Chronic Bronchitis: Symptoms, Causes, Diagnosis, Treatment, Complications, Prognosis and Prevention

The bronchial tubes extend from the trachea and end in the lungs’ alveoli.

Bronchitis is a term that describes the inflammation of the bronchi that produces excessive secretions of mucus in the tubes, which creates inflammation of the tissue that can narrow or close the bronchi.

The bronchial system resembles an inverted tree and is sometimes referred to as a ” bronchial tree. “

Some authors include the trachea and the upper airway in the definition of bronchitis.

There are two main types of bronchitis, acute and chronic.

Chronic bronchitis differs from acute bronchitis: pathology, disease progression, significant causes, treatments, and prognosis.

According to some doctors and researchers, recurrent incidences of acute bronchitis are the first steps that can lead to the development of chronic bronchitis.


Chronic bronchitis has been a characteristic sign of a recurrent cough for three months and can last up to 2 years; this cough comes with sputum production.

The bronchi can be generated much inflammation and swelling and production of mucus in excess.

Due to inflammation, there is a change in the cells that line the airways to varying degrees.

Many cells lining the airways lose the function of their cilia (appendages similar to hairs that can beat quickly), and, finally, the hair cells are lost.

Cilia are responsible for maintaining the trachea, bronchi, and nasal cavities free of particles and fluid (normal mucus) by moving them over their coating surface.

Often these cells have replaced that help to clear secretions (hair cells) with goblet cells.

These cells are responsible for secreting mucus in the airways.

The growth of bacteria is favored thanks to the warm and humid airways and the nutrients in the mucus.

Due to bacterial overgrowth and the body’s inflammatory response, mucus often becomes infected.

The flow of air to and from the pulmonary alveoli is usually and noticeably affected by inflammation, swelling, and mucus narrowing and partially obstructing the bronchi and bronchioles.

The irritation of the respiratory tract can generate the stimulation of the muscles that surround these routes.

A narrowing of the airways can be generated due to this muscle spasm, also known as bronchospasm.

The muscular spasm and long-term inflammation present in chronic bronchitis result in a non-reversible and permanent narrowing of the respiratory airways; this condition is known as COPD ( chronic obstructive pulmonary disease ).

Chronic coughing is generated when the body tries to clean and unclog the bronchi in the airways of particles and mucus or as an exaggerated reaction to the ongoing inflammation.

The symptoms of chronic bronchitis increase with time, so it can become a progressive disease.

For some doctors or researchers, chronic bronchitis can be considered a chronic obstructive pulmonary disease.

Emphysema, asthma, and chronic bronchitis are part of COPD.

Patients commonly have components of each condition above since these are not always separable.

In the case of airway inflammation, retained secretions, obstruction of the fixed airway, and chronic bronchitis can cause a mismatch of airflow to the lungs and blood flow.

This can deteriorate the disposal of the waste product, carbon dioxide, and the oxygenation of the blood.

Most people diagnosed with this condition are 45 years old or older, although all people can develop it.

Signs and symptoms

The most characteristic signs and symptoms of the disease include:

  • Difficulty breathing ( dyspnea ): in most cases, shortness of breath and cough when performing an activity are present in people suffering from chronic bronchitis; difficulty breathing at rest is usually an indication of COPD. This symptom gradually increases with the severity of the disease.
  • Cough and the production of secretions ( sputum ): these symptoms are usually maintained for three months to 2 years and are present daily. The secretion may have yellowish, greenish, transparent, and sometimes blood spots.
  • The sibilants are noise or sharp sounds produced by the respiratory tract when they are moderately obstructed.

Some other symptoms that may be present in chronic bronchitis are:

  • Muscle pains.
  • Sore throat.
  • Nasal congestion.
  • Headaches.
  • Fatigue.

The exacerbation of this disease occurs at the moment when the symptoms become more recurrent or worsen.

These complications can often require increased inhaled respiratory medications, antibiotics, and steroid medications.

The symptoms and signs of exacerbation of COPD or chronic bronchitis are:

  • Cyanosis: a condition that can develop in people with advanced COPD and is characterized by the gray and blue tone taken by the skin due to lack of oxygenation.
  • Cough consequent: that can generate pain and discomfort in the chest.
  • Fever: which usually evidences the presence of a secondary bacterium or a pulmonary infection.


There are many possible causes of chronic bronchitis, but cigarette or tobacco smoke is the most prominent and common.

Many people suffering from this disease are diagnosed after having been or continue to be smokers; various investigations prove that being a long-term smoker increases the risk of chronic bronchitis.

However, other factors can increase the risk of chronic bronchitis, such as:

  • Many other inhaled irritants: example, smog, industrial pollutants, and solvents.
  • Respiratory infections: can be both bacterial and viral. When acute bronchitis or disease occurs very recurrently, it can cause the onset of chronic bronchitis.
  • Underlying diseases: such as congenital or acquired dilation of the bronchioles ( bronchiectasis ), cystic fibrosis, familial genetic predisposition to bronchitis, asthma, congestive heart failure, and immunodeficiency.

