Mesothelioma Info

Chronic bronchitis is a long-term, often irreversible respiratory illness. Those with chronic bronchitis have a daily mucus-producing cough that persists for at least 3 months a year, at least 2 years in a row.

Bronchitis is an inflammation of the lining of the air passages. Bronchitis can be classified as acute or chronic. Acute bronchitis is a mild inflammation of the air passages of the lungs that clears up within a few days, often without treatment. Chronic bronchitis is a persistent, serious lung disease that requires ongoing medical care and can lead to gradual deterioration of the lungs. Many people with chronic bronchitis also develop another respiratory disease called emphysema.

Chronic bronchitis involves restriction of airflow in the air passages that worsens over time. This causes increasing difficulty in breathing and more sputum (mucus) production in the lungs.

Chronic bronchitis is a form of chronic obstructive pulmonary disease (COPD), a serious health condition.

COPD is the fourth-leading cause of death in the United States. About 11 million American adults suffer from COPD.

The diseases that fall under the COPD “umbrella” all lead to some type of long-term airflow problem in the lungs. The most common COPD conditions are chronic bronchitis, emphysema, and chronic asthmatic bronchitis. These may occur by themselves, but often a person has more than one condition occurring at the same time.

Chronic bronchitis, like other COPD conditions, can have episodes where symptoms get worse very quickly. These episodes are called exacerbations, and they can vary in degree of severity.

Exacerbations of chronic bronchitis can be triggered by upper- or lower-airway infections, such as colds or influenza. Exposure to environmental irritants, such as dust, fumes, or air pollution, may also exacerbate chronic bronchitis. Other medical conditions, such as heart problems or infection elsewhere in the body, can worsen chronic bronchitis symptoms. Exacerbations can be serious and even life threatening.

Causes

Smoking is the major cause of chronic bronchitis and other chronic obstructive pulmonary diseases (COPDs).

Cigarette smoking causes approximately 80%-90% of COPD cases. Inhaling smoke temporarily paralyzes the tiny, hair-like cells called cilia that line the air passages of the lungs. These cilia are important because they help to keep germs and irritants out of the lungs. The more you smoke, the more damage you do to the cilia.

When the cilia do not work properly, mucus stays trapped in the lungs. This causes the walls of the bronchial tubes to become irritated, swell, and narrow. The bronchial tubes also become less able to expand when the body needs more oxygen. Mucus stuck in the smaller passages causes stale air to be trapped instead of exhaled. This leads to difficulty breathing that becomes progressively worse over time. The walls of the air sacs (alveoli) in the lungs also suffer damage as the disease progresses. As air sacs are destroyed, the lungs become less able to send oxygen to the bloodstream.
Exposure to occupational or environmental irritants can cause chronic bronchitis.

If you work around dust or fumes, know and follow the safety precautions recommended in the Material Safety Data Sheet(s) of the products or substances. Let your clinician know what you are exposed to in your work environment. If your bronchitis gets worse because of exposure to irritants in your workplace, you may need to change employment.
Irritants may include:

• Smoke
• Air pollution irritants, such as ozone and nitrogen dioxide
• Fumes from chemicals such as sulfur dioxide, hydrogen sulfide, bromine, strong acids, ammonia, some organic solvents, and chlorine
• Dusts, such as coal dust or grain dust

Chronic bronchitis can develop from repeated episodes of acute bronchitis or other repeated lung infections.
The recurring cough from repeated episodes of acute bronchitis may damage the lining of the bronchial tubes, making it increasingly difficult to clear mucus from the lungs. The mucus then leads to further coughing and more scarring of the air passages in the lungs. Chronic bronchitis may develop over time because of this damage. Recurrent respiratory tract infections during infancy or early childhood can also lead to chronic bronchitis.

Symptoms

The first noticeable symptom of chronic bronchitis is a persistent, mucus-producing cough.

In its early stages, chronic bronchitis has few symptoms. It often begins with a recurring morning cough that brings up mucus from the lungs (phlegm). Smokers often dismiss this cough as a “normal” smoker's cough. Many people also complain of postnasal drip or sinus congestion, a bad taste in their mouth, or bad breath (halitosis). As time passes, the amount of phlegm gradually increases and coughing continues throughout the day.
Chronic bronchitis can cause wheezing and shortness of breath.

