Chronic Bronchitis (cont.)

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What is the treatment for chronic bronchitis?

For the majority of cases, the initial treatment is simple to prescribe but frequently ignored or rejected by the patient – stop smoking cigarettes and avoid second-hand tobacco smoke. People should be encouraged in every way to cease smoking, as continuation will only cause further lung damage. Similarly, blocking or removing other underlying causes of repeated bronchial irritation (for example, exposure to chemical fumes) is a treatment goal. Half of patients with chronic bronchitis who smoke will no longer cough after 1 month of smoking cessation. The number increases to 80% after 2 months.

Two major classes of medications are used to treat chronic bronchitis, bronchodilators and steroids.

  • Bronchodilators (for example, albuterol [Ventolin, Proventil, AccuNeb, Vospire, ProAir], metaproterenol [Alupent], formoterol [Foradil],salmeterol [Serevent]) work by relaxing the smooth muscles that encircle the bronchi, which allows the inner airways to expand. Anticholinergic drugs also can act as bronchodilators, including tiotropium (Spiriva) andipratropium (Atrovent).
  • Steroids (for example,prednisone, methylprednisolone [Medrol, Depo-Medrol]) reduce the inflammatory reaction and thus decrease the bronchial swelling and secretions that in turn allows better airflow because of reduced airway obstruction. Often inhaled steroids are administered since they have fewer side effects than systemic (oral) steroids. Examples include budesonide (Pulmicort), fluticasone (Flovent), beclomethasone (Qvar), and mometasone (Asmanex). Combination therapy with both steroids and bronchodilators is often utilized. These include fluticasone/salmeterol (Advair), budesonide/formoterol (Symbicort), and mometasone/formoterol (Dulera).
  • PDE4 inhibitors are a class of anti-inflammatory agents for exacerbations of COPD. It is primarily for exacerbations that involve excessive bronchitis and mucus production. There is currently only one agent available called roflumilast (Daliresp), a pill taken once per day.

Occasionally, antibiotics are used to treat chronic bronchitis exacerbations caused by bacterial infections. Broad spectrum antibiotics are often the choice. Examples include:

Of course, if a culture is obtained, directed therapy at the specific offending organism is always best.

Pulmonary rehabilitation is another treatment method that combines education and graded physical exercise. The education portion often includes smoking cessation techniques and the relationship of tobacco use to symptoms. Breathing techniques can be very helpful in overcoming the anxiety and discomfort of exacerbations. When chronic bronchitis is severe, airflow and blood flow may not move appropriately through the lungs. It is crucial for lung function that airflow and blood flow to the lung are precisely matched. When they are not, drops in oxygen and increases in carbon dioxide can result with profound negative consequences.

Supplemental oxygen therapy may be an integral part of treatment. Often it is required with activity and sleep. Patients with severe disease may benefit from purchasing a small finger oximeter (around $100) for monitoring blood oxygen levels at rest and with activity.

Certain "home remedies" may ease the symptoms of chronic bronchitis. Cold air often aggravates coughing and dyspnea, so avoiding cold air or wearing a cold-air mask (such as a ski mask or face scarf) may help when in cold environments. Dry air also aggravates coughing so warm, humidified air may help by reducing coughing and also may allow mucus to flow more freely, which may result in better clearing of the bronchial airways and less blockage by viscous mucus. One of the lessons of pulmonary rehabilitation is to instruct patients on the proper path for air to follow. This involves breathing in through the nose so that the air is moistened, cleansed, and warmed by the function of the upper airways (sinuses). Air is than expelled through the mouth and in some cases with pursed lips to help optimize the lung's function.

Over-the-counter (OTC) cough suppressants such as dextromethorphan (for example, Pertussin, Vicks 44 or Benylin) may be helpful in reducing cough symptoms. OTC preparations with guaifenesin (for example, Robitussin or Mucinex) may make patients feel more comfortable but there is no scientific evidence that it helps mucus to become less viscous.

Alternative treatments have been suggested by some individuals with little or no evidence of any benefit; and some may even be harmful (for example, herbal teas, high doses of vitamin C, South African geranium herb, eucalyptus oil inhalation therapy, and many others); it is advisable to check with the  health care professional before using any of these remedies or products.

Medically Reviewed by a Doctor on 11/26/2013

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