American Medical Association Family Medical Guide - American Medical Association [403]
Irritation of the airway lining increases the production of mucus. With persistent irritation, the mucus glands and cells multiply and grow larger, thickening the lining of the airways. As the lining thickens, the airways narrow. Irritants such as cigarette smoke also damage the tiny hairlike projections called cilia that help move mucus along the airways. When the cilia can no longer move the mucus, it stays in the airways, where it can become infected with bacteria. Over time, the chronic inflammation can damage the lining of the airways and destroy the cilia.
If the infection spreads into the alveoli (the air sacs at the ends of the bronchioles in the lungs), it can cause pneumonia (see page 660). Chronic bronchitis may also lead to heart or circulation problems such as pulmonary hypertension (see page 594) or congestive heart failure (see page 570).
Symptoms
The first symptom of chronic bronchitis is a persistent cough (especially in the morning), usually from smoking, that brings up phlegm from the lungs. The person coughs and wheezes throughout the day. People with chronic bronchitis become progressively more breathless and experience a gradual decline in their ability to tolerate exercise. Some people who have severe chronic bronchitis may look blue in the face, especially around the lips, because they are not getting enough oxygen. They may eventually experience respiratory failure (see page 645) because their lungs cannot supply their body with enough oxygen.
Diagnosis
If you have symptoms of chronic bronchitis, especially a chronic cough, your doctor will ask you if you smoke (and how much) and where you live and work. He or she also will recommend diagnostic tests such as a chest X-ray and lung function tests (see page 647).
Q & A
Chronic Bronchitis
Q. I have chronic bronchitis and my coughing keeps me up at night. Why did my doctor ask me not to take cough suppressants?
A. Although cough-suppressing medications may relieve your cough, most contain derivatives of opium (such as codeine) that keep you from coughing up phlegm. The phlegm can dry and plug up your lungs and airways, making your bronchitis worse.
Treatment
The treatment for chronic bronchitis depends on how far it has progressed before it is diagnosed. If you are having difficulty breathing, your doctor probably will prescribe a bronchodilator (see page 641) administered through an aerosol inhaler to open the airways and make your breathing easier. You will probably use the bronchodilator three or four times a day, every 4 to 6 hours. Your doctor may prescribe a small dose of an antibiotic to take for several weeks or months to help prevent bacterial infections. Alternatively, he or she may prescribe a full course of antibiotics only for flare-ups or obvious infections.
If you smoke, the best thing you can do for your chronic bronchitis is to quit smoking (see page 29) and avoid smoky environments. If you work or live in a polluted environment, consider changing jobs or moving. If you move, try to choose not only a cleaner environment but also a warmer, drier one. Warm, dry air is easier to breathe than cold, humid air. Avoid contact with people who have a cold or the flu because illnesses that affect the respiratory system can bring on an episode of bronchitis. Get a vaccination against pneumococcal pneumonia (see page 145) every 5 to 7 years and a flu shot (see page 650) every year.
Emphysema
Emphysema is a disease that causes a permanent change in the structure of the alveoli (the tiny