Narrowing of the airways due to inflammation, coupled with increased mucus in the lungs, leads to shortness of breath that worsens over time. This shortness of breath may be accompanied by episodes of wheezing, which is a raspy, whistle-like sound heard with breathing. Wheezing occurs when air moves through the narrowed air passages in the lungs. The wheezing and shortness of breath of chronic bronchitis often occur or worsen with exertion.

In the later stages of the disease, chronic bronchitis may cause the skin and lips to develop a bluish tinge due to a lack of oxygen in the blood. Lack of oxygen in the blood, coupled with the increased work it takes to breathe through obstructed air passages, can cause a person to tire easily with even small amounts of activity.

Chronic bronchitis, and the heart problems it may cause, can lead to swelling (edema) in the legs and ankles.

Swelling in the ankles and legs, and sometimes swelling in the abdomen, may occur in advanced chronic bronchitis. This happens because blood vessels narrow (constrict) to try and divert blood to less damaged areas of the lungs where more oxygen is available. This constriction can lead to high blood pressure in the lungs (pulmonary hypertension).

Pulmonary hypertension causes the right side of the heart to work harder than it should. Eventually, that side of the heart may not be able to keep up with the workload. This is called right heart failure, or cor pulmonale. Right heart failure may cause blood to back up in the liver, intestines, and legs. This may cause swelling in the ankles, legs, and abdomen. High blood pressure and chest pain may also occur. It is important to see your clinician regularly so that any new problems with your heart or lungs can be caught early.

A sudden worsening of chronic bronchitis is called an exacerbation. Symptoms of an exacerbation include coughing up more mucus or mucus that is a different color than usual, as well as increased shortness of breath.

Viral infections are the most common trigger of an exacerbation of chronic bronchitis. When chronic bronchitis is in its later stages, even a mild cold can trigger a severe worsening of symptoms.

Exacerbations of chronic bronchitis can make it hard for you to breathe. If you cannot get your breath, begin to wear out from the effort it takes to breathe, become confused, or have a new or worsening dusky tint of the skin of your fingers or mouth, seek medical attention immediately.

Risk Factors

Smoking tobacco products increases your risk for chronic bronchitis and chronic obstructive pulmonary disease (COPD).

Cigarette smoking causes approximately 80%-90% of COPD cases. Even after you develop bronchitis or emphysema, your health could still benefit from quitting smoking. Your clinician can inform you of a number of medications and programs available to help you quit smoking.

Children of heavy smokers also have an increased risk for developing chronic bronchitis, as do nonsmoking adults who are repeatedly exposed to the cigarette smoke of others (passive smoke).

Being exposed to environmental pollutants, such as large amounts of dust or irritants, may increase your chance of developing chronic bronchitis.
Chronic bronchitis is more common in urban areas that have air pollution. Exposure to emissions of sulfur dioxide (SO2, a chemical used in bleaching and as a refrigerant and preservative) in particular has been shown to increase the risk of chronic bronchitis. Workers exposed to dusts, such as coal miners, grain handlers, and metal molders, are also at an increased risk for developing chronic bronchitis.

Frequent respiratory illnesses and infections can increase your chance of developing chronic bronchitis.

People who have repeated episodes of acute bronchitis have an increased risk of developing the chronic form of the disease. Recurrent respiratory tract infections during infancy or early childhood can also lead to chronic bronchitis.

Alpha1-antitrypsin (AAT) deficiency, an uncommon hereditary condition, can put you at greater risk of developing COPD and chronic bronchitis.
AAT is a protein that is made in the liver and released into the blood. It plays a role in protecting the lungs. AAT deficiency is an inherited disorder in which there is not enough AAT in the blood. This may leave the lungs less protected against damage. AAT deficiency is uncommon, but if you have it, your risk of developing COPD can be significantly increased. If you have this hereditary deficiency, your clinician may recommend AAT-replacement therapy.

