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Chronic bronchitis is an inflammation of the bronchi that is characterized by cough and expectoration of sputum that occurs on most days for at least 3 months. In order to qualify for a diagnosis of chronic bronchitis, all other lung and/or heart conditions that can cause similar symptoms (e.g., cough; sputum production) must be excluded as the cause. Approximately 85% to 90% of cases of chronic bronchitis are caused by cigarette smoking and the rest of the cases are caused by occupational and/or environmental exposure to a variety of irritants (e.g., organic dusts; chemicals; agricultural products; air pollutants).

Principles of management of people with chronic bronchitis includes:

• Smoking cessation - 90% of patients will experience resolution of cough and sputum production after quitting smoking

• Avoidance of exposure to occupational and environmental irritants

• Antibiotics

  • not recommended for routine use in patients with stable chronic bronchitis
  • usually reserved for acute exacerbations of chronic bronchitis

• Inhaled bronchodilators

  • in patients with stable chronic bronchits, short-acting Beta agonist inhaled bronchodilators (e.g., albuterol) have been shown to improve lung function, shortness of breath, and exercise toerance.
  • in patients with stable chronic bronchitis, a short-acting anticholinergic bronchodilator (e.g., ipratroprium) can be used to control coughing
  • short-acting Beta agonists and short-acting anticholinertic inhaled bronchodilators are also recommended for the treatment of acute exacerbations of acute exacerbations of chronic bronchitis

• Corticosteroids

  • inhaled corticosteroids, in combination with a long-acting Beta agonist bronchodilator, are recommended to control coughing in patients with stable chronic bronchitis
  • a short-course of systemic or oral corticosteroids (10-15 days) is recommended to improve cough in patients with acute exacerbations

• Expectorants

  • expectorants are substances that help to loosen and clear mucous and phlegm from the respiratory tract
  • expectorants are not recommended for the treatment of cough in patients with either stable or acute exacerbations of chronic bronchitis since evidence of efficacy is lacking

• Antitussive agents

  • antitussive agents are medications that help to suppress cough by acting on the medullary cough center in the brain
  • antitussive agents, such as codeine and dextromethorphan, may be used for temporary cough suppression in patients with chronic bronchitis