What's the Progression Rate for Chronic Bronchitis?

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phaeton - 12 Jul 2006 21:34 GMT

I've just been diagnosed with the "early stages of chronic bronchitis".
I was a smoker for 15 years, but I quit smoking around 3 years ago.
When I asked my doctor how fast Chronic Bronchitis will progress, or if
it will progress at all he simply answered "You've already done the
best thing you can do, which is quit smoking."

Maybe he's reluctant to tell me a doom-n-gloom answer? I don't know.

It's very mild. I don't really have a cough, just shortness of breath.
It responds very well to a bronchiodialator, (lung function went from
54% to 93% in the before/after spirometer test) and there are some days
where the shortness doesn't seem to bother me much.

I'll be 32 next month, so what can I expect with treatment and proper
living? Is Chronic Bronchitis something that I treat and live with for
a very long time, say into my 60s? Will I be on oxygen bottles and
miserable by my 40s? Will this kill me in 5 years?

Stuff on the web is kind of vague- lumping it all together in COPD with
asthma and emphysema, or even using all three terms interchangeably.
Some websites say that the disease stops when you quit smoking, others
say it continues to progress into emphysema until it kills you.

Thanks for any suggestions

-phaeton

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phaeton - 14 Jul 2006 17:18 GMT

I see that this is a low-volume newsgroup. Should I be asking this
somewhere else?

Thanks

-phaeton

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NorthShoreCEO - 14 Jul 2006 18:11 GMT

No, this is the correct place to ask this, but you might have to
wait another day or two before getting a response from someone
who might know. We also have a resident doctor who frequents the
newsgroup and answers questions - his handle is doc - and he'll
probably reply, as well.

I'm a little surprised that your doctor is blaming your current
bronchitis on smoking if you quit three years ago and haven't had
this problem until now. Unless I'm misunderstanding you , and
he/she is only saying that it's good you've quit.

Many doctors start out saying you've got bronchitis, only to tell
you later that you've got asthma. I don't know if bronchitis has
become a catch all phrase, but I know I've heard more than one
tale where this has happened.

Have you had an illness like really bad acute bronchitis or
pneumonia that you never seemed to fully get over?

> I've just been diagnosed with the "early stages of chronic
> bronchitis".
[quoted text clipped - 36 lines]
>
> -phaeton

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phaeton - 14 Jul 2006 20:10 GMT

> No, this is the correct place to ask this, but you might have to
> wait another day or two before getting a response from someone
> who might know.

Ah ok. I had a feeling I wasn't being patient enough. :-)

> We also have a resident doctor who frequents the
> newsgroup and answers questions - his handle is doc - and he'll
> probably reply, as well.

Excellent.

> I'm a little surprised that your doctor is blaming your current
> bronchitis on smoking if you quit three years ago and haven't had
> this problem until now. Unless I'm misunderstanding you , and
> he/she is only saying that it's good you've quit.

I actually noticed the shortness of breath about two weeks after I quit
smoking. Many ex-smokers and even my doctor at the time (not this one)
said that some people experience a temporary shortness of breath after
they quit. Some say you've always been short of breath as a smoker,
but the nerves were dulled by the nicotine, and now that they're waking
up you actually feel it. Others say it's because of the cilia growing
back and starting to wad up big chunks of tar and other crap to take it
out.

Nobody had a specific timeframe for this, just "it will improve after
awhile". My shortness of breath hasn't really gotten any better or
worse since that time, so I figured it was time to see a doctor about
it.

> Many doctors start out saying you've got bronchitis, only to tell
> you later that you've got asthma. I don't know if bronchitis has
> become a catch all phrase, but I know I've heard more than one
> tale where this has happened.

Maybe? The only thing that nags me about this is that I'm not coughing
anything up. Nothing at all. In fact, I don't even have a cough.
When the Xopenex starts wearing off I get a little tickle, but that's
pretty minor.

> Have you had an illness like really bad acute bronchitis or
> pneumonia that you never seemed to fully get over?

As a toddler I spent several weeks in a humidified tent at the
hospital. I don't remember if it was pneumonia or bronchitis or which.
I mentioned this to my doctor and he suggested it might have been
'croup'. I'll have to ask my mother, she'll know.

I also had tubes put in my ears as a small child due to repeated
infections of the ears, sinuses, etc. I've also got the usual round of
allergies, particularly hayfever and such. These allergies have
improved somewhat as I've grown into adulthood. They're still there,
but they're not severe and I don't treat them with anything.