Pneumococcal and influenza vaccines may reduce your risk of having an acute exacerbation (sudden worsening) of your chronic bronchitis.
Any lung infection can make the symptoms of your bronchitis worse. Preventing pneumonia and influenza can help you decrease the risk of bronchitis exacerbations. Ask your clinician about whether you should receive the pneumococcal and influenza vaccines. Both vaccines are usually recommended for people who are over the age of 65, have a chronic illness, or have a weak immune system. The pneumococcal vaccine is effective for 5 years in people who receive it before age 65 for the first time. But people who receive it for the first time who are over 65 only need to get it one time. The influenza vaccine must be taken yearly, because it protects against only that year's strains of influenza viruses.

Smoking increases your risk of developing lung cancer. If you begin to cough up blood, notify your clinician right away. This may be a sign of lung cancer.

Diagnosis

Your clinician will take a thorough medical history.
Your clinician will also ask about your past and current smoking habits and if you live with someone who smokes. Any history of on-the-job exposure to airborne irritants is important to your clinician. You should tell your clinician about any family history of respiratory diseases, such as cystic fibrosis or emphysema.

Your clinician will ask about your cough: how long you've had it, whether it produces mucus, and how frequently you've had it within the past 2 years. You will be asked about the color, consistency, and amount of phlegm you cough up in a typical day. It's important that you answer these questions fully and report any breathing problems that you have.

Your clinician will use a stethoscope to listen to your lungs.
Your clinician will be listening for wheezes (high-pitched sounds that occur when air is pushed out through constricted airways) and rales (small rattling sounds that result when air moves through airways filled with fluid). The clinician may also percuss your lungs, which involves placing one hand on your chest and thumping it with the fingers of the other hand. The vibration from the chest percussion helps the clinician determine the size and condition of the lungs.

You may need a chest x-ray to rule out pneumonia or other diseases that may mimic or contribute to chronic bronchitis.
Sometimes an x-ray is taken to rule out the possibility of other illnesses or diseases. An x-ray cannot be used to diagnose early chronic bronchitis because an x-ray taken during the beginning stages of the disease is often normal.

You may need to take lung function tests.

Lung function tests (also called pulmonary function tests) measure how well the lungs can take in, hold, and use air. Spirometry is the most important of these tests for diagnosing chronic bronchitis and chronic obstructive pulmonary disease (COPD).

Lung function tests are simple to take. You breathe into a mouthpiece attached to special monitoring equipment. The test results will help your clinician find out how well your lungs are working and determine the severity of your bronchitis. These tests may need to be repeated over time so your clinician can keep track of whether the disease is getting worse and whether your treatment is helping.

You may need various laboratory tests.

Laboratory tests may include a complete blood cell count (CBC), to see if an infection is causing (or worsening) your bronchitis symptoms. Your clinician may take a sample of the phlegm (mucus) you are coughing up to determine if your symptoms are caused by a virus or a bacterium.

Another laboratory test you may need is an arterial blood gases (ABG) test. An ABG test includes measurement of the levels of oxygen and carbon dioxide in your blood. For this test, blood must be drawn from an artery in the wrist, arm, or groin. Your clinician uses the results of this test to see how advanced your disease is and if you need oxygen therapy. You may need ABG testing more than once, especially during a severe episode of difficulty breathing.

If you are around the age of 45 or younger, are a nonsmoker, or have a strong family history of COPD, your clinician may do a blood test to see if you have enough alpha1-antitrypsin (AAT).

AAT is a protein that is made in the liver and released into the blood. It plays a role in protecting the lungs. AAT deficiency is an inherited disorder in which there is not enough AAT in the blood and the lungs are not protected. AAT deficiency is a major (but uncommon) risk factor for COPD. If you have this hereditary deficiency, your clinician may recommend AAT-replacement therapy.

AAT-replacement therapy in those with AAT deficiency cannot reverse any lung damage that has already occurred. However, it can slow the progression of lung disease. This therapy must be continued for the rest of your life.

Your clinician may need to perform an electrocardiogram (ECG).
An ECG records the electrical activity of your heart as a tracing on paper that your clinician can examine. The results of your ECG can help your clinician determine if your bronchitis symptoms are caused by, or worsened by, a heart problem. It may also show if your heart is having trouble tolerating your illness. Since chronic bronchitis can cause heart problems over time, your clinician may perform an ECG more than once.

