Chronic bronchitis is the most common cause for chronic cough in middle aged and elderly people. It occurs due to chronic inflammation of the medium and large airways of the lungs which transport air both ways in the lungs. Prevalence of chronic bronchitis is variable in different regions of the world.

Smoking is the most common cause for chronic bronchitis. But it also occurs due to chronic exposure to various fumes or dust. As per demographic health survey of Rwanda 2005, only 7% of adult population smoked cigarettes. Therefore the cases of chronic bronchitis would have been due to exposure to biomass fuel. The women who are exposed to indoor smoke while cooking, children accompanying these mothers, all are at risk. The Government of Rwanda is doing appreciable work in motivating and assisting people to change to alternate fuels like smokeless stoves solar cookers and cooking gas. People working in mines, fields, construction work, are prone to develop chronic bronchitis, later in life.

Most characteristic feature of chronic bronchitis is chronic cough. It is associated with scanty white colored phlegm, which occurs due to the excess secretions from the inflamed air tubes. The expectoration is maximum in the morning when the individual wakes up. In case of superadded infection, the person can develop fever, chest pain and blood tinged or yellowish green sputum. There may be associated breathlessness, particularly when the person exerts.

Later on, the lungs get hyper inflated due to the stress placed on them to carry out their normal function. The individual though cachexic, has an inflated chest, aptly called, "barrel chest”. Due to inefficient ventilation performed by diseased lungs, there is chronic deficiency of oxygen in the body. This leads to bluish coloration of the lips and tongue with swelling of tips of fingers.

Once chronic bronchitis develops, it is an irreversible condition. If exposure to the causative substance continues, the walls of the airways get damaged and can collapse. At this stage, the affected person gets constant cough with profuse expectoration. Due to chronic bronchitis one becomes more prone to infections. The weakened lungs can succumb to T.B., pneumonia, e.t.c. infections easily. In later age, one can develop lung cancer.

Chronic bronchitis is diagnosed easily by the features of chronic cough with expectoration, present recurrently. Lung function tests show irreversible obstruction of the airways. This is in contrast to Bronchial asthma, where removal of the offending substance or use of a bronchodilator, opens the closed airways again.

Smoking is harmful not only for the lungs but for the entire body, hence smokers should be motivated to quit smoking before they develop chronic bronchitis. People working in occupations involving chronic exposure to smoke, fumes or dust should be encouraged to cover their noses while working to minimize the inhalation of these harmful substances. They should be aware of chronic bronchitis and take treatment at the earliest symptoms .

Treatment of chronic bronchitis is mainly directed towards relief of symptoms and there is no total cure. Antibiotics are to be used only if there is evidence of infection. These persons visit the hospitals number of times seeking relief from the cough , undergo X-rays many times and consume a lot of antibiotics. Thus inadvertently they are exposed to risk of radiation and side effects of antibiotics. Adequate hydration is useful for the person suffering from chronic bronchitis as it helps to clear the expectoration and reduces cough. Drinking warm water 2 or 3 times is beneficial. Different types of breathing exercises of yoga are also very useful in increasing the ventilatory function of the lungs in case of chronic bronchitis. In case of chronic oxygen deficiency, oxygen inhalation is needed.

An individual can adopt all these measures to prevent aggravation of chronic bronchitis and its later complications.

Dr Rachna Pande,

Specialist, internal medicine