Bronchitis

WHAT IS MEANT BY CHRONIC BRONCHITIS AND EMPHYSEMA?

Chronic bronchitis and emphysema are very common lung diseases that cause the sufferer to cough and become short of breath. These diseases usually occur together, are caused by smoking, with chronic bronchitis 7 times more common than emphysema. These diseases are also described under the umbrella term, "chronic obstructive airways disease" (COAD) or "chronic obstructive pulmonary disease" (COPD). Chronic bronchitis and emphysema are both associated with smoking of tobacco. If you stop smoking, you can reduce your chances of developing the diseases or stop any disease present from getting any worse. Even with severe disease, stopping smoking can help. In rare cases, environmental dusts or an inherited problem can cause emphysema. There are over 100,000 people in Ireland suffering from chronic bronchitis and emphysema. However, public awareness of these illnesses is very poor. To understand these illnesses better, it is useful to know the inner workings of the normal lungs.

YOUR LUNGS AS A TREE: THE "BRANCHES" AND THE "LEAVES"

Your lungs are like a "tree". When you breathe in, air passes into the windpipe, the trunk of the tree. Air passes from the windpipe into two large bronchial tubes (bronchi), one supplying air to each lung. These bronchi are the first "branches" of the tree. They divide into smaller and smaller branches, finally delivering air into tiny air sacs, called alveoli. The alveoli are the "leaves" of the tree. There are many thousands of alveoli in your lungs, and if laid out flat, would cover an entire football pitch! It is in these alveoli (or "leaves") that oxygen is taken from the breathed-in air. The oxygen is then passed into the bloodstream, through thin blood vessels called capillaries. The oxygen is then carried round the body to important organs, such as the brain, heart and kidneys.

WHAT HAPPENS TO THE LUNGS IN CHRONIC BRONCHITIS?

In chronic bronchitis, the branches of the tree, or bronchial tubes, are affected. Bronchitis means inflammation in the bronchial tubes, and chronic means that the inflammation has been there a long time. When inflamed, the walls of the bronchial tubes produce thick material called mucus. The person tends to cough up this mucus every day, especially in the morning. The mucus can block the bronchial tubes, making it more difficult to breathe in and out. The mucus can sit in the tubes for a long time, and become infected with bacteria. This is why people with chronic bronchitis get frequent chest infections. After long-term smoking, the walls of the bronchial tubes can become thicker. This narrows the tubes, making it more difficult to breathe.

WHAT HAPPENS TO THE LUNGS IN EMPHYSEMA?

In emphysema, the leaves of the tree, or alveoli, are slowly destroyed, so that oxygen cannot be extracted from the breathed-in air. The more alveoli damaged, the worse the problem, and the greater the degree of breathlessness. Cigarette smoking is the most common cause of emphysema.

SYMPTOMS OF CHRONIC BRONCHITIS AND EMPHYSEMA

The first symptom that people with chronic bronchitis and emphysema notice is usually a cough i.e. a "smoker's cough". This is a dry cough initially, and occurs when the person is in their thirties. Then, in their forties, the cough tends to become productive. This means the sufferer starts to cough up phlegm daily, and becomes prone to chest infections. Finally, in their fifties, the person becomes short of breath when doing things that they used to do easily, such as walking. As the disease gets worse, the person's ability to do things becomes less. Eventually, breathlessness may occur at rest. The deterioration in breathing can make the sufferer irritable, or depressed. It is important to learn how to pace yourself when you have this illness, and learn to do what you can and cannot do. Even people with normal lungs tend to slow down as they get older.

TREATMENT OPTIONS

Chronic bronchitis and emphysema cannot be cured. That does not mean that we cannot help people with these illnesses. Much can be done to make the symptoms better, and help people to lead as active a life as possible. The most important aspect of treatment is stopping smoking. Even in severe disease, this can help. Your doctor will probably start you on medications called bronchodilators or 'relievers'. These dilate or widen the bronchial tubes and dry up the excess mucus making it easier to breathe through them. Bronchodilators can be taken in tablet or inhaler form. There are also medications that reduce inflammation in the bronchial tubes, called steroids. Again, these can be taken in tablet or inhaler form, and also help with breathing. Doctors prefer to prescribe steroids in inhaler form. This is because long-term use of steroid tablets can cause unwelcome side effects. (Having said that, your doctor may give you a short course of steroid tablets if your breathing has suddenly become temporarily worse; this worsening is called an exacerbation. Short courses of steroids used like this usually do not cause problems).
Many exacerbations are caused by chest infections, and it is important that these are treated quickly, to prevent them becoming bad. You can tell if you are getting a chest infection by a change in the coughed up. Your doctor will give you a short course of antibiotic tablets with steroids to get rid of the infection. Some people keep antibiotics and steroids in the house for this purpose, but ask your doctor about this first. Most of these infections can be treated at home, however, if the infection or breathing becomes very bad, then a short stay in hospital may be needed.
People with chronic bronchitis and emphysema should get the 'flu vaccination every autumn. It is also important to try and keep as active as the illness will allow. Exercise can stop your muscles from becoming weak, as staying fit will help the breathlessness.
In some cases, your doctor will prescribe a machine called a nebuliser to bring bronchodilator medication to your lungs. This is best kept for emergency use. We would normally recommend using inhalers where possible.
Rarely, some people with severe chronic bronchitis and emphysema benefit from oxygen treatment at home. This can be tested by a blood test or a simple exercise (walking) test. Some people only become some exercise. If this is the case, you will be given an oxygen cylinder for short-term and emergency use. However, if your blood oxygen level is very low, the doctor may decide that you need oxygen for 16 hours a day (long-term oxygen treatment) at home. Then you will be given a machine called an oxygen concentrator to use at home. This machine takes oxygen from the air and transports the oxygen to your lungs through a mask. The mask is worn on the face or through small nasal tubes called nasal prongs or cannulae. The machines generally come with a long piece of tubing, so that you can move around the house with the oxygen on. Generally, oxygen therapy is safe, but should never be used near an open fire. Also, you should never smoke or light a match when on oxygen. This can lead to nasty burns on the face.