Chronic bronchitis is the most common cause for chronic cough, particularly 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, and is part of the lung diseases grouped as COPD (chronic obstructive airways disease). In the current Covid-19 scenario, it is scary for any person to be found coughing in public. The affected person feels embarrassed and onlookers get frightened. Hence, it is necessary for all to be more aware of non-infectious conditions causing cough, like chronic bronchitis. 

Smoking is implicated as the most common cause for chronic bronchitis. But it also occurs due to chronic exposure to various other   fumes and dust. Women cooking indoors with charcoal or wood are exposed to smoke daily and children accompanying them are vulnerable to chronic bronchitis later in life. In this regard, the Government of Rwanda is doing significant work in motivating and assisting people to change to alternate smoke-less means of fuel, like cooking gas smoke-less stoves.  People working in   mines, fields, construction work, are prone to chronic bronchitis later in life due to exposure to dusts of various kinds.

Chronic cough is the most common symptom of chronic bronchitis. It may be associated with scanty, white coloured phlegm, which occurs due to the excess secretions from the inflamed air tubes, with or without breathlessness. The expectoration is maximum in the morning when the individual   wakes up. If bacterial infection occurs, the person can develop fever, chest pain and blood tinged or yellowish green sputum. Over time, the lungs get hyper inflated due to the stress placed on them.  The individual though cachexic, has an inflated chest, called, "barrel chest”. Chronic deficiency of oxygen sets in the body gradually due to inefficient ventilation   performed by diseased lungs.  This leads to bluish colouration of the lips and tongue with swelling of tips of fingers.

If not checked in the early stages, chronic bronchitis can become irreversible. Slowly, the walls of the airways get damaged and can collapse. The intensity of cough and quantity of expectoration also increases slowly. This makes one more prone to acquire infections like TB and pneumonia. In current scenario, one suffering from chronic bronchitis is susceptible to develop Covid-19 pneumonia if exposed. 

Chronic bronchitis is diagnosed by clinical history, physical examination and lung function tests.

Smoking is harmful not only to the lungs but the entire body, hence, smokers should be motivated to quit as soon as possible.  People working in occupations involving chronic exposure to smoke/ dust should be encouraged to cover their noses while working to minimise 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 should 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 two or three times is beneficial. Different types of breathing exercises 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

rachna212002@yahoo.co.uk