What Is Chronic Bronchitis? Causes, Symptoms, Diagnosis, Treatment, and Prevention

Diagnosing COPD

Take a big deep breath in, up, up, up, up! Suck it in – blow hard! Blast out fast! Blow it out, blow it out, blow it out, blow, blow, blow. Breathe deep, up, up, up, up and catch your breath

Narrator

Ed King is working hard to find out how well his lungs are functioning.

Nurse

Let's do that again. Same thing.

Narrator

He's doing a lung function test called Spirometry. Ed suffers from COPD – Chronic Obstructive Pulmonary Disease. It's progressive…getting worse over time and there's no cure.

Ed King

You might have an easy day of breathing. The next day you get up, you may not have an easy day of breathing.

Nurse

Breathe deep, up, up, up, up and let it go.

Narrator

In patients like Ed…doctors follow disease progression and sometimes make treatment changes. Spirometry is an important tool in both monitoring and diagnosing COPD.

David Schulman, MD, MPH

And with that we measure two things. The amount of air they can move in and out of their lungs and the speed with which they do it.

Nurse

Blow HARD! Blast out fast.

Narrator

Patients are asked to forcefully blow out as much air as they can in one second. That speed is referred to as FEV1 – or Forced Expiratory Volume in 1 second.

David Schulman, MD, MPH

One of the early signs of COPD is obstruction, is the inability to move air out as quickly as you normally should be able to do. FEV1 is a marker of obstruction

Nurse

Now take a BIG breath in.

Narrator

The other measure is referred to as FVC – or Forced Vital Capacity.

Narrator

After a huge inhalation, the amount of air that can be forcibly breathed out is measured.

Nurse

Just a little further, all the way empty, all the way out…and take a big full breath in, up, up, up, up and catch your breath

David Schulman, MD, MPH

The ratio between FEV1 and Forced Vital Capacity is the data point we use to determine whether you have obstructive disease or not.

Narrator

About half of those with COPD don't know it…even though they may have symptoms such as shortness of breath, ongoing cough, wheezing or chest tightness.

Narrator

That's why screening may be suggested if you're a current or former smoker over age 45…have a family history of Emphysema…or worked with chemicals or other lung irritants.

David Schulman, MD, MPH

It's a disease that these folks live with everyday. It's slowly progressive, they don't appreciate the symptoms, and by the time they realize, wow, I am actually in a different place than I was a few years ago, it's often too late to do anything about it.

Narrator

Since his diagnosis, Ed King has learned to live with his COPD.

Ed King\t

You accept it for what it's worth, and you wind up with an attitude that generally don't let it whip you

Narrator

Ed and his wife Joyce stay active…she gives him chores to do at home and continues to make travel plans.

Joyce King

I just feel that he's done well, taken it within his stride. So have I, because that's the kind of people we are.

Narrator

For WebMD, I'm Rhonda Rowland.

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Nurse

Take a big deep breath in, up, up, up, up! Suck it in – blow hard! Blast out fast! Blow it out, blow it out, blow it out, blow, blow, blow. Breathe deep, up, up, up, up and catch your breath

Narrator

Ed King is working hard to find out how well his lungs are functioning.

Nurse

Let's do that again. Same thing.

Narrator

He's doing a lung function test called Spirometry. Ed suffers from COPD – Chronic Obstructive Pulmonary Disease. It's progressive…getting worse over time and there's no cure.

Ed King

You might have an easy day of breathing. The next day you get up, you may not have an easy day of breathing.

Nurse

Breathe deep, up, up, up, up and let it go.

Narrator

In patients like Ed…doctors follow disease progression and sometimes make treatment changes. Spirometry is an important tool in both monitoring and diagnosing COPD.

David Schulman, MD, MPH

And with that we measure two things. The amount of air they can move in and out of their lungs and the speed with which they do it.

Nurse

Blow HARD! Blast out fast.

