Bronchitis, Chronic


What should I know about Chronic Bronchitis?

Colds, flu, and bronchial infections are common. Some are minor and yet as we age, our resistance to the damage caused by these infections creates problems. Respiratory tract infections remain the major cause of death from acute illness in the United States, and most likely, they represent the single most common reason patients seek medical attention. (1) The respiratory tract has a wonderful defense system, that, when functioning properly, is very effective against invasion, and removing potentially infectious substances from the lungs.

Lower respiratory tract infections generally occur only when lung defense mechanisms are not functioning properly. Lung function can be impaired by such things as the chronic inflammation that accompanies cigarette smoking or continued exposure to other irritants. Defenses may be additionally compromised when a particularly infectious microorganism invades the lungs. The majority of lower respiratory tract infections follow a colonization of the upper respiratory tract by these microorganisms. After achieving sufficiently high concentrations, the microorganisms then gain access to the lungs through the breathing process itself. Microbes can also enter the lung by inhaling infected aerosolized particles, or by way of the blood from another source; however, this occurs less frequently.

The most common lower respiratory tract infections are bronchitis, pneumonia, and bronchiolitis. Bronchitis, both acute and chronic, occurs most often in the winter months. Cold, damp climates and the presence of high concentrations of irrritating substances also seem to precipitate attacks. An appropriate treatment program for an individual who has an uncomplicated lower respiratory tract infection can usually be established by a history, physical examination, chest radiograph, and properly collected sputum cultures, interpreted knowing the most common lung pathogens and their antibiotic susceptibility patterns within one’s community.

Chronic bronchitis is a condition with continuous or recurrent excess mucus secretions into the bronchial tree. This condition can be exhausting. There is a cough that occurs most days during a period of at least three months of the year for two consecutive years in an individual where other causes of chronic cough have been ruled out. (2) The cough is the body’s response to try to get rid of the excess mucus produced as a result of continued bronchial irritation caused by one or a combination of factors. Cigarette smoking has been identified as the most prominent bronchial irritant; however, exposure to occupational dusts, fumes, environmental pollution, and bacterial (and possibly viral) infections must also be included.

As mucus-producing glands are continually stimulated, damage may occur. The cells, which secrete mucus, are called goblet cells. These goblet cells are generally absent from the smaller bronchi of normal healthy individuals, yet the number and size is markedly increased in both the larger and small bronchi of a person with chronic bronchitis. Further complicating matters is the fact that the mucus gland ducts also become dilated. As a result of these changes, those with chronic bronchitis have increased mucus in their peripheral airways further compromising lung defenses. Additional changes occur in the bronchi, including increased smooth muscle, cartilage atrophy, inflammation, and loss of cilia. These bronchial changes do not contribute significantly to obstruction. (3)

Although the majority of chronic bronchitis sufferers have a positive history of cigarette smoking, as many as 10 percent have no smoking history. For these patients, other airway irritants, alone, or more likely in combination, are responsible for helping to create or worsen the condition. The influence of recurrent respiratory tract infections in childhood or young adult life to the later development of chronic bronchitis remains unclear.


American Lung Association, 2005.

    After seeing a 10 percent decline in chronic bronchitis prevalence rates between 1997 and 1999, the prevalence rate increased 24 percent from 1999 to 2001. In 2001, it was estimated that 11.2 million Americans reported a physician diagnosis of chronic bronchitis. In 2003, 8.5 million Americans had chronic bronchitis with 2.7 million cases in males and 5.8 million cases in females. People living in the South (3.5 million) were more likely to have chronic bronchitis than those living in the Northeast (1.4 million), West (1.4 million), Midwest (2.0 million). Those over 65 had the highest prevalence rate at 67.3 per 1000 persons.

The Center for Disease Control, 2000.

    There are a total of 1,167 deaths from Bronchitis in the U.S. each year.

Signs and Symptoms

[span class=alert]The following list does not insure the presence of this health condition. Please see the text and your healthcare professional for more information.[/span]

The most notable sign of chronic bronchitis is a cough that may range in severity from a mild “smoker’s cough" to severe incessant coughing producing obviously infectious sputum. Most people who suffer from chronic bronchitis expectorate excessive amounts of sputum upon arising in the morning although many patients expectorate throughout the day. The sputum is generally thick and ranges in color from white to yellow-green.

A diagnosis of chronic bronchitis is made based upon the individual’s history and clinical assessment, and when other possibilities such as cardiac failure, bronchiectasis, cystic fibrosis, and lung cancer have been ruled out. An ad hoc international committee comprised of pulmonary and infectious disease physicians developed a classification system that can serve as a practical guide for initial assessment and management of individuals with chronic bronchitis. (4) This type of guideline helps a healthcare professional to determine the status of the condition, the type of infection, and then determine the treatment. Classifications of bronchitis are as follows: Class 1, acute tracheobronchitis; Class 2, chronic bronchitis; Class 3, chronic bronchitis with complications; Class 4, Chronic bronchial infection.

