|Chronic bronchitis and emphysema
stop the lungs from working properly, typically causing breathlessness
and wheezing. The two conditions lead to similar symptoms are
often referred to as 'chronic obstructive pulmonary disease',
or COPD for short.
The biggest single cause of COPD is smoking, and the risk increases
with the number of cigarettes smoked*. As smoking habits have
changed over the last 20 years the death rate seems to have declined
steadily in men but has increased in women.
Due to industrial smoke and pollutants, it is also more common
in people living in cities than in the country, and in people
who work in dusty environments. Generally, it is more likely to
affect older people and the vast majority of sufferers are aged
70 to 85.
|What is chronic bronchitis?
|Bronchitis means inflammation
of the bronchi - the main airways that lead from the trachea (windpipe)
into your lungs. This inflammation may be caused by irritants,
such as tobacco smoke or by infection.
When an episode of bronchitis clears up once the infection responsible
has cleared, the condition is termed acute bronchitis. The chronic
form of bronchitis develops only after prolonged exposure to irritants,
causing abnormalities to develop in the bronchial lining. The
chronic inflammation causes excessive amounts of mucus - otherwise
known as phlegm or sputum - to be produced by the bronchi. This
mucus then blocks the airways and air sacs - alveoli - reducing
the amount of oxygen available to the lungs, causing breathlessness.
The condition is often made worse by infections such as colds
Chronic bronchitis is an unpleasant and ongoing condition and
a slow deterioration is likely.
|Emphysema is a form of lung
disease related to bronchitis. Like chronic bronchitis, it generally
occurs as a result smoking, which damages the elastic supporting
structure within the lungs. These leads to breakdown and collapse
of some of the airways which causes air to become trapped and
the lungs over-inflated. Long term heavy smokers may well get
emphysema and bronchitis together
There is one rare inherited form of emphysema - called homozygotic
alpha-one antitrypsin deficiency - where the condition occurs
by middle age, even without exposure to the usual irritants (such
as cigarette smoke). This is due to the deficiency of a protein
- found in the serum part of blood - which acts to protect the
|The symptoms of COPD will
usually come on in the winter, and are often worse in the mornings.
The GP (General Practitioner) will take a history of symptoms
and perform a physical examination. He or she will probably listen
to the chest with a stethoscope, listening for noises such as
wheezing or crackles and perform a lung function test. This involves
blowing into a device that measures how much and how fast air
can be expelled from the lungs. Different lung problems produce
different patterns of breathing capability and help to differentiate
chronic bronchitis from, other breathing-related conditions such
The GP (General Practitioner) may refer patients suspected of
having COPD to hospital for more detailed lung function tests
and possibly a chest X-ray. In people are very unwell as a result
of their breathing difficulties, the levels of oxygen and carbon
dioxide in the bloodstream may be measured.
This involves taking a blood sample from an artery - usually at
the wrist. Alternatively, a pulse oximeter is a monitoring device
that measures the oxygen concentration in the bloodstream without
the need for needles. It simply requires a small clip device to
be placed around one of your fingers.
More specialised tests - such as CT (computed tomography) and
MRI (magnetic resonance imaging) scans - may also be carried out
to clarify the extent of any disease and exclude any other lung
problems, such as cancer.
|There is no cure for COPD
and any damage to the lungs is irreversible The most important
step is to stop smoking. It will also help to avoid dusty and
smoky environments. This will slow down the progression of the
Prompt treatment of any bacterial infection with antibiotics is
important - this should ease the symptoms, and may help slow the
deterioration of the disease.
There are also a couple of practical steps that can help:
- Sleep in a warm bedroom - this may reduce night-time
- Try inhalations of steam - this may make it easier
to cough up the sputum
Cough suppressant medicines are not generally recommended.
Sometimes people may have asthma in addition to chronic obstructive
pulmonary disease and asthma treatments, such as an inhaler (puffer)
may help alleviate some of the symptoms of wheezing and breathlessness.
A bronchodilator drug such as salbutamol (Ventolin) or ipratropium
bromide (Atrovent), usually taken via an inhaler or a nebuliser,
to relieve the constriction of the airways.
Steroid medication - either by inhaler or in tablet (oral) form
- has been found to improve the short-term symptoms of chronic
bronchitis, though not to improve the long-term outlook, or slow
down the progression of the disease. Long term oral steroid treatment
also carries the risk of side effects, such as osteoporosis and
People with severe COPD that results in low levels of oxygen in
the blood may need long-term oxygen therapy to help relieve their
symptoms. Oxygen is inhaled in via a mask or nasal cannula (small
tube). The oxygen is provided in large tanks for home use, or
smaller, portable versions for outside the home. An oxygen concentrator
- a machine that uses air to produce a supply of more oxygen-rich
gas - is an alternative to tanks.
People who have COPD should certainly have a flu immunisation
each year as they are particularly vulnerable to complications.
Also, think about getting a jab against pneumonia - this injection
protects against the pneumococcus bacterium, and lasts up to ten
|*Doll R, Peto R, Wheatley
K, Gray R. Sutherland I. Mortality in relation to smoking: 40
years observation on male British doctors. BMJ 1994; 309:901-10
|British Lung Foundation
British Thoracic Society
American Lung Foundation
|Healthwise (Health Information Resource
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