Narrator

Patients are asked to forcefully blow out as much air as they can in one second. That speed is referred to as FEV1 – or Forced Expiratory Volume in 1 second.

David Schulman, MD, MPH

One of the early signs of COPD is obstruction, is the inability to move air out as quickly as you normally should be able to do. FEV1 is a marker of obstruction

Nurse

Now take a BIG breath in.

Narrator

The other measure is referred to as FVC – or Forced Vital Capacity.

Narrator

After a huge inhalation, the amount of air that can be forcibly breathed out is measured.

Nurse

Just a little further, all the way empty, all the way out…and take a big full breath in, up, up, up, up and catch your breath

David Schulman, MD, MPH

The ratio between FEV1 and Forced Vital Capacity is the data point we use to determine whether you have obstructive disease or not.

Narrator

About half of those with COPD don't know it…even though they may have symptoms such as shortness of breath, ongoing cough, wheezing or chest tightness.

Narrator

That's why screening may be suggested if you're a current or former smoker over age 45…have a family history of Emphysema…or worked with chemicals or other lung irritants.

David Schulman, MD, MPH

It's a disease that these folks live with everyday. It's slowly progressive, they don't appreciate the symptoms, and by the time they realize, wow, I am actually in a different place than I was a few years ago, it's often too late to do anything about it.

Narrator

Since his diagnosis, Ed King has learned to live with his COPD.

Ed King

You accept it for what it's worth, and you wind up with an attitude that generally don't let it whip you

Narrator

Ed and his wife Joyce stay active…she gives him chores to do at home and continues to make travel plans.

Joyce King

I just feel that he's done well, taken it within his stride. So have I, because that's the kind of people we are.

Narrator

For WebMD, I'm Rhonda Rowland.

Lung Disease: Facts You Need To Know

In August 2019, Angie Abad went to the ER to be treated for a respiratory infection. Medical workers there tested her and prescribed meds, but Abad "never really felt right after that."

After a second respiratory infection and growing problems with breathing, her local hospital still couldn't put a finger on the problem. Finally, a more specialized hospital nearby ran more breathing and lung tests and diagnosed her with the lung disease COPD.

But the diagnosis and the treatments that followed -- including extra oxygen, a nebulizer, and an inhaler -- still left Abad, who is 50 and lives in Denver, without answers to mounting questions. She felt even worse about her condition because she'd watched her father die of the same disease 8 years before.

"I didn't know any questions to ask my pulmonologist," Abad says. "I've just taken the meds she's put me on and left it at that. No one has told me what to expect, possible side effects of meds, or [other] things I would experience."

She didn't find much more support from friends, either. "When you tell people about your diagnosis of COPD, they say, 'Oh,'" she says. "There isn't enough awareness. People don't understand the daily struggles of this disease."

David Mannino, MD, a pulmonologist in Lexington, KY, and the medical director and co-founder of the COPD Foundation, agrees that too many people with lung disease remain in the dark after diagnosis.

On top of people not knowing what questions to ask, "One of the challenges we always seem to have is, a lot of people think it's some type of death sentence. It's not," he says. Mannino has been treating some COPD patients for 15 to 20 years.

Another factor is people with COPD perhaps not knowing they can seek -- and deserve -- support. "A lot of people go into it with shame and blame," Mannino says. For example, smokers might react to their diagnosis by realizing their habit helped set the stage to get the disease. But the guilt should stop there.

"You are dealing with something that is incredibly addicting," Mannino says. "And it's not that way by accident," he says, referring to tobacco companies' longtime knowledge of the harms the substance causes. Even if you can trace the cause of COPD to your lifestyle, this is a time to be gentle on yourself.

Abad filled the many gaps in her grasp of her medical condition "through research, COPD groups, and personal experience."

