Transcription:
Bronchitis, Chronic Cough or COVID-19 Symptoms?

Joey Wahler (Host): Well, a severe cough can be just one common symptom of COVID-19, but many people already suffer from bronchitis or chronic cough. So, how do you know if your symptoms are from bronchitis, a chronic cough or COVID? This is Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest. This podcast is sponsored by UM Capital Region Health. I'm Joey Wahler. Our guest, Dr. Ed Pickering, Interventional Pulmonologist at UM Capital Region Health and Associate Professor of Medicine at the University of Maryland School of Medicine.

Dr. Pickering, thanks so much for joining us.

Ed Pickering, MD (Guest): Thank you very much for having me. It's a pleasure.

Host: Same here. So we'll discuss where COVID fits in here in just a moment. But first, since sometimes the terms are used kind of interchangeably, what is the basic difference between bronchitis and a chronic cough?

Ed Pickering, MD (Guest): So that is a great question cause right, they're sometimes used interchangeably. So I think it's important to set up definitions. To make it simple, bronchitis is just the term delineating inflammation of the airways. And it can be either acute or chronic. Many people are familiar with acute bronchitis where they often have an inciting viral infection, where they get, you know, a runny nose, sore throat, maybe a headache and generally that's self-limited. Now, when it comes to chronic bronchitis, this is actually as a medical definition where you have a chronic productive cough, meaning you're bringing up sputum or mucus, and you have that for at least three months of the year for at least two years in a row. That's how you define chronic bronchitis.

Those patients have long-term inflammation of the bronchi or airways and it commonly affects smokers. So, these people with the chronic bronchitis will oftentimes have a cough, but most people that have a chronic cough don't actually have chronic bronchitis. And we can go over the most common causes of a chronic cough if that is helpful.

Host: Sure why not. Go right ahead.

Dr. Pickering: So when you're talking about the most common causes of chronic cough, you're talking about upper airway cough syndrome, also known as post-nasal drip or sinusitis, where you have inflammation of the lining of kind of your upper airways. So, that's one of the most common causes. The other most common cause would be cough due to asthma or cough variant asthma.

And then the third would be what people would term as acid reflux or heartburn or the medical term GERD. Those are really going to be the most common causes of chronic cough. One other important thing to remember is for people that have high blood pressure or hypertension, they're often on a medication called an ACE inhibitor or angiotensin converting enzyme inhibitor and a common side effect of that medication is cough.

Host: So having said that, what treatment options are available for those with bronchitis or chronic cough?

Dr. Pickering: Right. And that's a very good question and that's kind of a laundry list because it's really important to differentiate and actually try and find out the cause or etiology, that we'd talk about. So I'll try and kind of take that a little bit stepwise. So, let's talk about the upper airway cough syndrome or, the post-nasal drip, rhinitis, which is again, the runny nose, things like that, where oftentimes you get sneezing, runny nose and congestion. So treatments for that oftentimes are intra-nasal or inside the nose, steroids, people are probably familiar with those. They've used steroid drops that they inhale, other medications such as oral anti-histamines, which help treat allergy type phenomenon. Those are frequently helpful. And then in more rare instances where again, the inflammation of the lining of the sinuses or sinusitis, if that becomes chronic and is not due to infection, sometimes a referral to an ENT specialist or an ear, nose and throat doctor can be helpful to address that.

In patients where the cough is due to asthma, the treatment focuses on inhaled steroids as well as, as needed, short acting medications called bronchodilators, which can help open up some of the smaller airways. Other treatments include oral medications that reduce the body's kind of inflammatory response, that can help reduce the cough severity. And in rare cases where the cough is really, really debilitating for people where you just can't break that cycle, a short course of steroids that you actually take and ingest and go throughout the body for a week or two can help break this.

Now, moving on to GERD, also known as acid reflux, also known as, heartburn, just to keep it simple for people. The treatment's often focused on lifestyle modifications. Things as weight loss, elevating the head of one's bed when you sleep, not eating later in the day, reducing fatty meals, alcohol, caffeine, chocolates, but these are often used in conjunction or in combination with medications that also suppress the production of acid by the stomach.

And these are called PPIs or proton pump inhibitors. And I think many people are familiar with those, over the counter, you can get them over the counter, you can get them as prescription. And I think it's important, talking about all three of these, again, as the most common causes that it can take a month or two for you to actually develop maximum relief, especially when you're talking about the treatment for acid reflux.

So, those are kind of, some of the treatments available for the typical common causes of chronic cough. Now transitioning to chronic bronchitis, which I think was the other part of your question again, treatment is aimed at both the cause and the symptoms, right? And most people with chronic bronchitis, they're current smokers. And so the most important action you can take is to stop smoking and reduce exposure to secondhand smoke and other irritants that can affect the lining of the lungs. Often people with chronic bronchitis also have significant mucus, as we talked about. They're going to have a productive cough where they bring up mucus and sputum at least three months out of the year for more than two years in a row and frequently that's significant amounts of mucus.

And they can sometimes have difficulty bringing that up or coughing it out where they feel like there's something gets stuck in their throat. So, medications often over the counter to thin the secretions can be helpful. And in addition, those with chronic bronchitis also have an aspect of chronic obstructive pulmonary disease, COPD, emphysema and I think many people are familiar with. So treatment using inhaled steroids to decrease the airway inflammation, as well as using other medications to open the airways are frequently used. And then in people that meet criteria such as they have low oxygen levels in this setting, oxygen therapy is helpful.

