Chronic Bronchitis

Chronic bronchitis describes the inflammation and narrowing of the bronchial tubes (airways in the lungs).  As a result, patients cannot exhale normally. The air passes through the narrowed, inflamed tubes at a slower rate, and not enough time exists between breaths for all the inhaled air to escape.

Imagine a liquid flowing through a pipe. If the force pushing the liquid does not change and the diameter of the pipe shrinks, the liquid will flow more slowly and require more time to travel the length of the pipe. Since our bodies naturally initiate a new breath every four or five seconds, people with chronic bronchitis lack sufficient time to exhale completely before starting another breath.

The inflammation of the airways associated with chronic bronchitis produces mucus. People who suffer from chronic bronchitis cough frequently in order to clear mucus from their airways.  This cough is most severe in the mornings when patients wake up.

The word chronic means persistent. Chronic bronchitis does not go away easily or quickly. This “chronic” component distinguishes it from the routine bronchitis most people associate with chest congestion and a temporary cough. This more common “acute bronchitis” lasts only a week or two before disappearing with antibiotic treatment. The symptoms of chronic bronchitis wax and wane. Any upper respiratory congestion, viral illness or bacterial infection of the bronchial tubes can worsen the symptoms. Exposure to smoke, high levels of pollution, cold air and perfumes aggravate chronic bronchitis as well.


Emphysema refers to the destruction of the alveoli, or tiny air sacs in the outer parts of the lungs. Damage to the alveoli decreases the elasticity of the lungs and prevents them from recoiling naturally. Imagine a balloon as it fills with air. It expands and inflates. If the knot keeping the balloon closed is untied, the air escapes and the balloon recoils. Lungs with emphysema do not recoil normally when air is exhaled. Consequently, patients with emphysema cannot exhale all the old air in their lungs before starting a new breath. A small amount of air remains after each breath and the lungs progressively increase in size due to the retention of air. Doctors label this gradual expansion of the lungs “hyperinflation.” Patients with pure emphysema usually do not cough or expectorate phlegm. They complain of persistent fatigue and shortness of breath.

Chronic Obstructive Pulmonary Disease (COPD)

Distinguishing between emphysema and chronic bronchitis is difficult. The vast majority of smokers with lung disease suffer from a combination of both.  For example, patients often display the damaged alveoli and lack of elasticity seen in emphysema, as well as the inflamed airways common in chronic bronchitis. Therefore, doctors use the diagnosis of chronic obstructive pulmonary disease (COPD) to describe the combination of emphysema and chronic bronchitis.

Correspondingly, patients with COPD experience a combination of the symptoms of emphysema and chronic bronchitis. They often experience the fatigue and shortness of breath associated with emphysema, coupled with the productive morning cough seen in chronic bronchitis.

Doctors confirm the presence of COPD based on a variety of factors. A history of any previous shortness of breath, smoking or chronic coughing point towards COPD. 
In severe cases, chest x-rays will show flattening of the diaphragm (the large muscle separating the chest from the abdomen) and enlarged lungs. In addition, the x-ray may show air sacs at the top of the lungs called bullae. In milder cases of COPD, the chest x-ray may be completely normal.

The most important tests in diagnosing and evaluating COPD are the pulmonary function tests. These tests consist of three major parts: spirometry, lung volumes and diffusion capacity. The spirometry measures the amount of air a person can exhale from his or her lungs in a single breath. Patients with obstructive lung diseases cannot exhale air as quickly as those with healthy lungs. Pulmonary function tests also measure the size of the lungs (volume) and the ability of the lungs to extract oxygen from the air (diffusion capacity).

Treatment of COPD

Once lung tissue is destroyed it cannot be replaced, but physicians can use medications, exercise programs and supplemental oxygen to treat the symptoms of COPD.  There are a variety of inhaled medications on the market that decrease the inflammation of the airways and dilate the bronchial tubes so that patients can exhale easier.  Exercise programs help strengthen the muscles used to breathe and reduce the symptoms of shortness of breath.  Oxygen at night prevents the increase in pressure in the arteries of the chest and prolongs the lives of patients with severe COPD.

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