Chronic bronchitis is an ailment of the bronchi, which is manifested through cough and sputum expectoration that occurs on most days for a minimum 3 months of the year and for at least 2 consecutive years once the other respiratory or cardiovascular causes for the chronic productive cough are omitted. The sickness is caused by an interaction between noxious inhaled agents (e.g., cigarette smoke, certain environmental pollutants and industrial pollutants) and along with host factors such as genetic and respiratory infections resulting in chronic inflammation in the lumen and the walls of the airways.

As the disease further advances, the progressive airflow limitation happens, generally in association with pathological changes of emphysema, called COPD. When a stable patient suffers a sudden clinical worsening with increased sputum volume, purulence in sputum, deteriorating of shortness of breath, is referred to as an acute exacerbation of chronic bronchitis as long as conditions are ruled out.

The objective of the current review is to display the evidence for the diagnosis and treatment of cough because of chronic bronchitis and to make suggestions useful for clinical practice. References for this review were gained from data using a National Library of Medicine (PubMed) search. The search was limited to human studies, terms "cough," "chronic bronchitis," and "COPD."

The results of the review are that the most effective way to decrease or remove cough in patients with chronic bronchitis and persistent contact to respiratory irritants, i.e., personal tobacco use, passive exposure to smoke and workplace hazards is avoidance. Treatment with a short-acting inhaled beta-agonist, oral theophylline, inhaled ipratropium bromide and a combined routine of inhaled long-acting beta-agonist with an inhaled corticosteroid might improve the cough in patients with chronic bronchitis. However, there is no proven benefit regarding the use of prophylactic antibiotics, expectorants, oral corticosteroids, postural drainage, or chest physiotherapy.

There is evidence that inhaled bronchodilators, oral corticosteroids and oral antibiotics are useful in the treatment of an acute exacerbation of chronic bronchitis, however their effects on cough are not systematically assessed. Treatment with expectorants, chest physiotherapy, postural drainage and theophylline is not advised. Central cough suppressant such as dextromethorphan is recommended for short-term symptomatic relief of cough.

The review concluded that chronic bronchitis because of cigarette smoking or exposures to other inhaled harmful agents is one of the most common causes of chronic cough in the overall population. The most real and effective way to remove cough is the avoidance of all these respiratory irritants. When cough continues in spite of the removal of these provoking agents, there are effective agents such as dextromethorphan to reduce cough.

Source: Braman SS. Chronic cough due to chronic bronchitis: ACCP evidence-based clinical practice guidelines. Chest. 2006 Jan;129(1 Suppl):104S-115S.