Table 1. Common Tests Done to Diagnose Chronic Bronchitis

Test Why it is done Spirometry This simple test is the most important test in diagnosing chronic obstructive pulmonary disease (COPD). You will breathe into a tube, and readings will be taken. Your clinician may use this test to diagnose chronic bronchitis, track the progression of the disease, and see how well any treatments are working.

Arterial blood gases (ABG) test This test measures the amount of oxygen and carbon dioxide in your blood. It is helpful in diagnosing more advanced stages of the disease and can help your clinician determine whether you require oxygen therapy.

Pulse oximetry This test uses a probe that gently warms the skin to take indirect readings on the amount of oxygen in your small blood vessels. Pulse oximetry is comfortable and easy to perform; however, it does not give as much information to your clinician as an ABG test does.

Complete blood count (CBC) Your clinician can see if you have an infection and can monitor your blood for changes that may occur due to lack of oxygen.

Serum alpha1-antitrypsin Your clinician may perform this test if you get chronic bronchitis but don't smoke, are young, or have many family members with COPD.

Electrocardiogram (ECG) An ECG can help rule out a cardiac cause of your bronchitis symptoms. As your disease progresses, an ECG can help your clinician see how your heart is tolerating your illness. Since chronic bronchitis can cause heart problems as the disease advances, ECGs done on a regular basis may help your clinician catch problems early.

Chest x-ray A chest x-ray often cannot be used to diagnose early chronic bronchitis, since lung changes often are not visible until later in the disease. However, a chest x-ray can help your clinician rule out some other causes of your bronchitis symptoms.

Prevention and Screening

The best way to keep from getting chronic bronchitis and other lung problems is not to smoke.

Smoking can cause a variety of lung diseases, including chronic obstructive pulmonary disease (COPD) and cancer. Smoking can also make your chronic bronchitis get worse more quickly, increase your susceptibility to other illnesses, and shorten your life. People who are exposed to your secondhand smoke are also at greater risk of illness and disease. It is never too late to quit smoking. Ask your clinician for information about medications and programs to help you quit smoking.

Avoid inhaled irritants, such as air pollution or workplace dust or fumes.
If you live in a polluted area, limit your exposure to potentially damaging chemical irritants by staying indoors as much as possible on days when pollutant levels are high. Also, limit your exposure to indoor pollutants by using fewer aerosol deodorants, insecticides, and hair sprays.

Treatment

Urgent Care

If you are having significant difficulty breathing, are confused or less alert, or have chest pain, seek medical attention immediately.
It is important to seek medical care if your chronic bronchitis is getting worse. Sometimes, emergency care is necessary.

Dial 9-1-1 or 0 for an ambulance if:

• You get confused or become less alert to what is going on around you
• You cannot get your breath
• You have to work so hard to breathe that you become very tired
• You notice a blue or gray tint to the skin of your fingers and around your mouth or if an existing tint gets worse
• You become dizzy or develop heart palpitations or chest pain

Self Care

The goal of chronic bronchitis treatment is to help you live more comfortably and slow the progression of your disease. Quitting smoking is the single most important thing you can do to help your chronic bronchitis.
The only effective way to significantly slow the downhill course of chronic bronchitis is to quit smoking. It is never too late to quit smoking. Quitting smoking will help you feel better, slow progression of the disease, and help you live longer. Medical research has shown that quitting smoking is helpful, even for people with advanced chronic obstructive pulmonary disease (COPD).

A variety of options are available to help you stop smoking, such as nicotine-containing patches, gum, and nasal spray. Support groups can also be very helpful when you are trying to quit smoking. Certain antidepressants have been shown to increase the success rate in people who try to quit smoking. Remember that concerned professionals and other people are available to help you through this tough change.

Table 2. Ways to Be As Healthy As Possible When Living With Chronic Bronchitis

Maintain a healthy environment

Avoid respiratory irritants, such as smoke, air pollution, and marked variations in temperature and humidity. Consider major lifestyle changes, such as getting a new job (if needed to avoid irritant exposure) or moving to a lower altitude or a less polluted area. Avoid exposure to people with colds or flu.

