Exacerbated chronic bronchitis

Introduction

Chronic bronchitis is a chronic inflammation of the bronchi, defined by a cough and monthly daily sputum production for at least three months a year, for two consecutive years. Exacerbation corresponds to an acute worsening of the usual symptoms: increase in dyspnea, increase in sputum volume, and a change in its appearance (becoming purulent). Exacerbations are the leading cause of hospitalization for patients with chronic obstructive pulmonary disease (COPD) and permanently damage respiratory function.

If your respiratory symptoms worsen, contact your primary care physician first. If they are unavailable, Docadom offers an emergency consultation by a doctor at home: call 021 845 45 45 or use our application available on the App Store and Google Play.

Who is at risk?

Exacerbations primarily affect patients with COPD or chronic bronchitis, the main cause of which is smoking (active or passive). Occupational exposure to dust or irritating gases (mining, construction, agriculture), air pollution, repeated respiratory infections in childhood, and alpha-1 antitrypsin deficiency are other factors. Older patients, those with poor nutritional status, heart failure, diabetes or gastroesophageal reflux are more exposed to severe forms.

Symptoms of Exacerbation

Exacerbation manifests as a worsening of usual respiratory symptoms over a few hours to a few days. Recognizing these signs early allows for treatment adjustment and avoids hospitalization.

Main Symptoms

• More frequent, more intense cough, sometimes at night.

• Altered sputum: increased volume, change in color (becoming yellowish, greenish, or even bloody).

• Increased shortness of breath on exertion and then at rest, limiting walking and speaking.

• Wheezing on exhalation.

• Chest tightness, feeling of weight on the chest.

• Moderate fever in case of an infectious cause.

• Intense fatigue and decreased physical performance.

• Signs of severity: cyanosis, confusion, drowsiness, intercostal retraction, tachycardia > 110/min, saturation < 90%.

When to Consult in an Emergency?

An emergency consultation is necessary in the following situations:

• Worsening of symptoms despite adjustment of the usual treatment.

• Appearance of signs of severity (cyanosis, dyspnea at rest, inability to speak, leg swelling) — call 144 immediately.

• Patient presenting cardiorespiratory severe comorbidity (heart failure, diabetes, immunosuppression).

• Elderly patient living alone or with low independence.

• History of hospitalization for previous exacerbation.

What to do before calling Docadom? First contact your primary care physician, who knows your maintenance treatment and respiratory history. If they cannot be reached or if you need a doctor at home outside of opening hours, call Docadom at 021 845 45 45 or make your request directly from our smartphone application (App Store and Google Play). In case of signs of severity (cyanosis, confusion, extreme shortness of breath), dial 144 without delay.

Causes of Exacerbated Chronic Bronchitis

Exacerbations are more often than not multifactorial. Identification of the triggering factor guides treatment.

Infectious Causes

They account for about 70% of exacerbations. The main agents are viruses (rhinovirus, influenza virus, RSV, coronavirus) and bacteria (Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, Pseudomonas aeruginosa in severe forms). Seasonal flu is a classic trigger.

Environmental Causes

Peaks of air pollution, exposure to fumes or irritating vapors, cold and dry air, or an allergic episode can trigger an exacerbation.

Aggravating Factors

Poor compliance with maintenance therapy, inhalation errors, inappropriate intake of non-cardio-selective beta-blockers or sedatives, undiagnosed pulmonary embolism, decompensated heart failure, pneumothorax and ENT infections are all factors to be systematically checked for.

Diagnosis of Exacerbation

The diagnosis is essentially clinical, based on the modification of symptoms compared to the baseline state. Complementary examinations evaluate severity and look for complications.

Diagnostic Methods

• Physical examination: respiratory rate, saturation, auscultation (wheezes, rhonchi, crackles), signs of right heart failure.

• Saturand arterial blood gas analysis in case of signs of severity.

• Chest X-ray looking for an infectious focus, pneumothorax, or cardiac decompensation.

• Biological evaluation: CBC, CRP, electrolyte panel, kidney function, NT-proBNP, D-dimer if pulmonary embolism is suspected.