During the time I smoked, it was almost guaranteed that every winter I
was going to catch a cold, and it was always going to go into my lungs,
and I was always going to get a bacterial bronchitis infection. You
know, constant coughing, hacking up lots of green and yellow phlegm
that has a certain taste to it, and after the rest of the cold went
away, this phlegmatic cough would persist until I treated it. It got
to where I would call up my doctor (at the time), and just tell him "I
have bronchitis again" and he'd write out a prescription for
antibiotics without even seeing me. Imoxicillin would clear it up
quickly and completely (until I became allergic to it).

Since I've quit smoking I've only gotten a sort of bronchitis similar
to that once. I'm going to guess perhaps a *viral* bronchitis this
time- I was coughing up white phlegm that didn't have the telltale
bacterial 'taste'. (yeah i know it's gross, but...). It otherwise
felt like bronchitis, but it went away on its own after a few weeks.
This was last October or so- my roommate's son was in his first year of
school and he kept bringing home strain after strain of sickness.

Thanks for the reply.

-phaeton

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00doc - 15 Jul 2006 15:00 GMT

> I've just been diagnosed with the "early stages of chronic bronchitis".
> I was a smoker for 15 years, but I quit smoking around 3 years ago.
[quoted text clipped - 20 lines]
>
> Thanks for any suggestions

The whole this doesn't sit quite right. Usually lung function in smokers
declines at about the same rate as everyone else after they stop smoking -
the smoking just gives them a big headstart while they were doing it.
Unfortunately, the lungs do not seem to heal and they do not have much, if
any, catching up after they stop. I would expect whatever component was from
bronchoconstriction to get better once you are no longer smoking - it is
just the fixed (emphysematous) damage that does not get better.

I agree with your docs and your observation that people people often feel
worse immediately after stopping smoking. It sounds like you have heard most
of the theories as to why. This usually entails increased feelings of
irritation and cough and sometimes increased coughing up of secretions.
Sometimes this chronically irritated feeling is permanent.

The problem I have with your case is that you are younger than we usually
see chronic changes/emphysema/COPD and do not have an incredibly intense
smoking history to account for that. If your symptoms are all from asthma
they should be getting better off of the cigarettes. Usually "chronic
bronchitis" is a late stage of smoking related lung disease where the people
have frequent boughts of bacterial infections; usually characterised by
fevers, chest pain and coughing up really thick secretions (basically puss).
I'm not sure that I am buying that you have "chronic bronchitis" at the age
of 32 and without well established emphysema.

I would say that you either have plain and simple asthma and it is worsening
despite being off of cigarettes for some reason (your dramatic response to
dilators on PFT's suggests this is likely) or you have an unusual
sensitivity to cigarettes like alpha-1 antitrypsin deficiency or have
something else going on entirely. You should be aggressively treated for
asthma (inhaled steroids etc) and look for other causes/triggers (like
reflux, sinus disease, allergies, A1T def, cystic fibrosis, autoimmune
diseases, thromboembolic disease, cardiac disease, or chronic infection such
as mycoplasma). You shouldn't be getting worse at a rate that you can notice
over short times (like a year or two) so if your general doc isn't stopping
it you should be seen by a specialist.

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00doc

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phaeton - 17 Jul 2006 16:42 GMT

> The problem I have with your case is that you are younger than we usually
> see chronic changes/emphysema/COPD and do not have an incredibly intense
> smoking history to account for that.

A pack a day for 15 years isn't 'intense'? We could also add my
childhood to that- both parents smoked (my dad quit when I was 9 or so,
my mom still does).

As an aside, my doc notes that in lung disease statistics, there's a
huge difference between people who don't smoke, and people who smoke a
little bit, such as 3 cigarettes a day. But then there is only a very
slight difference between those who smoke 3 cigarettes a day and 3
packs a day. I.e. it only takes a small amount of smoking to do
maximum damage to your lungs. What are your thoughts on this?

>If your symptoms are all from asthma
> they should be getting better off of the cigarettes. Usually "chronic
[quoted text clipped - 3 lines]
> I'm not sure that I am buying that you have "chronic bronchitis" at the age
> of 32 and without well established emphysema.

There are some days where this bothers me more than others, but as a
whole, it hasn't really gotten better or worse (on its own) in the last
3 years since I've quit smoking- at least not that I can tell. I'm
aware of the possibility that I've been this way for many many years,
but didn't realize it until the quitting smoking 'flareup' made me
notice it, and this 'flareup' has since gradually faded down to my
usual level of obstruction.