Ensure good nutrition and fluid intake

Eat nutritious foods from a variety of food groups. If you are underweight, eat frequent high-calorie small meals and snacks. Drink at least 6 to 8 large glasses of water a day, unless instructed otherwise by your clinician. This helps to keep the mucus in your lungs thin, making it easier to cough up.

Exercise your lungs

Be as physically active as you can. Participate in a regular program of exercise (such as walking or riding a stationary bicycle several times a day for a total of at least 20 to 30 minutes every day). Consult your clinician before beginning any exercise program. Learn to use breathing exercises, such as pursed-lip breathing.

Work with your clinician to find the treatment that is best for you

Take any prescribed medication as directed by your clinician. If it does not seem to help or you have side effects, contact your clinician before stopping the medication. Use only over-the-counter or alternative medications that are approved by your clinician. Medications that are otherwise safe could worsen chronic obstructive pulmonary disease (COPD) symptoms or have bad interactions with your prescribed medications. Make certain that you get an influenza vaccine every year, and a pneumococcal (pneumonia) vaccine when recommended by your clinician.

If your breathing, coughing, or other symptoms suddenly get worse, seek medical attention right away. Ask your clinician whether a pulmonary rehabilitation program may be right for you. If you have chronic bronchitis, avoid people who are ill and wash your hands frequently to prevent exposure to germs that may cause an infection in your lungs. Immediately seek treatment whenever you get a respiratory infection.

Washing your hands frequently is a good way to decrease your risk of falling ill with many different kinds of infection. Be sure to wash your hands before eating, before touching your eyes or nose, and after going outside. Also wash your hands after caring for a sick person or handling items used by a sick person. If you do become ill with a respiratory tract infection, see your clinician right away.

Pneumococcal and influenza vaccines may reduce your risk of having an acute exacerbation (sudden worsening) of your chronic bronchitis.
Any lung infection can make the symptoms of your bronchitis worse. Preventing pneumonia and influenza can help you avoid bronchitis exacerbations.

Ask your clinician whether you should receive pneumococcal and influenza vaccines. Both vaccines are usually recommended for people who are over the age of 65, have a chronic illness, or have a weak immune system. The pneumococcal vaccine is given once to people over age 65. Someone who gets their first influenza vaccine before age 65 will need a repeat vaccine in 10 years. The influenza vaccine must be taken yearly, because it protects against only that year's strains of influenza viruses.

Your clinician can help you plan an exercise routine. Regular exercise can help you increase your energy and endurance.

Establishing a general exercise regimen, such as a walking program, under your clinician's supervision can help you build strength and improve your overall well-being. It is important to use your inhalers as directed by your clinician before you exercise. Start your exercise with a warm-up period, and stop if you become too winded.

Certain breathing exercises and techniques can be helpful.
A 10-minute exercise called pursed-lip breathing can improve your breathing, especially before beginning an activity.

• Lie flat on a bed with your head on a pillow and inhale through your nose. Be sure you are using your abdominal muscles to help your lungs fill with air.
• Slowly exhale through your mouth with your lips pursed (slightly puckered, as if blowing out a candle), so that you make a quiet hissing sound.
• Try to prolong the exhalation to get rid of as much “used” air from your lungs as possible. It should take you twice as long to breathe out as it did to breathe in.
• Repeat this exercise several times. Once you are used to the pursed-lip breathing technique you can perform it anytime you need more air, even while standing.

Exercises to strengthen your diaphragm and abdominal muscles can also help you breathe easier. Diaphragmatic breathing requires a bit more concentration than pursed-lip breathing, but it becomes easier with practice.

• Place one hand on your stomach just below your ribs. Place your other hand in the middle of your chest over your breastbone.
• Breathe in slowly through your nose, as deeply as you can.
• Breathe out slowly through pursed lips, while concentrating on tightening the muscles in your stomach. Use your hand to gently push in and up. Repeat this for a few minutes.
• You may need to practice this many times a day. Slowly increase the amount of time you spend during each practice session.

Learning special positions for sleeping and lying down can help you breathe easier.

In moderate to advanced chronic bronchitis, you may find it easier to breathe when sitting up. Foam wedges used to elevate the upper body while in bed may be useful in helping you breathe more comfortably during sleep.