Her journey has turned up many points she feels are key for people with lung disease to cover with their doctors, answers she wished she'd had all along. They include:

What symptoms you can expect to have

How many stages the disease has

What stage you're in now

How long you might live

Types of breathing exercises

If you'll be on the meds forever

A special question for her was if altitude makes COPD worse. She's newly moved to Denver, which clocks in at 1 mile above sea level. A higher altitude can tax your breathing, mainly at first.

Mannino says he often hears people who have moderate to severe COPD say they wished they'd gone to a pulmonary rehab center or other educational program years before. In these programs, people learn earlier rather than later how to, for example, stretch and breathe properly. They're also taught to fend off panic attacks and times when they can't catch their breath with methods like pursed lip breathing. It's a technique in which you inhale through your nose and breathe out through puckered lips.

Some exercises can actually be fun, Mannino notes, such as playing the harmonica. The higher notes provide ideal breathing workouts.

Such programs also teach people with lung disease how to use meds and lung devices the right way. "Patients learn too late that different respiratory meds require different techniques as to how to use them correctly," Mannino says. "Even physicians might not know how to use these correctly."

However, "the number of rehab programs for COPD are far too few," especially in rural places, he says. The COVID-19 pandemic and its limits on people getting together for anything "nonessential" has made it even harder to get into these programs. Doctors also expect some people who've had COVID will need pulmonary rehab, which will put more strain on the system.

Technology has made it simple for anyone to access disease support, though. A number of lung disease management apps have sprung up, including a free app through the COPD Foundation called the COPD Pocket Consultant Guide. It's designed for people with the disease and their families. You can download it from the foundation website or Google Play.

The app includes links for the right way to use meds, easy ways to track your schedules, and other useful tools rehab programs cover. "You can even print out [info] sheets to give the doctor" to prompt helpful questions and start talks that can sharpen your insights into your condition, Mannino says.

Lung Disease

Increasing level of pollution has made breathing in urban areas very difficult, raising the incidence of respiratory problems. Out of the world's top 20 cities with polluted air, 13 belong to India and according to the World health Organisation (WHO) report published in 2011, lung diseases rank 2ndin the list of top 20 causes of death. Naturally, lung disease is a big health issue that needs to be addressed. Here are some facts about lung disease you should know about.

To understand the condition of your lungs, you need to first understand how the lungs function. Lungs are soft organs present on both right and left side of the chest. They are protected by a had covering called the ribcage. Each lung is made of sections called lobes. The main function of the lungs is to make oxygen available for purifying blood and to and eliminate carbondioxide from impure blood or deoxygenated blood. So when you breathe, air travels down your windpipe (trachea). The windpipe bifurcates with each branch entering each of the lungs. Into the lungs, the windpipe is further branched to tubes called bronchioles that end in small sacs called alveoli, where the inhaled air reaches for delivering oxygen.

A lung disease or disorder occurs in the various structures of lungs and disrupts its functioning. It can vary from a mild common cold to life-threatening conditions like pneumonia and cancer. Lung disease can be caused by infections, inflammation, obstruction of airways, decreased lung function, problems related to pulmonary circulation, etc. Smoking, infections, air pollution, genetics, exposure to asbestos, etc. Can cause various lung diseases.

Types

The common as well as rare types of lung disease include -

Causes

'In any form of lung disease mainly the breathing gets affected,' says Dr Animesh Arya, Senior Consultant, Respiratory Medicine, Delhi based Sri Balaji Action Medical Institute. Here are some common forms of lung diseases he explains. 1. Asthma:It is the most common lung disease triggered by allergies, infections and pollutants that harm the airways and cause inflammation. 2. Acute bronchitis: Bronchitis is the inflammation of the air passage. Acute bronchitis is caused by viral or bacterial respiratory infections. 3. Chronic Obstructive Pulmonary Disease (COPD): It a group of diseases that causes breathing difficulties and interfere with the exhalation process of breathing. 4. Chronic bronchitis: It is a type of COPD caused mainly due to smoking. 5. Emphysema: It is a COPD caused by environmental factors and may also be triggered by allergens or organisms that cause diseases like pneumonia and tuberculosis. Apart from these common forms of lung diseases, other rare lung diseases include: 6. Cystic fibrosis: It is rare lung disease caused by genetic mutation that results in excess mucus production causing blockage of airways. 7. Acute respiratory distress syndrome (ARDS): It is a medical emergency caused as a result of lung injury due to a severe illness. 8. Lung cancer: It can affect any part of the lung. It is mainly caused due to smoking. Here are  10 common symptoms of lung cancer you need to know. 9. Interstitial lung disease: This is a group of diseases affecting the interstitium, a thin lining separating the air sacs.

