bronchitis.

    Only those people with severe lung disease that has not improved with drug treatment are considered for surgical procedures. In lung reduction surgery, a large portion of the severely damaged lung tissue is removed. The extra room in the chest allows air to move more easily into and out of the healthy lung tissue that remains. Many people who undergo this surgery report that it improves their quality of life, sometimes enabling them to return to a moderately active life without continuous oxygen therapy. However, the surgery has serious risks; mortality (death) rates can be as high as 15%, and complication rates are even higher.

    With lung transplant surgery, a person with severe chronic bronchitis is given a healthy lung from a person who has recently died. This surgery is rarely recommended for chronic bronchitis. Complications from the drugs needed to keep the body from rejecting the new lung are high, and the 5-year survival rate is only 50%.

    Some people with severe chronic obstructive pulmonary disease (COPD) may benefit from acupuncture, acupressure, or breathing retraining to relieve dyspnea.

    Complementary and alternative therapies may sometimes be used for symptoms that are not helped by conventional therapies alone. Acupuncture, acupressure, hypnosis, and relaxation techniques may be beneficial and can be used at the same time as conventional treatments.

    Alternative therapies should not be used as a substitute for medical care. You should always tell your clinician or pharmacist what medicines you are taking, such as prescription or over-the-counter medicines, herbs, vitamins, or other supplements.

    Alternative therapies may react poorly with some prescribed or over-the-counter medicines. Taking herbs, vitamins, or other supplements may interfere with lab tests or healing after surgery or illness, or may worsen some illnesses and health conditions. Your clinician and pharmacist can help you choose the complementary therapies or supplements that are right for you.

    Weather and altitude can worsen your difficulty breathing. Plan ahead when traveling or flying.

    Temperature extremes (either too hot or too cold) can irritate your airways and make your chronic bronchitis symptoms worse. Traveling to high altitudes can also make it more difficult for you to breathe. Stay inside on very hot or very cold days, and avoid traveling to areas of high altitude.

    Commercial airplanes typically have a cabin pressure equal to that of an elevation of 5,000 to 10,000 feet. You may need oxygen to help you breathe when traveling by plane. Discuss with your clinician any travel plans you have, and notify the airline in advance of any special needs you may have during your flight.

    Chronic bronchitis is a lifelong, serious disease that requires treatment and should not be ignored.

    The damage done to the respiratory system cannot be reversed, but prompt treatment can help slow down the gradual deterioration of the lungs.

    The more severe the damage to the lungs, the poorer the prognosis will be. Ask your caregiver for information about the progression of your chronic bronchitis.

    People with chronic bronchitis should remain under the ongoing care of a clinician.

    Because chronic bronchitis can lead to more serious lung conditions as well as heart disease, your clinician will want to monitor you on a regular basis. Keep all appointments, and notify your clinician immediately if you develop a cold or any signs of a respiratory infection. Call your clinician if you are experiencing any difficulties with your medication (such as trouble taking medication as prescribed or unpleasant side effects) or if your symptoms worsen.

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