Chronic bronchitis: causes and symptoms

Chronic bronchitis is a permanent airway inflammation that primarily affects smokers and former smokers. In Germany, about 20 percent of all adult men are affected by chronic bronchitis, which can severely impair quality of life, especially at an advanced stage.

When is bronchitis chronic?

Chronic bronchitis shows the same symptoms as acute bronchitis. However, according to the World Health Organization (WHO), chronic bronchitis is only diagnosed when there is at least three months of cough or other signs of bronchitis over a period of two years (one year in children). Smokers are much more affected by this disease than non-smokers. Men are two to three times more likely than women. The incidence increases with age and reaches its peak in the seventh decade of life.

Chronic bronchitis is classified into three severity levels:

  • Simple chronic bronchitis: Slimy white sputum without bronchial obstruction (so-called smoker's cough).
  • Chronic obstructive bronchitis: sputum obstruction due to tough sputum (dyscrinia) and mucosal swelling.
  • Obstructive emphysema: Like chronic obstructive bronchitis, but additionally with increased residual volume and reduced gas exchange area.

Causes of chronic bronchitis

Repeated occurrence of acute bronchitis can lead to chronic bronchitis. But even after other diseases, such as whooping cough, as well as chronic damage (tobacco smoke, dusty air in quarries, grinders, spinning mills, weaving, bakeries, mills, etc.) may become chronic bronchitis over time.

Chronic bronchitis also develops increasingly in congestive conditions in the pulmonary circulation, chronic cardiac and renal diseases, in round backs and in pleural adhesions. In the elderly, it is not uncommon for a lung flatulence, which in turn is a frequent cause of chronic bronchitis.

Symptoms of chronic bronchitis

Typically, the person concerned initially has hardly any complaints for years. The coughing with muco-white expectoration, which occurs predominantly in the morning, is not taken seriously by most. Excessive mucus production obstructs the small airways (bronchioles), complicates exhalation and provokes coughing. Due to the persistent strong cough, the alveoli can be overstretched.

The constant irritation and permanent inflammation of the airways promotes the rebuilding of the lung tissue over the years. This process promotes hyperinflation of the alveoli and allows the development of a bleaching lung. The pathologically altered lung tissue can not adequately ensure normal gas exchange. The patients complain of respiratory distress, which initially occurs only under stress, later also at rest.

In addition, people with chronic bronchitis are much more prone to bacterial infections, which are associated with high fever, worsening of the general condition and purulent sputum. This bacterial infection of the previously damaged tissue is referred to as an infection exacerbation.

Chronic bronchitis in the terminal stage

Chronic bronchitis arises as a result of this hyperinflation and narrowing of the airways by the mucus. After years of no complaints the patient gets slowly attack-like shortness of air under load. Acute infectious exacerbations of chronic bronchitis are becoming more common due to bacterial colonization of the previously damaged tissue.

In the final stage of the disease, oxygen deficiency, carbon dioxide accumulation, right heart strain and later right heart failure (cor pulmonale) are added. A herd-shaped pneumonia develops when the bronchial inflammation spreads to the pulmonary environment. In the enlarged alveoli, lung abscesses and pulmonary gangrene can occur.

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