Smoking and prolonged exposure to tobacco smoke and cigarettes are the main risk factors for obtaining this disease. However, others include:

  • Gastric reflux: by inhalation of gastric content.
  • Repetitive contact with contaminants: above all elements that can be inhaled, such as chlorine, ammonia, hydrogen sulfide, dust, sulfur dioxide, and bromine.

When to consult a doctor?

Call or other emergency services if:

  • The breathing stops.
  • There are moderate and severe breathing problems involving difficulty breathing during physical activity or speaking by saying complete sentences.
  • Severe chest pain occurs, or the chest pain quickly gets worse.
  • The cough presents with significant amounts of blood.

If you have been diagnosed with COPD before and have the following symptoms, tell your doctor:

  • You have trouble breathing or wheezing that gets worse quickly.
  • Feel pain in the chest.
  • If you cough recurrently and more deeply, especially if there is an increase in sputum and a color variation.
  • The swelling in your legs or belly has increased.
  • You have a high fever [more than 101 ° F (38.3 ° C)].
  • It has symptoms similar to those of the flu.

If your symptoms (cough, mucus, and shortness of breath) suddenly worsen, you may have an outbreak of COPD or an exacerbation.

Rapid treatment for an outbreak can help you stay out of the hospital.

Call your doctor early for an appointment if:

  • Your symptoms worsen slowly, and you have not seen a doctor recently.
  • Fever during a cold lasts more than two days.
  • Medicine is not having the same effect as before.
  • Shortness of breath occurs or worsens noticeably.
  • Your cough gets worse.
  • You have symptoms of COPD, although you have not yet been diagnosed.


Health professionals diagnose chronic bronchitis based on a person’s medical history, physical examination, and diagnostic tests.

If there is a daily cough (with the production of mucus) that lasts three months for at least two years, it is considered that it can fit with the symptoms for the diagnosis of chronic bronchitis.

Wheezing and prolongations of breathing exhalation, signs of obstruction of airflow in the lungs, can be measured by physical examinations by health professionals.

Chest radiographs are the most common tests to rule out additional lung problems such as pneumonia and bronchial obstruction.

Some other additional tests may be done to characterize the structure and function of the lungs and help exclude other conditions (such as tuberculosis, lung cancer, and lung infections); these tests include:

  • Computed tomography of the thorax.
  • A complete blood count.
  • Pulmonary function tests.
  • Measurements of gases in the blood.

The pulmonologist (specialist in lung diseases) is the doctor charged with diagnosing and treating this disease is the pulmonologist (specialist in lung diseases).

Testing is done as necessary:

  • Oximetry: allows for seeing the saturation of oxygen in the blood. This test provides less information than the arterial gas test and lets us know if oxygen treatment is needed.
  • Blood gas test in blood: this test allows us to measure acid, carbon dioxide, and oxygen levels in the blood.
  • Electrocardiogram: These tests can find specific heart problems that cause shortness of breath.
  • Transfer factor for carbon monoxide: with this medical examination, we can see how severe COPD or bronchitis is by analyzing the damage to your lungs.

Rarely performed tests:

  • CT scan or CT scan: This test allows doctors to see a clearer picture of the lungs.
  • Alpha-1 antitrypsin test (AAT): AAT is a protein that your body makes that helps protect the lungs. A person is more likely to get emphysema if they do not have enough AAT production in their body.


The goals of treatment for chronic bronchitis and COPD include:

  • Reduce the speed at which the disease progresses, avoiding triggers such as polluted air and smoking cessation.
  • Improve symptoms, such as coughing and respiratory obstruction, with medicines.
  • Increase your quality of life and health in general.
  • With medications and treatments, prevent outbreaks.

The first treatment is straightforward, but in most cases, the patient prefers to omit and deny that the primary part of the treatment is to stop or avoid cigarettes and tobacco.

It is important to encourage patients in all possible ways to stop smoking because if they continue with this, they will only achieve more damage to the lungs.

When the patient stops smoking (in most cases), the cough tends to disappear after a month of stopping.

Steroids and bronchodilators are the two most commonly used medications to treat this disease.

  • Bronchodilators: (e.g., albuterol, metaproterenol, formoterol, and salmeterol) work by relaxing the smooth muscles surrounding the bronchi, allowing the internal airways to expand.
  • Steroids: help reduce inflammation and decrease bronchial secretions and obstruction of the airways. The most common steroids are mometasone, methylprednisone, budesonide, and prednisone.