In order to determine which class of bronchial problem is present, the healthcare professional will examine the individual by first listening to the breathing to find any abnormalities. The practitioner usually also depends upon the microscopic and laboratory assessment of sputum which is considered an important component of the overall evaluation of chronic bronchitis patients. A fresh sputum specimen obtained as an early morning sample is preferred. (5) Comparison of the cells of chronic bronchitic sputum with those of normal sputum can provide insight into the degree of activity of the disease processes. (6)


  • Mild to Severe cough
  • Coughing up excessive sputum in the morning, with some throughout the day
  • Sputum is generally thick and ranges in color from white to yellow-green
  • Wheezing and other abnormal lung sounds heard while inhaling and/or exhaling

Treatment Options


The overall goal of treatment should be to reduce the severity of the chronic symptoms, eliminate the acute attacks, and establish longer periods of time during which the individual is free from infection. This usually involves taking a complete environmental and occupational history to determine exposure to noxious or irritating gasses. If cigarette smoking is a part of the history, the individual is encouraged to stop smoking or at least to cut down.

Sometimes the airflow is limited for such a time and extent that a bronchiodilator such as an albuterol aerosol may be a recommendation. Usually the dose for albuterol is one or two puffs of a metered dose three or four times each day.

The use of antibiotics in the treatment of chronic bronchitis has been studied numerous times with widely varied results. Making the determination as to which antibiotic to use is complicated even further because of the emergence of resistant strains of bacteria. If the practitioner determines that an antibiotic should be used, he/she will match that antibiotic to the most likely microorganism that is responsible for the infection.

Nutritional Suplementation

Vitamin C

Data from the Second National Health and Nutrition Examination Survey (NHANES II) revealed that bronchitis was negatively associated with serum vitamin C levels. (7) In one double-blind cross-over study, administration of 2 grams of vitamin C resulted in a noticeable improvement when compared to those individuals taking a placebo. (8) In addition vitamin C has antihistaminic activity due to its ability to metabolize and detoxify histamine. (9)


Patients with chronic bronchitis have been found to have low zinc status. Zinc supplementation normalized plasma zinc levels and resulted in an improvement in general health status. (10)

N-Acetyl Cysteine (NAC)

N-acetylcysteine is an agent that has is useful in the treatment of chronic bronchitis. Several studies report that taking N-acetylcysteine (400 mg/day) over a 6 month period resulted in a significant reduction in the number of acute exacerbations per month, a reduction in days of sick leave, and a lower rate of hospitalizations. (11) , (12)

Herbal Suplementation


Licorice has long been used as both a flavoring agent and a medicinal herb. It is often used in fatigue (in the case of adrenal insufficiency), (13) as an expectorant, (14) in GI distress (particularly of benefit in ulcers), (15) , (16) , (17) and in inflammation. (18) , (19)

Licorice is claimed to inhibit antibody formation and support the stress response and the inflammatory response. (20) Licorice may also stimulate interferon production in the body, which could support its antiviral activity. (21) , (22) Licorice also is used as an expectorant. The component glycyrrhizin produces demulcent and expectorant effects by stimulation of tracheal mucous secretion, although the potential for side effects are increased. (23)


Tylophora has been used traditionally in Ayurvedic medicine for thousands of years in problems with the lungs and breathing. Tylophora is used in the nutritional support of bronchial asthma and symptoms of allergies. Numerous studies report the beneficial effects of tylophora in the treatment and management of bronchial asthma. (24) , (25) , (26) Tylophora has been claimed to have short acting bronchodilator activity, but anti-asthmatic effects are believed to be more accurately explained by tylophora’s reported depression of cell-mediated immunity. (27)


Cordyceps has been used in traditional Chinese medicine as the herb of choice in lung and kidney problems, and as a general tonic for promoting longevity, vitality, and endurance. (28) Cordyceps has been used in humans for centuries as a tonic for improving performance and vitality, with the proposed mechanism of action being improved oxygen consumption by the cardiopulmonary system under stress and increased tissue "steady state" energy levels. Cordyceps may modulate immune function and optimize endocrine systems, increasing physical strength and endurance. (29) , (30) Cordyceps has traditionally been used for its improvement in respiration and in individuals with decreased lung function, such as asthma and bronchitis, by increasing oxygenation (improving VO2 max by 9-15%). (31)


Experiments have reported that astragalus promotes regeneration of cells in the bronchi after viral infection. Astragalus is claimed to protect against cellular damage in the liver, (32) , (33) help with oxygenation of the lungs, heart, and cerebrovascular tissue, improving stamina and endurance. (34) , (35) , (36)


Echinacea is one of the most popular herbs in the world. It has non-specific stimulatory effects on the immune system. (37) It has been used to help in the treatment of colds and flu. (38) Echinacea has been evaluated in many studies for its effect on upper respiratory tract infections (URIs). A recent review of several studies involving the use of echinacea in the treatment of URIs reported that echinacea products are generally effective in decreasing the duration and severity of URIs. (39) Another review of twelve clinical studies published from 1961-1997 concluded that echinacea was helpful in treating the common cold, but the results are unclear due to inherent flaws in study design. The trial also discusses five trials that were published since 1997; two showed that echinacea lacked efficacy for treating and preventing URI symptoms, and three concluded that it was effective in reducing the frequency, duration, and severity of common cold symptoms. (40) Again, the overall consensus is that echinacea has been used in Europe for over a decade for URI with positive results in the clinical setting. Further clinical studies need to be performed with quality-standardized products to definitively prove Echinacea’s usefulness in managing the symptoms of URIs.


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