Symptoms

'Bronchitis, asthma, COPD, lung infections and pulmonary fibrosis have similar symptoms even though they are very different in nature,' says Dr Arya.  He lists a few common symptoms of lung diseases:

Difficulty in breathing

Chronic cough

Being short of breath easily after any strenuous activity

Excess mucus production

Coughing up blood due to inflammation in the lining of the respiratory tract

Chest pain

Air hunger which indicates lack of oxygen and also can cause fatigue

Diagnosis

In most cases, chronic cough, chest pain and breathing difficulties necessitate a lung function test. But your doctor might first take a look at the results of your blood test that may indicate whether you have any kind of lung infection. Otherwise, based on your symptoms your doctor might recommend the following lung function tests for you, as explained by Dr Arya.

Imaging tests: A chest X ray, CT scan or nuclear lung scanning can be done to reveal any kind of structural abnormality of the lungs and the chest. With the help of an Xray, the doctor will be able to detect lung tumors, infections like pneumonia, emphysema, interstitial lung disease. It also helps identification of fluid accumulation around the lungs (pulmonary edema).

Lung Volume measurement or spirometry:  This test will determine how much air your lungs can hold. A device called spirometer is used in the test to record and analyse the volume of air inhaled and exhaled. The test is repeated after administering a bronchodilator which opens up the airways.

Diffusing capacity measurement: This test determines how well oxygen is transferred from the air sacs (alveoli) to the bloodstream.

Maximal Voluntary Ventilation: The maximum capacity a person can breathe is checked in this test.

Lung biopsy: In case interstitial lung disease is suspected, the doctor may suggest a lung biopsy where a tissue from the lung is obtained using procedures like bronchoscopy for investigation.

Treatment

'If any of the above mentioned symptoms persist for a long time, it is better to consult a doctor immediately for diagnosis,' says Dr Arya. The management of lung disease depends on the type of lung disease you're diagnosed with but largely medication is the main treatment option for lung disease patients.

Asthma and COPD patients may require bronchodialtors and inhalers for relieving asthma symptoms and opening up the airways. Read more about medicines for asthma

Expectorants may be prescribed in case of chronic productive cough to loosen the mucus and facilitate easy expulsion

Corticosteroids are given for reducing inflammation and swelling of the lung tissue

Patients with extreme shortness of breath are managed with oxygen therapy, where the prescribed level of oxygen is delivered through a mask

Antibiotics like azithromycin may be prescribed for patients diagnosed with interstitial lung disease. Lung Infections are also treated with antibiotics

There are some thoracic surgical interventions in which the lung volume or contraction and expansion of the diaphragm can be improved for better lung function

Lung transplantation is the last option for patients with end stage lung disease

'However additional measures like lifestyle management are also needed,' says Dr Arya. These measures not only help you protect lung function but also prevent lung disease. Here are some tips he offers for better management and prevention of lung disease.

If you are a smoker, quit smoking and if not, avoid smokers as far as possible.

Identify things that you are allergic to and avoid them. Some common allergens include animal dander, dust, and aerosols.

Contrary to popular belief, exercise helps with lung diseases. Exercising for even half an hour daily can increase your lung capacity.

Manage your weight as being obese puts more stress on your heart and lungs.

 It is important is to take your medication on time every day.

Lastly, get as much rest as possible.

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