What causes chronic bronchitis?

Bronchitis is an inflammatory disorder involving the respiratory channels in the lungs called bronchi. It can be
acute with sudden and severe presentation, whereas chronic bronchitis is a low grade and long drawn process.
Chronic bronchitis
Chronic bronchitis is defined as production of cough and sputum on most days for at least 3 consecutive months,
for at least 2 successive years. This disease forms part of the chronic obstructive pulmonary disease, commonly
known as C!". C!" is defined as a lung disease characteri#ed by airflow limitation that is not fully
reversible. The airflow limitation is usually due to an abnormal inflammatory response of the lungs to no$ious
particles or gases though it is preventable and treatable. It is also associated with other complications like
impaired nutrition, weight loss and skeletal muscle dysfunction.
This condition is more common in people who resort to tobacco smoking. The environmental pollution also
poses a risk for this condition. In 2%%&, C!" contributed to more than 3 million deaths, and if it continues at
this pace, it is likely to become the third most important cause of death worldwide by 2%2%. This impact is
especially going to be strongest in 'sian and 'frican countries due to e$cessive tobacco consumption.
Causes of bronchitis
Cigarette smoking is the most significant risk factor for bronchitis and is responsible for more than (%) of cases.
It is related to the amount and duration of cigarettes smoked by an individual. Though individual susceptibility is
important, scientific studies have shown that the risk of chronic bronchitis occurs with more than *% pack years
+* pack year , 2% cigarettes-day-year..
!eople in rural areas who use bio/fuels like wood, animal dung, crop residues and coal are at high risk of
developing bronchitis due to high levels of indoor air pollution. This is more commonly seen in the rural areas
and in snow bound areas. ccupational risk is seen in coal miners. In many patients the condition has hereditary
factors. These include deficiency of an en#yme in the lungs called alfa * 0 antiproteinase. This en#yme normally
prevents the breakdown of proteins due to release of bacterial en#ymes. In the absence of this en#yme, lung
infections result in more damage leading to chronic bronchitis.
The genesis of bronchitis
The main initiating factors in the occurrence of chronic bronchitis is long term irritation of the respiratory passage
due to smoke from tobacco or environmental pollution caused by sulfur dio$ide and nitrogen dio$ide. The
cigarette smoke interferes with ciliary action of the respiratory epithelium which clears any mucus in the
passage1 it also inhibits the ability of bronchial and alveolar white blood cells to fight against the bacteria. The
e$posure of dust from grain, cotton and silica has similar effects. In the early stage of this disease, there is
greater production of mucus in the bronchi due to an increase in si#e of glands in the respiratory epithelial lining.
Inflammatory cells like neutrophils release en#ymes against proteins called elastase, cathepsin and matri$
metalloproteinases which are also responsible for increased mucus production. 2pecial types of cells called
goblet cells multiply, and produce more mucus in the small airways resulting in airway obstruction.
The role of infection seems to be secondary as it is not responsible for the initiation of chronic bronchitis, though
it plays a great role in maintaining it. Bacterial infections are responsible for acute aggravation of this condition
which occurs commonly. 3iral infections can also cause e$acerbations of chronic bronchitis.
Bronchitis is a chronic health problem and has a rising trend worldwide due to smoking and e$posure to
pollution. It poses a risk for development of lung cancer. It is preventable by avoidance of risk factors. !ublic
awareness is increased by warning messages shown in the media programs.