Acute bronchitis is a temporary condition that is usually viral and, as the name suggests, involves the bronchi. Unless it is complicated by pneumonia, which is rare, it usually resolves spontaneously. Treatment for just the symptoms usually suffices.
Chronic bronchitis, on the other hand, is a significantly different condition and is a type of chronic obstructive pulmonary disease (COPD). Treatment for it and COPD conditions requires more aggressive management due to how severely these conditions jeopardize one’s health.
The main feature of acute bronchitis is a cough that will persist from five days to several weeks, with an average duration of 18 days. Such a persistent cough can strain the intercostal muscles, which are chest muscles between the ribs, or can even strain portions of one’s diaphragm. Pain from inflamed intercostal muscles or the diaphragm can be addressed with NSAIDs if this were to happen. In the absence of these specific complaints, NSAIDs will do nothing to treat the acute bronchitis itself. For the most common symptoms of acute bronchitis, patients should use the following treatment modalities:
- Cough suppressants, such as dextromethorphan and Tessalon;
- Numbing agents;
- Throat lozenges;
- Avoiding second-hand smoke and smoking themselves.
Chronic obstructive pulmonary disease is a spectrum of conditions that are all interrelated but share a common criterion: airway obstruction. The following are conditions that fall under the umbrella term of COPD:
Emphysema: When the separations of spaces among alveoli are destroyed, the smaller spaces coalesce into larger ones, and the surface area that allows all of the chemical reactions for the complex process of respiration decreases.
People with this condition are referred to as a Pink Puffer, and it involves slightly reduced oxygen and normal carbon dioxide.
Chronic bronchitis: This is defined as a chronic productive cough that, at the minimum lasts for three months in two successive years. It is diagnosed when other causes for the chronic cough have been ruled out.
People with this condition are referred to as a Blue Bloater, and it involves markedly reduced oxygen and increased carbon dioxide. As the name implies, the complexion, due to the low oxygen and higher CO2, loses its rosy appearance and becomes dusky.
Chronic obstructive asthma: The chronic inflammation of the airways with COPD causes a tissue response that leads to wheezing, breathlessness, chest tightness, and coughing, especially at night and the early morning.
Treatment for COPD
For the chronic bronchitis condition seen in COPD, the same medications used in acute bronchitis are usually not helpful and may even be harmful, as they could cause further bronchoconstriction. Smoking cessation and avoiding second-hand smoke are certainly helpful.
An important consideration is what exactly is happening during this phase. Mucus is thicker (an overreaction of protection strategies) and the cilia that move the mucus and other substances up and out are paralyzed, allowing for accumulation that is coughed up sporadically, which is known as smoker’s cough.
Also, of the two brainstem stimuli for automatic breathing—low oxygen and high carbon dioxide—the chronic high carbon dioxide has dulled this reflex, making low oxygen the only stimulator left. As a result, giving someone with COPD oxygen, while appearing prudent, will raise the oxygen and eliminate the only stimulus left (hypoxia) for breathing. Oops!
How is COPD and its severity diagnosed?
- FEV/FVC: Pulmonary function studies can measure the amount of airway obstruction using a ratio of the amount of air that can be blown out in one second divided by the amount of air that can be exhaled from the lungs after taking the deepest breath possible. This is the FEV/FVC ratio.
- Pulse oximetry: This simple technique can evaluate the percentage of oxygenation at any time. Normal oxygenation is in the high 90s in terms of percentage.
- Arterial blood gases (ABGs): This is an evaluation of blood from an artery. This evaluation can determine the amount of oxygenation and the buildup of carbon dioxide, which is the more dangerous condition in airway obstruction.
- X-rays: Pink puffers (emphysema) may demonstrate bullae (large, coalesced areas of lung tissue), whereas blue bloaters (chronic bronchitis) may have a normal X-ray or increased markings.
- Other conditions: COPD often is associated with other conditions, all of which will affect the treatment strategies. Coronary heart disease, heart failure, obesity and metabolic syndrome, lung cancer, and GERD are common co-morbidities and require diagnostic tests to rule any of these conditions out or in. Also, anxiety and depression are often present.
Since pink puffers (emphysema) have normal or nearly normal oxygen, all will appear well until exercise, when their reduced “reserve” for exertion becomes apparent and the oxygen saturation crashes. With blue bloaters (chronic bronchitis), oxygenation may even improve with exercise due to the extra red blood cells that are in operation from the disease.
How is COPD treated?
- Quit smoking.
- Vaccination(s) for influenza and pneumococcal infections.
- Inhalants, particularly the following:
- Long-acting beta agonist (LABA): These bronchodilators that open the airways by stimulating the receptors that initiate these “beta” receptors. Such LABAs include the following:
- Long-acting muscarinic agents (LAMA). These are anticholinergics that oppose the sympathetic nervous system to reverse the “reversible” part of airway obstruction; however, some types are irreversible. They improve lung function and reduce hyperinflation. These are also bronchodilators. Such anticholinergics include the following:
- Combined therapy and Triple Inhaler Therapy: Usually one or the other (LABA vs. LAMA) are used. If symptoms are not well controlled, adding one from the other category can be tried. The addition of an inhaled steroid is not out of the question in particularly difficult cases. Using a LABA, a LAMA, and steroids together is called a triple inhaler therapy.
- Glucocorticoids (steroids): These are used for exacerbations but typically not for chronic use.
- Oxygen for severe hypoxia.
- Pulmonary rehabilitation: This involves an educational process that includes self-management skills, breathing training, airway management, coping, stress management, smoking cessation, and even end-of-life planning.
- Nocturnal ventilation via positive airway pressure (CPAP): This not only helps with nighttime oxygenation and sleep apnea if present), but it also rests the respiratory muscles, which improves their function in the daytime.
- Surgery: Bullae (“blebs”) of coalesced air sacs may spontaneously rupture, creating a risk of pneumothorax, which would require surgical intervention. Lung transplant is the endpoint treatment of any dramatic, end-stage disease.
COPD is the fourth leading cause of death worldwide. It is also preventable, most notably by quitting smoking, which is the subject of the next article in this series. The best treatment for COPD is preventative treatment, of which preventing smoking at an early age is a crucial element. Not everyone (about 17–30%) who smokes will get lung cancer, but a substantially larger percentage will get heart disease and lung disease to some extent.