Acute bronchitis generally follows a viral respiratory infection. The viral infection produces bronchial inflammation, which sets the stage for bronchitis and secondary bacterial infection.

Chronic bronchitis is a long-term condition of excessive bronchial mucus with a productive cough. Chronic bronchitis is also known as chronic obstructive pulmonary disease.

Cigarette smoking (active and passive exposure) is the chief cause of this disease. Factors that make it worse include air pollution, infection, familial factors like genetic history and allergies.

The severity of the disease often relates to the amount and duration of smoking. Chronic bronchitis, emphysema, and asthma as a group are the fourth-leading cause of death in the United States. Two to three out of 100 people have chronic bronchitis.

• cough that produces mucus (sputum), may be blood streaked
• shortness of breath aggravated by exertion or mild activity
• frequent respiratory infections (such as colds).
• wheezing
• fatigue
• ankle, feet, and leg swelling that affects both sides
• reddish face, palms, or mucous membranes
• reddish cheeks
• headaches
• vision abnormalities

• rales (abnormal sounds in the lungs) or other abnormal breathing sounds on lung examination with a stethoscope
• pulmonary (lung) function tests provide information useful for diagnosis and prognosis
• arterial blood gas measurements may show abnormal oxygen and carbon dioxide levels and provide more information about lung function
• chest X-ray

Treatment is aimed at relieving symptoms and preventing complications. Smoking and all other respiratory irritants should be avoided. Intake of plenty of fluids and inhalation of humidified warm air can help loosen secretions and ease coughing. It is best if productive coughing is allowed to bring up mucus, but a cough medicine should be used if coughing fits become unbearable.

Respiratory treatments including inhaled medicines are often used to open constricted airways and aid in the clearance of mucous from the airways. Medications include the bronchodilators albuterol and ipratropium. Postural drainage may also facilitate the removal of thick mucus from the airways. Oral antibiotics may be prescribed in certain circumstances.

In patients with chronic bronchitis, physical exercise programs, breathing exercises, and patient education programs all contribute to the treatment plan. For patients with low oxygen levels, home oxygen is also used. Steroids (either inhaled or by mouth) can also help some patients with chronic bronchitis.

The stress of illness can often be reduced by joining a support group where members share common experiences and problems.

The chance for recovery is poor for advanced disease. Early recognition and treatment, combined with smoking cessation, improve the chance of a good outcome significantly.

• acute bronchitis
• pneumonia
• right-sided heart failure (cor pulmonale)
• emphysema

Call your health care provider if respiratory infection or unexplained symptoms develop, or if you are coughing up blood.

Early recognition and treatment of small airway disease in people who smoke, combined with smoking cessation, may prevent the progression of the disease.