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Medical Author:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Medical Editor:

George Schiffman, MD, FCCP

George Schiffman, MD, FCCP

Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.

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Medical Editor:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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In this Article

• Chronic Bronchitis Facts
• What is bronchitis?
• What is acute bronchitis?
• What are the symptoms of acute bronchitis?
• What is chronic bronchitis?
• What are the causes of chronic bronchitis?
• What are the risk factors for chronic bronchitis?
• What are the symptoms of chronic bronchitis?
• When should an individual seek medical care for chronic bronchitis?
• How is chronic bronchitis diagnosed?
• What is the treatment for chronic bronchitis?
• What are the complications of chronic bronchitis?
• Can chronic bronchitis be prevented?
• What is the outlook (prognosis) for chronic bronchitis?
• Bronchitis FAQs
• Patient Comments: Chronic Bronchitis - Treatments
• Find a local Pulmonologist in your town
• Chronic Bronchitis Index

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. Fifty percent 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) and ipratropium (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 new class of anti-inflammatory agents for exacerbations of COPD that has recently been approved by the FDA. 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:

• Fluoroquinolones (levofloxacin [Levaquin])
  
  
• Macrolides (clarithromycin [Biaxin], azithromycin [Zithromax, Zmax])
  
  
• Sulfonamides (sulfamethoxazole and trimethoprim [Bactrim]) 
  
  
• Tetracyclines (doxycycline [Vibramycin])

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 can often 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 practitioner before using any of these remedies or products.