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| Chronic bronchitis, emphysema and COPD ('smoker's lung') |
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Reviewed by Dr Dan Rutherford, GP
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What is chronic bronchitis?
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| Smoking is the main cause of more than 8 out of 10 cases of
chronic bronchitis and smoking cessation has the most benefit in the long-term
outlook. |
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Chronic bronchitis is a chronic inflammatory condition in the
lungs that causes the respiratory passages to be swollen and irritated,
increases the mucus production and may damage the lungs. The symptoms are
coughing and breathlessness, which will get worse over the years.
The definition of chronic bronchitis is chronic cough or mucus
reproduction for at least three months in two successive years when other
causes have been excluded.
The most important 'treatment' is to quit smoking -
most people who develop chronic bronchitis are smokers. When lung damage
results in airflow restriction, the term 'COPD' (chronic obstructive
pulmonary disease) is used.
COPD accounts for about 7 per cent of all days off work from
sickness and the annual NHS workload for COPD exceeds that for
asthma.
Why does a person get chronic bronchitis and COPD?
Smoking is the most
important cause of chronic bronchitis. Other things that make it worse are air
pollution and allergy. The seriousness of the disease depends on how much and
for how long a person has been smoking.
What does chronic bronchitis feel like?
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You cough a lot, sometimes daily.
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You easily get short of breath.
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Your sputum is thick and difficult to cough up.
What can I do myself?
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If you smoke: QUIT!
It is never too late. Your doctor or pharmacist can provide advice on smoking
cessation products and techniques.
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Avoid irritations in your surroundings, such as
smoke.
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Make sure infections in the respiratory channels are treated
immediately.
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Avoid passive smoking.
How can the doctor tell if I have COPD?
Some other lung and heart diseases give the same symptoms as
COPD.
X-ray examinations,
lung function tests,
ECG, and
blood samples may be
necessary aids to make an exact diagnosis and assess the severity of the
condition.
How can I make my life a bit easier?
COPD can often be improved to some extent by removal of
exacerbating factors and careful use of medical treatments. The most important
thing you must do is quit smoking.
If you live in an area with heavy air pollution, you must do
everything in your power to avoid or reduce the risk. Consider getting a new
job. Avoid sudden temperature changes or cold, moist weather.
Is it important to exercise by taking walks or other
activities?
Yes. You should try and keep active.
Medication for COPD
It is important to maintain a positive attitude to treatment of
COPD. The condition is not curable but can often be improved, and patients
deserve a full trial of potential treatments. The difference between COPD and
asthma is that the airway obstruction
in asthma is reversible with treatment, whereas in COPD it is largely
irreversible.
The small degree of reversibility in COPD should however be
exploited, for example using drugs also of benefit in asthma such as
bronchodilators (beta-agonists and anticholinergics).
People with moderate to severe COPD should be seen by a
specialist in chest medicine with a view to establishing if the patient will
benefit from steroid therapy, either by inhaler or by mouth, or from other
drugs such as oral
theophylline.
COPD patients are prone to have short-term exacerbations of
their condition, during which they will feel more breathless. These
exacerbations are generally the result of respiratory infections so will
usually need treatment with antibiotics. COPD patients should take advantage of
annual vaccinations against
influenza.
For those patients who have become severely limited by COPD,
home oxygen treatment may be required.
Surgery
In some people with COPD, large cysts known as bullae can
develop in the lung and hinder lung function. In certain circumstances these
can be removed surgically and will allow better inflation of the rest of the
lung tissue, but this treatment is suitable for only a minority of
patients.
Summary
The main drive in COPD treatment has to be of prevention rather
than cure.
COPD does occur in non-smokers but the vast majority of
sufferers smoke, and their likelihood of developing the disease is related to
the amount they smoke. There is an extra factor – that of individual
susceptibility – which cannot be predicted in advance.
Most people with chronic bronchitis caused by smoking do not go
to their doctor until they start to also become breathless, by which time much
irreversible lung damage has already occurred.
Those with known COPD who continue to smoke suffer more rapid
decline in lung function than those who stop completely. The message is clear –
smoking is extremely bad for your health, but it is never too late to
stop.
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Based on a text by Dr Carl J Brandt and Dr Finn Rasmussen
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Last updated 02.03.2005
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