• Sputum culture in case of severe exacerbation or failure of antibiotic therapy.

• Electrocardiogram to detect arrhythmia or associated heart disease.

Alternative Diagnoses

Several pathologies can mimic a COPD exacerbation:

• Acute community-acquired pneumonia (radiological focus).

• Decompensated heart failure with pulmonary edema.

• Pulmonary embolism in case of sudden dyspnea without infectious context.

• Spontaneous pneumothorax, more common in COPD.

• Poorly controlled asthma, sometimes associated.

• Bronchial cancer to be looked for in case of atypical exacerbation.

Treatment of Exacerbation

Treatment aims to relieve symptoms, treat the cause and prevent complications.

Bronchodilator Treatment

Short-acting beta-2 agonists (salbutamol, terbutaline) and short-acting anticholinergics (ipratropium bromide), in close inhalation or by nebulization in moderate to severe forms.

Corticosteroids and Antibiotics

A short course of oral corticosteroids (prednisone 30 to 40 mg/day for 5 days) reduces the duration and severity of the exacerbation. Antibiotic therapy is indicated in the presence of the three Anthonisen criteria (increased dyspnea, sputum volume and purulence): amoxicillin-clavulanic acid, macrolides, or fluoroquinolones in severe forms.

Oxygen Therapy, Ventilation and Associated Measures

Oxygen therapy aims for saturation between 88 and 92% to avoid worsening of hypercapnia. Non-invasive ventilation (NIV) is indicated in case of respiratory acidosis. Respiratory physiotherapy, hydration, thromboembolic prevention and smoking cessation complete the management.

Prevention of Exacerbated Chronic Bronchitis

Prevention relies on controlling triggers and rigorous monitoring of the underlying chronic disease.

• Complete smoking cessation, at any stage of the disease.

• Vaccinations: annual flu, pneumococcal, COVID-19, whooping cough.

• Optimized maintenance treatment with long-acting bronchodilators (LABA, LAMA) and inhaled corticosteroids in case of frequent exacerbations.

• Regular check of inhalation technique.

• Pulmonary rehabilitation combining physical activity, education and support.

• Avoidance of indoor pollutants (fumes, sprays, chemical vapors).

• Regular medical follow-up with annual spirometry.

• Management of comorbidities: heart failure, sleep apnea, gastroesophageal reflux, depression.

Possible Complications

Acute respiratory failure manifests as intense dyspnea, cyanosis, confusion or drowsiness. It requires oxygen therapy, non-invasive ventilation, or even intubation in intensive care.

Other complications include right heart decompensation (cor pulmonale), superinfected pneumonia, pneumothorax, pulmonary embolism, permanent worsening of respiratory function, and a non-negligible risk of death during severe hospitalized exacerbations.

When to Contact a Doctor for an Exacerbation

Any worsening of cough, sputum or dyspnea justifies a quick medical opinion. Here is what to do:

• As a first resort: contact your primary care physician. Only they know your maintenance treatment, history and personalized plan.

• If your primary care physician is unavailable (evenings, weekends, holidays), Docadom offers an emergency consultation by a doctor at home. Call 021 845 45 45 or make your request via our mobile application, available for free on the App Store and Google Play.

• In case of signs of severity (cyanosis, confusion, extreme dyspnea, impossibility to speak), call 144 without delay.

Conclusion: Act Fast to Preserve Breath

Exacerbated chronic bronchitis is a key event in the course of COPD. It can be triggered by an infection (particularly the flu), by pollution or by a cardiac factor. It is characterized by worsening cough, sputum and dyspnea, which can lead to complications such as acute respiratory failure, cor pulmonale or superinfected pneumonia. Rapid management — bronchodilators, corticosteroids, targeted antibiotics, oxygen therapy — limits hospitalizations and mortality.

If in doubt, consult your primary care physician first. If they are not available, Docadom provides you with an emergency doctor at home 7 days a week: call 021 845 45 45 or use our mobile application (App Store, Google Play) to request an emergency consultation.