Wheezing and shortness of breath due to chronic obstructive pulmonary disease, or COPD, can worsen when a bacterial or viral infection leads to acute bronchitis. People with COPD are especially vulnerable to these infections. Bronchitis causes inflammation of the airways and worsens COPD-related symptoms. In people with COPD, treating acute bronchitis aggressively helps prevent a potentially life-threatening decline in lung function.
1. Risk Factors
COPD causes rigidity and scarring in the airways and air sacs, or alveoli, of the lungs. Under normal circumstances, the alveoli allow oxygen to enter the bloodstream and carbon dioxide to exit. With COPD, the scarred air sacs become less numerous and efficient, which eventually leads to difficulty breathing. This lung scarring also means that people with COPD are particularly prone to bronchitis. People with COPD who smoke are at even greater risk for bronchitis. Cigarettes release a number of chemicals that irritate the airways and trigger bronchitis symptoms. People with long-standing COPD who develop profound dilation of the airways, or bronchiectasis, are also at increased risk for bronchitis.
Acute bronchitis is usually caused by viruses, including influenza, parainfluenza and respiratory syncytial virus. For this reason, an annual flu shot is especially important for people with COPD, as it can help stave off acute bronchitis. Because COPD makes the lungs prone to both viral and bacterial infections, a bacterial infection can sometimes become superimposed on a viral infection. When someone with COPD develops acute bronchitis, there is a sudden and often severe deterioration in lung function.
Medications known as bronchodilators are a mainstay of COPD treatment. They help the airways remain relaxed and improve airflow. Inhaled medications that combine bronchodilators with steroids -- such as fluticasone-salmeterol (Advair) and budesonide-formoterol (Symbicort) -- are also essential. When bronchitis is superimposed on COPD, oral steroids are often added to these daily medications to treat inflammation in the lungs and improve breathing. If a bacterial infection is suspected, antibiotics such as doxycycline (Vibrox, Doryx) or azithromycin (Zithromax) may be prescribed. The American Thoracic Society recommends the use of quinolone antibotics -- including moxifloxacin (Avelox) and levofloxacin (Levaquin) -- in people who have persistent bronchitis symptoms despite prior antibiotic treatment. People with other medical conditions, including diabetes and heart failure, or those who have severe symptoms may require hospitalization to receive steroids and antibiotics by an intravenous infusion.
The best way to prevent a COPD flare due to bronchitis is to quit smoking. Avoiding exposure to secondhand smoke is also critical for reducing bronchitis risk. People with COPD should be sure to get a flu shot every year, the pneumonia vaccine every 5 years and a pertussis booster shot every few years to reduce the risk of infections that lead to bronchitis. Preventive strategies like these can help maximize lung function for years to come.
- Chest: Chronic Cough Due to Acute Bronchitis -- ACCP Evidence-Based Clinical Practice Guidelines
- American Family Physician: Diagnosis and Treatment of Acute Bronchitis
- European Respiratory Journal: Chronic Bronchitis Sub-Phenotype Within COPD -- Inflammation in Sputum and Biopsies
- American Thoracic Society: Standards for the Diagnosis and Management of People With COPD
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