Take care of yourself to keep your immune system healthy. Eat a balanced diet, drink enough fluids, and get plenty of rest.

Your body will be better able to defend itself against respiratory infections if you lead a healthy lifestyle. Be sure to get enough rest every day. Eat foods that are rich in beta-carotene and the antioxidant vitamins C and E, such as dark green leafy vegetables (broccoli, spinach) and orange or yellow fruits and vegetables (carrots, oranges, mangos, apricots).

Drink plenty of fluids throughout the day (preferably water). This helps to keep your mucus membranes hydrated (moist), which can help your body stop bacteria and viruses from entering.

Eating extra snacks and dietary supplements can help you maintain your weight and nutritional balance if you are becoming too thin.
People with advanced chronic bronchitis may have trouble maintaining their weight and getting the proper nutrition. Underweight people should eat frequent high-calorie small meals and snacks. Products such as nutrition shakes may also be necessary. Your clinician can recommend nutritional guidelines that are right for you.

You may be given a prescription for a bronchodilator. A bronchodilator can help you breathe easier.

Bronchodilators help to relax and open your airways to help you breathe easier. Some bronchodilators are taken regularly, and some can be taken when needed for trouble breathing. Bronchodilators come in pill, liquid, or inhalation form.

For chronic bronchitis, bronchodilators are most often given by inhalation. The medicine may be inhaled through a metered-dose inhaler or through a nebulizer (a device that delivers the medication in droplet form, using moistened oxygen or air).

Different inhalers may have different purposes and work in different ways. It is important to follow directions from your pharmacist and clinician and not overuse your inhaler(s).

You won't get the full benefit of your inhaled medications unless you take the time to learn proper inhaler use. Even people who have been using inhalers for a long time may be using them incorrectly without even knowing it. Take your inhaler with you to medical appointments so your clinician can evaluate your technique. Your clinician may recommend you use a spacer or chamber with your inhaler. This is a device that goes between the inhaler and your mouth. A spacer can help you inhale more medicine and make inhaling your medicine easier.

Table 3. How to Use a Metered-Dose Inhaler (MDI)

Shake the inhaler thoroughly to be sure you get the correct amount of medicine per puff. Exhale (breathe out) as much air from your lungs as you can. Inhale at a slow and steady rate, as you depress the inhaler once to release the puff of medicine. Keep breathing in slowly and deeply as you inhale the medicine. Hold your breath for 10 full seconds. Then, breathe out slowly. Wait about 1 minute between puffs, if you are supposed to take more than one. At night, take the canister of medicine out of the mouthpiece, and rinse the mouthpiece and cap with warm water. Let the pieces dry overnight.

Adapted from: Facts About Controlling Asthma, National Asthma Education and Prevention Program, National Heart, Lung, and Blood Institute, NIH Publication No. 97-2339 - . Accessed April 14, 2003.

Check with your clinician before taking any over-the-counter or alternative therapies.

Common medications that are generally considered safe may not be safe for people with chronic bronchitis. Over-the-counter medications and some alternative therapies may worsen your COPD symptoms or have bad interactions with your prescribed medications. Use only over-the-counter and alternative medications that are approved by your clinician.

Drug Therapy

Your doctor is the best source of information on the drug treatment choices available to you.

Other Therapies

People with advanced chronic bronchitis who have low blood oxygen levels may require oxygen replacement therapy.

Signs that you may have low oxygen levels in your blood include being tired all of the time and being unable to do even simple things without becoming short of breath. You also may be irritable, have a harder time thinking than usual, or have headaches.

Your clinician may need to perform certain tests (such as pulse oximetry or arterial blood gases tests) to see if you need extra oxygen. Round-the-clock oxygen therapy is usually recommended for people who have low blood oxygen levels at rest or after minimal activity. Occasional (or, “as needed”) oxygen therapy is useful for people whose oxygen level drops while they are exercising or sleeping. Sometimes, extra oxygen is necessary for only a short time, such as when you are recovering from an illness, riding on an airplane, or traveling to high altitudes.