If chronic bronchitis or COPD gets worse, you may need other treatment, such as:

  • Oxygen treatment involves getting extra oxygen through a mask or a small tube that fits just inside the nose.
  • Treatment for muscle weakness and weight loss: is widespread for people suffering from chronic bronchitis, and COPD presents problems with the strength of their body and weight.
  • Help with depression: as you know, psychological issues can affect even more than just your lungs. It is essential to see a professional because this condition can also lead to depression, stress, and anxiety. These things take energy and can make your symptoms worse.
  • Surgery: Surgery is rarely used. This treatment only takes place in people who have very severe COPD and have not presented any improvement with the help of medications.

Dealing with outbreaks:

Outbreaks of chronic bronchitis, or exacerbations, occur when symptoms (difficulty breathing, coughing, and mucus production) worsen quickly.

The main thing is not to panic; if you are prepared, the most likely is to control the outbreak.

The best way to prevent severe respiratory problems is rapid treatment at home.

You may need to go to the hospital or your doctor’s office during an attack or outbreak, as this can be life-threatening.

Treatment for outbreaks of chronic bronchitis includes:

  • Machines to help you breathe: mechanical ventilation is the name given to the use of the device to help you live. This method is only used if your medication does not help and if the airway obstruction is severe.
  • Quick-relief medicines to help you live: beta2-agonists (such as albuterol or metaproterenol), oral corticosteroids (such as methylprednisolone or prednisone), and anticholinergic drugs (such as ipratropium or tiotropium).
  • Antibiotics: These medications are used when a bacterial lung infection is considered probable. People with chronic bronchitis have a higher risk of pneumonia and frequent lung infections. It is essential to avoid them, as they cause outbreaks or complications.


The primary complications of chronic bronchitis are:

  • Difficulty breathing: sometimes severe.
  • Respiratory insufficiency.
  • Pneumonia.
  • The right cardiac ventricle weakens and enlarges: caused by lung disease.
  • Pneumothorax: Pulmonary collapse is caused by the lung’s accumulation of air or gas.
  • Polycythemia: the levels of red blood cells needed to carry oxygen are abnormally high.
  • Chronic obstructive pulmonary disease.
  • The disease becomes progressively worse.
  • Emphysema.
  • In many cases, death.


People who stop smoking or avoid air pollutants have an excellent prognosis over the years because the bronchial damage is reduced, although this disease is chronic and progressive.

Some studies reveal that people who quit smoking reduce cough symptoms after a month in most cases.

If the patient stays away from the cigar and the tobacco, it will eliminate the cough.

The level of improvement in airflow obstruction depends on compliance with the therapy and the duration of the injury.

The recovery of lung function will be less in people who have more significant deterioration.

On the contrary, the prognosis is bad for those patients suffering from continuous bronchial irritation because the outbreaks get worse and become more consecutive, cough and dyspnea become more frequent, and there is a more excellent progression of abnormalities in pulmonary function.


No Smoking:

The best way to prevent chronic bronchitis from starting or worsening is to avoid smoking.

There are clear benefits to quitting smoking, even after years.

When you stop smoking, the damage to your lungs decreases.

The loss of lung function improves over time to be equal to that of a non-smoker, especially for people who stop smoking.

People with alpha-1 antitrypsin deficiency can reduce their risk of severe COPD if they receive regular injections of alpha-1 antitrypsin.

Avoid contaminated air:

Some other elements contribute to the irritation of the respiratory tract, such as polluted air, dust, and chemical vapors, so it is essential to avoid them.

Obtain vaccines:

  • Flu vaccines: you should get the flu vaccine every year. When people with the disease get the flu, it often becomes something more serious, like pneumonia. The flu can be prevented with the help of the vaccine.
  • Pneumococcal vaccine: receiving an injection can help you avoid getting seriously ill with pneumonia. People under the age of 65 usually only need one injection. If a person received their first injection before 65, doctors generally recommend a second injection after they turn 65.
  • Pertussis vaccine: whooping cough can increase the risk of bronchitis outbreak. The condition can be controlled if the pertussis vaccine is placed correctly.

Asthma control:

The development of chronic bronchitis can be prevented by suitable control of it. The genetic predisposition to chronic bronchitis is currently not preventable.

Difference between acute bronchitis and chronic bronchitis

Acute bronchitis usually improves within a few days, although symptoms such as cough may continue for a few weeks.

If you are a healthy person, the mucous membrane of your lungs should return to normal after recovering from the first phase of infection.

The second type of bronchitis, or chronic bronchitis, is defined by how long it lasts in your body, in this case, three months up to two years.

This inflammation of the membranes of the lungs requires medical treatment and is often part of what it means to have a chronic obstructive pulmonary disease (COPD).

When they become clogged with mucus, their lungs are more susceptible to viral and bacterial infections, permanently damaging their airways.

This damage is one of the main signs of going from chronic bronchitis to complete COPD and emphysema.

The damage is caused to the internal structures of the lungs, in this case, the tiny capillary structures of the lungs responsible for eliminating irritants and excess mucus known as cilia.

It can lead to a more complicated bronchitis recovery and significantly increase your chances of developing full-blown COPD.