When discussing the symptoms of chronic bronchitis, many people often confuse it with chronic obstructive pulmonary disease (COPD). However, “chronic bronchitis” is a term that was used more commonly in the past. Since the introduction of the term COPD, chronic bronchitis has been used less frequently. Still, it typically refers to long-lasting damage to the airway mucosa caused by prolonged acute bronchitis that was not treated promptly.

Clinical manifestations of chronic bronchitis
Clinical symptoms of chronic bronchitis
Clinical signs of chronic bronchitis (illustration)

Damage in chronic bronchitis is mainly localized in the airway mucosa. The disease often begins after repeated respiratory infections, causing inflammation, swelling, increased mucus secretion, and airway narrowing. Without proper treatment—or when respiratory infections recur frequently—chronic bronchitis can develop.

Chronic bronchitis commonly presents with the following clinical symptoms:

• Persistent cough
  Patients often experience a chronic, lingering cough or episodic coughing. Symptoms worsen after each respiratory infection or during weather changes, cold temperatures, or exposure to smoke and dust.

• Productive cough (cough with phlegm)
  The cough is usually accompanied by prolonged mucus production. The sputum is often white, but in cases of bacterial superinfection, it may turn yellow or green.

• Shortness of breath
  This symptom is less common in chronic bronchitis. If shortness of breath is present, clinicians must evaluate for COPD, asthma, or other causes such as heart failure.

• Fatigue
  Because chronic bronchitis often recurs and treatments can be prolonged, patients may feel tired. However, the condition does not usually cause weight loss. With proper evaluation and treatment, the disease is not severely harmful.

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Paraclinical (diagnostic) findings in chronic bronchitis

Before diagnosing chronic bronchitis, doctors may order the following tests:

• Chest X-ray
  Chest X-ray helps rule out other causes of chronic cough, such as pulmonary tuberculosis, lung cancer, interstitial pneumonia, or bronchiectasis.

• Pulmonary function test
  This test helps differentiate chronic bronchitis from other conditions. If patients have prolonged cough without lung parenchymal damage and pulmonary function is normal, chronic bronchitis can be diagnosed. If obstructive ventilatory disorders are present, COPD is diagnosed instead.

• ENT endoscopy or gastrointestinal endoscopy
  Doctors may perform nasal–throat endoscopy or stomach endoscopy if needed to rule out sinusitis, pharyngitis, or gastroesophageal reflux disease when other diagnostic methods are inconclusive.

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Treatment of chronic bronchitis

Patients should avoid risk factors that can trigger acute flare-ups:

• Do not smoke; avoid cigarette smoke, kitchen smoke, and polluted environments

• Avoid cold and damp conditions; wear a scarf and mask when going outside in such weather

• Avoid drafts indoors

• Get an annual flu vaccination, ideally in September, to significantly reduce flare-ups

• Take medications as prescribed by your doctor, especially antibiotics during acute exacerbations accompanied by yellow/green/purulent sputum (suggesting bacterial infection)

Common antibiotics used for chronic bronchitis include:

• Amoxicillin group

• First, second, and third-generation cephalosporins

• Macrolides

• Quinolones

• Combination of amoxicillin/clavulanic acid

Antibiotics are typically prescribed for 7–10 days per treatment course.

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Prevention of chronic bronchitis

• Do not smoke; avoid cigarette smoke and occupational dust

• Avoid cold and damp conditions

• Treat respiratory infections early and thoroughly

• Maintain good oral hygiene