Chronic Bronchitis

Excerpt

A persistent cough producing sputum for at least 3 months annually over 2 consecutive years characterizes chronic bronchitis in adults. Goblet cell hyperplasia leads to excessive mucus production. This, combined with reduced mucus clearance, causes airway inflammation, structural changes, and obstruction. Characteristically, chronic bronchitis in children is due to persistent neutrophilic airway inflammation driven by chronic bacterial infection of the airways. For this reason, experts use the term “protracted bacterial bronchitis.” The defining features of protracted bacterial bronchitis (PBB) are an isolated chronic wet cough lasting longer than 4 weeks, resolution with a 2-week course of appropriate antibiotic treatment, and the absence of evidence indicating an alternative cause. Chronic bronchitis in childhood can persist into adulthood, and proper management is imperative as progression to bronchiectasis, asthma, and lung function impairment is possible. In addition, studies reveal that a chronic productive cough in young adults 18 to 30 results in an increased risk of future cardiovascular events and premature deaths, likely due to systemic inflammation. Likewise, childhood asthma and allergies are risk factors for chronic bronchitis in adults.

Despite being a common finding in patients with chronic obstructive pulmonary disease (COPD), chronic bronchitis can be an isolated illness with or without airflow obstruction. However, patients with isolated chronic bronchitis are at risk factor for developing airflow obstruction, accelerated lung function decline, COPD exacerbations, and increased lung disease-related and all-cause mortality. In adults, a strong causal relationship with smoking exists; however, many cases of chronic bronchitis are not associated with smoking, indicating additional risk factors. Hard-rock mining, tunnel work, concrete manufacturing, non-mining industrial work, exposure to biomass fuel burning, and livestock farming are all well-known underlying causes explaining the presence of chronic bronchitis in patients who have never smoked.

Treatment of chronic bronchitis centers around reducing mucus production, improving mucus clearance, minimizing inflammation, and supporting effective cough mechanisms. Smoking cessation and secondhand smoke avoidance are critical for reducing airway damage and improving respiratory health. Clinicians tailor the management of acute exacerbations based on symptoms with antibiotics, short-acting bronchodilators, and systemic corticosteroids. Patient education regarding self-management and, when available, pulmonary rehabilitation are additional essential management components. Children with PBB require a minimum of 2 weeks of antibiotics, adjusted based on symptom resolution and guideline specifics. Chronic bronchitis and PBB significantly affect long-term lung function and overall mortality. Healthcare professionals should proactively manage these conditions, utilizing a well-balanced combination of pharmacologic and non-pharmacologic therapies.