Chronic Bronchitis Complications

Unlike acute bronchitis, complications are fairly common with chronic bronchitis, especially worsening of the condition

*Dyspnea

Dyspnea, the medical term that refers to the sensation of shortness of breath, is common with chronic bronchitis. Not only can dyspnea be uncomfortable and cause significant anxiety, but it has been found to greatly interfere with the overall quality of life. That said, appropriate management can be very helpful,4

Managing dyspnea requires a combination of several approaches:

_Appropriate medications
_Oxygen when indicated
_Pulmonary rehabilitation
_Using belly breathing
_Trying out methods to improve exercise tolerance, as exercise can improve symptoms
_Managing stress and anxiety (some people find it helpful to work with a therapist to break the dyspnea/anxiety cycle)

*Acute Exacerbation

Acute exacerbations of chronic bronchitis are common, yet of concern, in that they can be both uncomfortable (and sometimes dangerous) and may hasten the progression of the disease.

Symptoms of an acute exacerbation may include:

_Increased cough
_Change in sputum (either color or amount)
_Change in wheezing
_Change in chest tightness
_Fever
_Increased respiratory rate (tachypnea)
_Fever (usually low grade)
_Anxiety
_Lightheadedness and tingling (if oxygen levels are low)

Depending on the severity of an exacerbation, hospitalization may be required.

*Respiratory Failure

Respiratory failure is, unfortunately, a complication of chronic bronchitis. It occurs when the lungs fail to bring in enough oxygen to supply the tissues of the body (hypoxia). Without enough oxygen available, a number of bodily systems experience damage. It can also result in the buildup of carbon dioxide in the bloodstream.

A number of symptoms may suggest that respiratory failure is occurring, though the symptoms often vary depending on whether respiratory failure has come on slowly or rapidly.

With the sudden onset of severe respiratory failure, a person may develop severe cyanosis (a bluish tinge to the fingers and lips) or become unconscious.

More commonly, respiratory failure begins more gradually. Symptoms may include:

_Shortness of breath (dyspnea)
_A rapid respiratory rate (tachypnea)
_A rapid heart rate (tachycardia)
_Cyanosis
_Lack of coordination
_Impaired judgment
_Feelings of well-being and sometimes euphoria
_Tingling and warm sensations
_Tunnel vision

Respiratory failure is a medical emergency, especially if it develops rapidly.

*Cor Pulmonale

Cor pulmonale or right-sided heart failure, can occur with long-term chronic bronchitis.

Symptoms of cor pulmonale are similar to those of left-side heart failure, which is most common but is often more severe. These may include:

_A cough
_Shortness of breath, which may occur at rest as well as with activity
_Fluid retention (edema) of the extremities
_Fatigue (which can be severe)
_Dilated blood vessels in the neck
_Swelling of the abdomen (ascites)
_A rapid respiratory rate
_A rapid pulse
_Cyanosis
_Chest pain
_Fainting (syncope)

Cor pulmonale can rapidly become life threatening and is a medical emergency.

*Pneumothorax

A pneumothorax, or “collapsed lung,” is another potential complication of chronic bronchitis, especially in those who also have emphysematous changes in their lungs. With a pneumothorax, a “hole” in the lungs allows air to leak into the space (pleural cavity) between the two pleural membranes (pleura) that surround the lungs.

Symptoms of a pneumothorax can vary from very mild to life threatening and may include:

_Chest pain on one side of the body that can be mild to severe (present for most people with the complication)—The pain is often sharp, and worsens with a deep breath or with coughing. The pain may also radiate to the arm or shoulder, causing some people to be concerned they are having a heart attack.
_Shortness of breath
_An elevated heart rate
_A rapid pulse
_Cyanosis
_Lightheadedness
_Sometimes (if the air leaks into surrounding tissue), people may note a sensation under the skin of their chest or neck that has been likened to bubble wrap (subcutaneous emphysema)

It’s important to note that when non-life-threatening, symptoms of a pneumothorax often improve (and sometimes resolve) over the next 24 hours.

*Polycythemia

Polycythemia refers to a high red blood cell count and can have many causes. It is further divided into primary polycythemia and secondary polycythemia, with secondary polycythemia occurring as a compensatory process related to another medical condition.

Symptoms may include:

_Fatigue
_Headache
_Dizziness (vertigo)
_Visual disturbances
_Ringing in the ears (tinnitus)
_A ruddy appearance
_Easy bruising
_High blood pressure
_Decreased mental acuity/confusion
_Clubbing (a condition in which the fingernails and sometimes toes take on the appearance of upside-down spoons) and cyanosis due to relatively long-term hypoxia

*Reactive Airway Disease

Reactive airway disease (RAD) describes a condition in which the airways respond to an irritant (smoke, infection, etc.) by narrowing. There has been debate over what constitutes reactive airway disease, but in general, RAD refers to a narrowing of the airways that is reversible in nature and unknown with respect to diagnosis.

*Emphysema and COPD

Both chronic bronchitis and emphysema are types of COPD, and since they have similar risk factors (such as smoking, exposure to airway irritants, etc.), they often occur together. Overall, roughly half of people diagnosed with COPD have bronchitis and half emphysema, with a much smaller number having bronchiectasis.

Emphysema is not necessarily a complication of chronic bronchitis, but needs to be considered with any of the complications discussed above as well as with the management of the disease, as potential treatments may vary. Fortunately, actions to prevent the worsening of both (avoiding smoking, fume exposure, viral infections, etc.) can reduce complications and worsening of both conditions.

*Hemoptysis

Hemoptysis, or coughing up blood, may occur with acute bronchitis and chronic bronchitis, or it could signal another condition altogether. When talking about coughing up blood, most people note only a tinge of blood on a tissue—an amount so small that you may question whether or not it is really blood. But coughing up even a small amount of blood, say a teaspoon, is a medical emergency.

If you’ve coughed up blood, see your healthcare provider right away, even if you feel there is an obvious cause (such as throat irritation). In many cases, treatment of the underlying problem will resolve the hemoptysis. When severe, however, treatments such as bronchial artery embolization can quickly stop a bleed that could otherwise have a poor outcome.