When I used to smoke, I noticed that if I took in a deep breath and
filled my lungs to capacity it would 'tickle' in the tops of them and
make me cough. On days where my shortness of breath is worst, this is
also the case. Today is one of those days. I don't if it's the heat
or humidity or pollen or which. The inhaler isn't quite as effective
as other days.

So the difference is more day-to-day, and if there are certain
'triggers' that set it off, I haven't really found them yet. The
classic asthma triggers like cigarette smoke, stinky perfume, car
exhaust etc don't seem have have much effect on me. Sometimes it will
clog my nose up (the sinus allergies) but it doesn't seem to affect my
lungs.

I'll still note that I'm not coughing anything up. Ever. Not at all
like when I used to smoke and I would get sick (fever, chills,
achiness, coughing up tons of thick green phlegm. Everything would go
away but the cough and phlegm, which would require antibiotics).

> I would say that you either have plain and simple asthma and it is worsening
> despite being off of cigarettes for some reason (your dramatic response to
[quoted text clipped - 7 lines]
> over short times (like a year or two) so if your general doc isn't stopping
> it you should be seen by a specialist.

A few questions-

1) If this were actually something like Emphysema, the before/after PFT
wouldn't show a very large response to bronchiodilators, right?

2) Can inhaled bronchiodilators (levabuterol tartarate in my case) make
a person more prone to coughing (even if it improves air passage)

3) Can a person develop a 'tolerance' to bronchiodilators?

4) Is it difficult to make a specific diagnosis between the 3 (asthma,
chronic bronchitis, emphysema), especially in the early stages? How
about for mycoplasma?

Finally, I'd like to thank you for your responses. My own research
about lung disease since I had quit smoking led *me* to believe it was
asthma, and not necessarily related to smoking (or even exacerbated by
it), just coincidental. However, I'm not a doctor ;)

I like my doctor, and AFAICT he seems quite knowledgeable and competent
(and is a really nice guy too) but your suggestions seem more in line
with the conclusion I came up with. Doesn't mean we're right though-
there's always the difference between what i'm telling you over the
internet vs. what you would conclude if you could do an actual hands-on
examination. Just the facts.

There's a lot of stuff that I left out, i.e. that there were some
cardio tests involved too -turns out i have borderline hypertension as
well. It's not enough to treat or worry about right now, but something
to monitor as I get older. Hypertension doesn't surprise me, given my
family history. He also ordered a 'cholesterol index' test, I believe,
which came back stating my cholesterol levels are pretty normal. Chest
X-ray looked fine. Congestive Heart Failure was ruled out. I suppose I
should have specified in the original post that the doc says it's
"beginning stages" of chronic bronchitis.

I suppose there is no harm in me seeing a different doctor for a second
opinion, but that's not something i've ever done before. I don't know
if doctors get offended when you do that or not ;-)

Thanks again for your attention.

-phaeton

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00doc - 20 Jul 2006 01:04 GMT

>> The problem I have with your case is that you are younger than we usually
>> see chronic changes/emphysema/COPD and do not have an incredibly intense
[quoted text clipped - 3 lines]
> childhood to that- both parents smoked (my dad quit when I was 9 or so,
> my mom still does).

I wouldn't say so. That is average smoking for a relatively short period of
time. It is unusual to see non-asthmatic COPD/emphysema in someone under the
age of 40 or 50. To have it at age 32 I would think you would need more like
a 3 ppd (pack per day) exposure or an unusual sensitivity.

> As an aside, my doc notes that in lung disease statistics, there's a
> huge difference between people who don't smoke, and people who smoke a
> little bit, such as 3 cigarettes a day. But then there is only a very
> slight difference between those who smoke 3 cigarettes a day and 3
> packs a day. I.e. it only takes a small amount of smoking to do
> maximum damage to your lungs. What are your thoughts on this?

Apparently I've seen different statistics. We commonly express cigarette
exposure in "pack years" (ppd x yrs smoked). You have 15 py of smoking. Most
COPD'ers have more like 40-100. If your doc's opinion was the generally held
opinion we would just talk of years smoked and not ask about howmany ppd.

> A few questions-
>
> 1) If this were actually something like Emphysema, the before/after PFT
> wouldn't show a very large response to bronchiodilators, right?

Correct - COPD/emphysema is not from reversible bronchoconstriction
(technically that is - there usually is some reversibility in practice).
COPD will the same pattern of reduced airflow (primarily the medium sized
airways) as asthma but not reverse much with bronchodilators.

> 2) Can inhaled bronchiodilators (levabuterol tartarate in my case) make
> a person more prone to coughing (even if it improves air passage)

Sometimes it does.

> 3) Can a person develop a 'tolerance' to bronchiodilators?

