There are two types of bronchitis: acute (begins suddenly and clears up quickly) and chronic (long-term and recurrent). Chronic bronchitis is one of several diseases collectively known as Chronic Obstructive Pulmonary Disease, or COPD. Other diseases in this category include; asthmatic bronchitis, chronic obstructive bronchitis, bullous disease, and emphysema.
In chronic bronchitis, the airways (bronchi) become inflamed, congested, and narrowed. Persons also have a continuous or a recurrent excess of mucus secretion, which affects the bronchial tree. The body’s natural mechanism to rid itself of the excess mucus is by coughing. If one has a frequent overproduction of mucus with cough, and the cough occurs continuously for three consecutive months during two consecutive years; this person is usually diagnosed with chronic bronchitis.
The primary cause of chronic bronchitis is smoking. However, continuous exposure to other irritants such as occupational dusts, noxious gases, environmental pollution, and bacterial (possibly viral) infections, can also cause chronic bronchitis. In response to smoke or other irritants, the linings of the lung’s airways become thickened and narrowed. Mucus-producing glands in the bronchi increase and produce excessive mucus, which often impairs the normal coughing mechanism for clearing the airways.
According to the American Lung Association (1):
- Over 11 million Americans are diagnosed with chronic bronchitis annually.
- More women than men are diagnosed with chronic bronchitis.
- Chronic bronchitis affects people of all ages, but is more prevalent in people over 45 years old.
- In 2000, over 1,100 Americans died as a result of chronic bronchitis
Chronic bronchitis is classified into four different categories: Class 1-acute tracheobronchitis; Class 2-chronic bronchitis; Class 3-chronic bronchitis with complications; and Class 4-chronic bronchial infection. These categories serve as a guide for the assessment and treatment of this condition. Symptoms of chronic bronchitis may take years to develop and often include the following:
- Mild to Severe cough
- Coughing in the morning that produces excessive sputum (coughed up mucus)
- Coughing during the day
- Thick sputum ranging in color from white to yellow-green
- Frequent chest infections, especially in the winter, producing yellow-green sputum
- Wheezing and other abnormal lung sounds, especially after coughing and while inhaling and/or exhaling
- Shortness of breath on mild exertion, becoming progressively worse
- In advanced stages respiratory failure may develop in which the lack of oxygen causes the lips and fingernails to turn blue, along with heart and liver enlargement, and lower extremity fluid build-up.
A complete environmental and occupational history is usually taken to determine the nature of the irritant which is responsible for the onset of the condition. For patients who smoke, the cessation of smoking can reduce the severity of chronic symptoms, eliminate acute attacks, and delay the progress of chronic bronchitis. Other patients must identify and prevent exposure to their particular irritant, such as occupational dusts, noxious gases, and/or environmental pollution.
An inhaler may be prescribed containing a bronchodilator drug, such as albuterol aerosol. If a chest infection develops, an appropriate antibiotic may be prescribed.
Bromelain, a protein-digesting enzyme complex derived from pineapple, has been shown to have an antitussive effect (cough suppression), and to provide a reduction in the thickness of mucus. (2) Bromelain’s mucolytic activity reduces bronchial secretions, making it effective in treating respiratory tract diseases (3).
Vitamin C serum levels are often low in patients with chronic bronchitis and other severe respiratory illnesses (4). Supplementation with vitamin C can produce clinical improvement in patients with chronic bronchitis and respiratory infection (5).
Herbal expectorants decrease the thickness of mucus and promote the expulsion of mucus secretions. Effective herbal expectorants include; lobelia (Lobelia inflata), licorice (Glycyrrhiza glabra), gumweed (Grindelia comporum), wild cherry bark (Prunus sp.), horehound (Marrubium vulgare), coltsfoot (Tussilago farfara), sundew (Drosera rotundifolia), and glycerol guaiacolate. Glycerol guaiacolate is also known as guaifenesin, and is found in a large variety of over-the-counter cough formulas (6).
Studies show that N-Acetyl-Cysteine (NAC) supplementation may relieve certain symptoms associated with chronic bronchitis. NAC has also been found to lower the frequency and duration of acute exacerbations (AECBs). N-Acetyl-Cysteine may also be used as a preventive agent against the onset of this condition, as its usage has been shown to decrease the rate of hospitalizations for chronic bronchitis sufferers in clinical study (7, 8).
The botanical, Tylophora asthmatica, has been traditionally used in Ayurvedic medicine for millennia in the treatment of bronchial asthma and other lung disorders. Studies have shown that supplementation with tylophora leaves and extract are effective in relieving bronchial asthma symptoms. The bronchodilator effects credited to tylophora are, however, short-acting (9, 10).
1. American Lung Association: http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml
2. Pizzorno JE and Murray MT, eds. Encyclopedia of Natural Medicine, revised 2nd edition, CA: Prima Publishing, 1998: 297
3. Maurer HR. Bromelain: biochemistry, pharmacology and medical use. Cell Mol Life Sci. 2001 Aug;58(9):1234-45.
4. Schwartz J, Weiss ST. Dietary factors and their relation to respiratory symptoms. The Second National Health and Nutrition Examination Survey. Am J Epidemiol. Jul1990;132(1):67-76.
5. Hunt C et al. “The clinical effects of vitamin C supplementation in elderly hospitalized patients with acute respiratory infections,” Int J Vitam Nutr Res 1994 (64): 212-9.
6. Pizzorno JE and Murray MT, eds. Encyclopedia of Natural Medicine, revised 2nd edition, CA: Prima Publishing, 1998: 298
7. Grandjean EM, et al. Cost-effectiveness analysis of oral n-acetylcysteine as a preventive treatment in chronic bronchitis. Pharmacol Res Jul2000;42(1):39-50.
8. Boman G, et al. Oral acetylcysteine reduces exacerbation rate in chronic bronchitis: report of a trial organized by the Swedish Society for Pulmonary Diseases. Eur J Respir Dis. Aug1983;64(6):405-15.
9. Atal CK, et al. Immunomodulating Agents of Plant Origin. I: Preliminary Screening. J Ethnopharmacol. 1986;18(2):133-41.
10. Pizzorno JE and Murray MT, eds. Encyclopedia of Natural Medicine, revised 2nd edition, CA: Prima Publishing, 1998: 270
11. Stoppard M. Family Health Guide, New York: DK Publishing, 2002: 390