Several different oxygen delivery devices are available for home use, including tanks of compressed oxygen and devices that concentrate oxygen from the air in the room. Oxygen is usually delivered through a nasal cannula, which is a plastic tube that has small, flexible prongs that fit just inside your nostrils. This oxygen may need to be humidified (moistened) to keep your nose from drying out. Humidified oxygen is also important to help keep the secretions in your lungs loose, so you can cough them up more easily.

Oxygen canisters should be kept away from any open flame, such as a pilot flame on a stove or a burning cigarette. Since oxygen increases fire danger, you should never smoke or allow anyone around you to smoke when you are using oxygen.

Certain postures, methods of coughing, and ways of striking the chest and back can help keep air passages clear of mucus.
Certain techniques can help people with bronchitis to keep their airways clear of mucus. Your clinician or physical or respiratory therapist may be able to teach these techniques to you (and a family member or caregiver):

• Postural drainage - prescribed positions that allow gravity to assist in draining secretions from different areas of the lungs, making secretions easier to cough out
• Chest percussion - lightly clapping your chest and back to help dislodge secretions
• Controlled coughing - techniques that help you cough up mucus

Sometimes, bland aerosols - inhaled solutions of salt or baking soda that thin and loosen secretions - are used along with these treatments.
Surgery

Lung transplants and lung reduction surgery are used only rarely to treat chronic bronchitis.

Only those people with severe lung disease that has not improved with drug treatment are considered for surgical procedures. In lung reduction surgery, a large portion of the severely damaged lung tissue is removed. The extra room in the chest allows air to move more easily into and out of the healthy lung tissue that remains. Many people who undergo this surgery report that it improves their quality of life, sometimes enabling them to return to a moderately active life without continuous oxygen therapy. However, the surgery has serious risks; mortality (death) rates can be as high as 15%, and complication rates are even higher.

With lung transplant surgery, a person with severe chronic bronchitis is given a healthy lung from a person who has recently died. This surgery is rarely recommended for chronic bronchitis. Complications from the drugs needed to keep the body from rejecting the new lung are high, and the 5-year survival rate is only 50%.

Alternative Medicine

Some people with severe chronic obstructive pulmonary disease (COPD) may benefit from acupuncture, acupressure, or breathing retraining to relieve dyspnea.

Complementary and alternative therapies may sometimes be used for symptoms that are not helped by conventional therapies alone. Acupuncture, acupressure, hypnosis, and relaxation techniques may be beneficial and can be used at the same time as conventional treatments.
Alternative therapies should not be used as a substitute for medical care. You should always tell your clinician or pharmacist what medicines you are taking, such as prescription or over-the-counter medicines, herbs, vitamins, or other supplements.

Alternative therapies may react poorly with some prescribed or over-the-counter medicines. Taking herbs, vitamins, or other supplements may interfere with lab tests or healing after surgery or illness, or may worsen some illnesses and health conditions. Your clinician and pharmacist can help you choose the complementary therapies or supplements that are right for you.

Special Circumstances

Weather and altitude can worsen your difficulty breathing. Plan ahead when traveling or flying.

Temperature extremes (either too hot or too cold) can irritate your airways and make your chronic bronchitis symptoms worse. Traveling to high altitudes can also make it more difficult for you to breathe. Stay inside on very hot or very cold days, and avoid traveling to areas of high altitude.
Commercial airplanes typically have a cabin pressure equal to that of an elevation of 5,000 to 10,000 feet. You may need oxygen to help you breathe when traveling by plane. Discuss with your clinician any travel plans you have, and notify the airline in advance of any special needs you may have during your flight.

Prognosis

Chronic bronchitis is a lifelong, serious disease that requires treatment and should not be ignored.

The damage done to the respiratory system cannot be reversed, but prompt treatment can help slow down the gradual deterioration of the lungs.

The more severe the damage to the lungs, the poorer the prognosis will be. Ask your caregiver for information about the progression of your chronic bronchitis.

Follow-up

People with chronic bronchitis should remain under the ongoing care of a clinician.

Because chronic bronchitis can lead to more serious lung conditions as well as heart disease, your clinician will want to monitor you on a regular basis. Keep all appointments, and notify your clinician immediately if you develop a cold or any signs of a respiratory infection. Call your clinician if you are experiencing any difficulties with your medication (such as trouble taking medication as prescribed or unpleasant side effects) or if your symptoms worsen.