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Chronic Bronchitis

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What is Chronic Bronchitis?

The bronchi are air passages connecting the windpipe (trachea) with the sacs of the lung (alveoli) where oxygen is taken up by the blood. Bronchitis is an inflammation of the bronchi causing excessive mucous production and swelling of the bronchial walls.
Many people suffer a brief attack of acute bronchitis with fever, coughing and spitting when they have a severe cold. Chronic bronchitis, however, is the term applied when this coughing and spitting continue for months and return each year, generally lasting slightly longer each time. Undue breathlessness on exertion is eventually noticed, due to obstruction to air flow in the air passages caused by swelling of the bronchial wall and the presence of mucus that cannot be cleared.
Emphysema is a disease in which there is destruction of the walls of the air sacs of the lung, and it is frequently preceded by chronic bronchitis. Emphysema adds to the breathlessness suffered by the patient with chronic bronchitis.

What does Chronic Bronchitis feel like?

Initially, it begins as a “smoker’™s cough” the expectoration of small amounts of phlegm each morning. It is usually worse in the winter time and when the person has a head cold. In these early phases of chronic bronchitis, the person may lead an entirely normal life, including vigorous sports. Sensitive breathing tests, however, can indicate the beginning of irreversible damage to the lung even at this stage.
The cough becomes more frequent during the day time and even at night, disturbing sleep. The patient then notices that activities previously tolerated well, cause shortness of breath and perhaps some wheezing. As the disease progresses, shortness of breath may be caused by very ordinary activities such as getting dressed in the morning or having a bath.
The patient with advanced bronchitis may be unable to walk or climb stairs without supplemental oxygen. He or she may be confined to a chair or bed because of shortness of breath and the type of heart failure which may develop in the late stages of this disease. Minor chest infections in patients with severe chronic bronchitis may require intensive treatment in hospital. As the disease is not rapidly fatal, it becomes an important cause of disability and the annual cost of this disease in terms of time lost from work, disability pensions and medical therapy may approach one hundred million dollars annually in Canada.

What causes Chronic Bronchitis?

Cigarette smoking is the most important cause of chronic bronchitis which rarely occurs in the non-smoker. Environmental pollution may contribute to the development of chronic bronchitis. Some smokers are resistant to the development of chronic bronchitis, but as yet there is no way of predicting which smokers will not develop chronic bronchitis. The decreased incidence of chronic bronchitis among women probably reflects the difference in smoking habits between the sexes. As these differences have diminished we are seeing an increasing incidence of chronic bronchitis in women.

How is Chronic Bronchitis treated?

The best treatment for chronic bronchitis is prevention which means no smoking. Once chronic bronchitis is established, smoking cessation does not cure the disease. The cough of chronic bronchitis will diminish within weeks of smoking cessation and usually disappears entirely within three months. Obstruction to air flow caused by swelling of the walls of the bronchi persists, although medications to dilate the bronchi (bronchodilators) may diminish the breathlessness. The important point to remember is that patients with chronic bronchitis who continue to smoke continue to deteriorate relatively rapidly. Smoking cessation will stop this rapid deterioration and there may actually be a slight improvement in the ability to lead a normal life.

Medication management

The successful approach to asthma management depends on using anti-inflammatory medications with bronchodilators as needed for immediate and occasional relief of symptioms.

  1. Anti-Inflammatory – Anti-inflammatories are used to treat the inflammation that is present in this condition .
  2. Bronchodilators – Bronchodilators are used to relieve the bronchoconstriction when an asthmatic component is present.

The successful approach to management, both in and out of hospital settings, is dependent upon the use of anti-inflammatory treatments with bronchodilators being prescribed for immediate and occasional relief of symptoms.

Anti-inflammatory medications prevent and reduce inflammation, swelling and mucus

  • prevent symtpoms such as cough, wheeze and breathlessness
  • need to be taken on a regular basis
  • are slow acting (hours or weeks)

Types of anti-inflammatory drugs

There are steroidal and non-steroidal anti-inflammatory drugs. The most common ones include:


Corticosteroid inhalers

They work by reducing and preventing airway inflammation, swelling and mucus.
Side Effects of Corticosteroid Inhalers

  • few side effects at low doses
  • side effects, in general, are usually restricted to the throat:
    • hoarseness and sore throat
    • thrush or yeast infection
    • This can be prevented by rinsing the mouth and gargling, and by using a holding chamber.

Corticosteroid tablets

Corticosteroid tablets or Prednisone®:

  • are used when inflammation becomes severe
  • reduce inflammation, swelling & mucus, and help bronchodilators work better
  • start to work within a few hours, but may take several days to have a full effect
  • often are used for short periods of time to get the inflammation under control
  • there are many side effects if used long-term, such as water retention, bruising, puffy face, increased appetite, weight gain and stomach irritation

Many physicians prescribe antibiotics for acute chest infections which may shorten their duration and help prevent pneumonia.
Annual vaccinations against influenza and a once only vaccination against bacterial pneumococcal pneumonia may help prevent the pulmonary complication of infections in chronic bronchitis.
The sufferer from chronic bronchitis should avoid excessive dust and fumes although under normal circumstances, the contribution of atmospheric pollution to chronic bronchitis is extremely small.
Regular exercise is even more important for patients suffering chronic bronchitis than for healthy individuals. Exercise does not improve the ability of the lungs to take up oxygen, but the effects of physical fitness on the cardiovascular system will compensate somewhat for the impaired lung function. The result of physical fitness in the patient suffering from chronic bronchitis is a lessening in breathlessness on exercise.
Chronic bronchitis is basically a preventable disease being rare in the non-smoker. It is never too late to stop smoking. The patient with chronic bronchitis can be treated with better results in the early stages of the disease.

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