If they are used constantly - yes. With constant exposure the body
"downregulates" the receptors (puts fewer of them on the cell surface). We
think this is why standing dose (every 6 hours) albuterol and possibly
Serevent increases asthma deaths. Steroids help to reduce this effect by
promoting "up regulation" of the receptors.

> 4) Is it difficult to make a specific diagnosis between the 3 (asthma,
> chronic bronchitis, emphysema), especially in the early stages? How
> about for mycoplasma?

The symptoms of asthma and COPD can be very similar and sometimes people
with COPD do have a fair response to inhalers. Since severe asthma often
doesn;t respond completely either it can be very difficult to tell the
difference between the two. Reverisbility on PFT testing is one clue that it
is asthma and evidence of lung tissue destruction on chest x-ray or CT is a
clue that it is COPD. Also, as I said before, usually COPD requires a high
smoking exposure or some other predisposing factor.

> Finally, I'd like to thank you for your responses. My own research
> about lung disease since I had quit smoking led *me* to believe it was
> asthma, and not necessarily related to smoking (or even exacerbated by
> it), just coincidental. However, I'm not a doctor ;)

You're welcome.

> I like my doctor, and AFAICT he seems quite knowledgeable and competent
> (and is a really nice guy too) but your suggestions seem more in line
> with the conclusion I came up with. Doesn't mean we're right though-
> there's always the difference between what i'm telling you over the
> internet vs. what you would conclude if you could do an actual hands-on
> examination. Just the facts.

That's true.

I would say that I compressed things a bit for brevity. In real life I would
take a step-wise approach and not do all the things I suggested at once.

> I suppose I
> should have specified in the original post that the doc says it's
> "beginning stages" of chronic bronchitis.

I think one of the problems here is that "chronic bronchitis" is often
loosely used and means different tings to different people. If you stick to
the strict definition of chronic bronchitis it is not an early type of
thing. It occurs late in the course of COPD and requires substantial lung
damamge.

> I suppose there is no harm in me seeing a different doctor for a second
> opinion, but that's not something i've ever done before. I don't know
> if doctors get offended when you do that or not ;-)

Some do and some don't. Usually if I am not making the person better I want
them to see someone else.

--
00doc

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phaeton - 21 Jul 2006 18:35 GMT

Thanks again for the replies.

I guess that while I'm prodding you, I should ask another opinion...

The Xopenex was working great for about the first 3 days of having it,
but i started to develop the cough (as previously mentioned). Lung
irritation increased until it got to where i had a feeling of
congestion in my chest all the time (like when I had acute bacterial
bronchitis, but without the coughing up crap), and the Xopenex wasn't
helping at all. Essentially, it started making me feel *worse*, and it
was harder to breathe than normal, instead of easier.

I called the doc's office and explained this, and they suggested I stop
for a couple of days, which I did. This feeling went away in 48 hours
or so.

Now they suggest to restart usage of it (only when necessary, though)
and see if it continues to get worse. He says that sometimes when
people start using a bronchiodialator it will open their lungs up, the
lungs will start clearing out crap that it originally couldn't do, and
it's normal for it to make you feel worse at first, but after some time
this will improve until it works as described. It just takes some
"getting used to".

What are your thoughts on this? Sound normal?

thanks.

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00doc - 22 Jul 2006 01:50 GMT

> He says that sometimes when
> people start using a bronchiodialator it will open their lungs up, the
[quoted text clipped - 4 lines]
>
> What are your thoughts on this? Sound normal?

Sometimes nebs do get people to start mobilizing secretion that they were
not able to mobilize before. Many older peds ward nurses celebrate when the
asthmatic child throws up because they think it is a step in the right
direction.

On the other hand it could be that something in the Xopenex was making you
worse.

Only one way to find out.

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00doc

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phaeton - 24 Jul 2006 17:20 GMT

> Sometimes nebs do get people to start mobilizing secretion that they were
> not able to mobilize before. Many older peds ward nurses celebrate when the
[quoted text clipped - 8 lines]
> --
> 00doc

Thanks again for you time and attention.

I haven't needed my inhaler as much lately (maybe less humidity these
last few days? have made it easier to breathe?). The few times that I
have used it haven't seemed to affect me as negatively as before. I
don't cough anywhere near as much, and I don't get the 'usual' amount
of tightness in the chest or feeling like i'm trying to breathe
underwater.

Although the effect *is* cumulative, so I don't know that this really
proves anything. I've considered hitting it as often as I was doing
before (3-4 times a day) to see if it crops up the same way, but that's
probably not so good an idea.

-phaeton

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