Pulmonology focuses on diagnosing and treating lung and airway conditions such as asthma, COPD, and pneumonia, as well as overall respiratory health.
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The cardinal symptom of chronic bronchitis is the cough. Initially, it may be dismissed as a “smoker’s cough,” a seemingly benign clearing of the throat in the mornings. This cough results from mucostasis, the accumulation of mucus during sleep when ciliary clearance is reduced. As the disease advances, the cough becomes persistent, occurring throughout the day. It is “productive,” meaning it brings up sputum. The characteristics of this sputum are a barometer of the disease state.
Dyspnea, or shortness of breath, is the symptom that most severely impacts quality of life. In the early stages, it is exertional, occurring only during strenuous activity, such as climbing stairs or carrying groceries. Patients often unconsciously adapt by reducing their activity levels (“I just don’t walk as fast as I used to”), masking the progression of the disease. As the airway lumen narrows and lung mechanics worsen, dyspnea occurs with progressively lighter activities, such as walking on level ground, showering, or dressing. In advanced stages, patients experience dyspnea at rest.
Several factors cause this breathlessness:
Patients frequently report wheezing, a high-pitched whistling sound, usually on exhalation. This sound is generated by turbulent airflow through narrowed, oscillating airways. It may be constant or triggered by exertion or lying down. Alongside wheezing, patients often describe “chest tightness,” a sensation of constriction or heaviness distinct from cardiac angina. This sensation correlates with the increased effort of the intercostal muscles working against high resistance. The variability of these symptoms is notable; they can fluctuate from day to day or even hour to hour based on mucus clearance, weather, and environmental exposures.
Chronic bronchitis is a systemic inflammatory disease. The spillover of inflammatory mediators (cytokines such as IL-6 and TNF-alpha) from the lungs into the systemic circulation drives comorbidities.
Cigarette smoking is the single most dominant risk factor, accounting for the vast majority of cases in developed nations. The relationship is dose-dependent: the more pack-years (packs per day × years smoked), the greater the risk and severity.
In non-smokers, environmental exposures are the primary drivers.
Not all smokers develop COPD, highlighting the role of genetic susceptibility.
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When you exercise, you breathe faster, and because your airways are narrowed and don’t empty quickly enough, air gets trapped in your lungs (dynamic hyperinflation), making it impossible to take a deep breath.
Yes, stress causes anxiety, which changes your breathing pattern to rapid, shallow breathing; this inefficient breathing worsens air trapping and the sensation of breathlessness.
A full stomach can press on the diaphragm, limiting lung expansion; in addition, many people with chronic bronchitis have silent acid reflux that irritates the airways after meals.
Absolutely; cold, dry air can trigger airway spasms, while hot, humid air can feel “heavy” and hard to breathe; high pollen or pollution days also trigger inflammation.
Unintended weight loss is a serious sign; it means the work of breathing is burning so many calories that you are losing muscle mass, which further weakens your breathing muscles.
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