And then also pulmonary rehabilitation, which is kind of an education and exercise program for people with lung disease is also quite helpful in the treatments. So I know that was a long answer but I hope it kind of gives the spectrum when you're talking about differences of chronic cough and chronic bronchitis.

Host: Absolutely. It does indeed. So, moving on now to what we alluded to a little bit at the top, COVID-19 symptoms, as we said, include cough, of course, as well as shortness of breath or difficulty breathing for some. So, how do the experts like you doc make that distinction between COVID and the chronic conditions you were just discussing?

Dr. Pickering: It is really, really hard. Right? So, in the initial waves of the pandemic, right? Many people with COVID-19 had profound fever, they had fatigue. They had muscle aches also known as myalgias, you know, loss of taste, loss of smell.

So, those aren't really typical hallmarks of acute bronchitis or bronchitis, and maybe more suggestive of COVID-19. However, those may be the ones that people associate, but there's numerous studies in a report that illustrates the overlap of symptoms of COVID-19 to those of other respiratory viral illnesses, the adenovirus, the flu, the common coronaviruses that circulate before COVID-19.

And in fact recently with the new Omicron variant, there is data suggesting, and I want to be clear, it's still kind of early in, getting that information, mild upper respiratory symptoms. Again, that's sore throat, maybe a little bit of headache, runny nose, where it's acting more as a common coronavirus, those symptoms seem to be more associated with the Omicron. And so it is very difficult to delineate or differentiate based on those symptoms from COVID-19 to something else. So, it's kind of a quandary for us. And despite seeing it a lot, I think it's really hard to say based on that symptom it's going to be COVID-19 and based on that symptom it's going to be something else.

So, I think one is really important to pay attention to somebody's baseline symptoms. Right. Do you have chronic bronchitis? What is your daily sputum production? What is your daily shortness of breath. Has it gotten worse? And if you do start to have these symptoms, really the only good way to really differentiate the cause is to go and get tested. And a lot of the panels that we have nowadays, they test both for COVID and they also test for the other viral illnesses. So, I really think the best way to delineate is actually to get tested. It's really, really hard to do based on symptoms alone.

Host: Gotcha. Now, in addition to getting tested, on a day-to-day basis, you mentioned Omicron. So let me pick up on that, especially in light of the fact that it's a highly contagious variant, what precautions can someone take on their own, if any, if they have bronchitis or a chronic cough to try and prevent developing more serious, COVID complications?

Dr. Pickering: I think the best precaution as you said, it's very infectious, the best precautions is not to get infected at all. Right. So, this means doing one's best with, I think people are familiar with the term non-pharmacologic interventions, right, which are things like hand washing, wearing your mask. However, the reality is the virus is not going away.

And, some point, if not all, we're going to contract the illness. So, I think the best precaution in addition to the non-pharmacologic is to get vaccinated. That's really been shown to help avoid the serious complications. And those with underlying lung disease, chronic bronchitis, interstitial lung disease, COPD, emphysema, those things, you are at higher risk of having a severe illness. So, I really can't stress enough that vaccination is your best line of defense in preventing the serious complications.

Host: And Doctor, what is it about lung disease, exactly, that it appears to make people more susceptible to developing serious complications from COVID?

Dr. Pickering: Yeah, I don't think we know exactly. There is some thought that those with underlying lung disease have a disruption of their epithelial lining. And to put that simply, that's the cell lining of the lung that creates a barrier and protects the lung from all of the things that you inhale on a daily basis and those cells also have other functions. So, if they have a disruption or that lining is abnormal, it can maybe make individuals more prone to the infection as well as the severity of illness. But I think probably more, importantly, is people with chronic lung disease, it's also the other ones that have other underlying chronic medical conditions, right?

Diabetes, obesity, people with chronic medical conditions, generally, it affects other organs in their body and people with chronic medical conditions, their organs don't function quite the same way as other healthier people. And so when you get an insult like COVID-19, which doesn't just affect the lungs, but it's been shown to go throughout the body, because of the underlying organs don't work quite as well as a younger, healthier person, they are more likely to have worse manifestations of the infection. If that makes sense.

Host: Absolutely. And so in closing here to kind of put a bow on this, we've gotten a lot of great information from you covering all these bases. What's the one main sort of general message you'd like to have people take away from our discussion here?

Dr. Pickering: You know, it goes back to a lot of the things that we've been talking about, good hand hygiene, wear your mask, get vaccinated, make sure to see your physician on a regular basis. Have a shared plan, take the medications that can help, both with the treatment of your symptoms, if you have underlying lung disease as well, as many of these medications help prevent worsening of symptoms. In addition to what I previously mentioned, I think we earlier touched upon that oftentimes respiratory symptoms are non-specific meaning, if you get the flu, it could look like COVID. If you get a regular coronavirus, if you get an adenovirus, these are all part of the upper respiratory viral illnesses; it is very, very hard to differentiate the cause and getting tested if you think you have it is also a really important way of delineating and also knowing do you have the infection so you can quarantine yourself away from people for a period of time to not help spread the virus.

Host: All right. Well, we hope we've provided some valuable information for differentiating between bronchitis, chronic cough and COVID-19. Dr. Ed Pickering of UM Capital Region Health, thanks again.

Dr. Pickering: Thank you very much for your time. Appreciate it.

Host: And this episode is sponsored by UM Capital Region Health, the largest healthcare provider in Prince George's County, dedicated to enhancing the health and wellness of the community by providing high quality accessible patient care. UM Capital Region Health, changing up healthcare in Prince George's County. You can find more shows just like this one at umms.org/podcast.

If you found this podcast helpful, please do share it on your social media. And thanks for listening to Live Greater, a health and wellness podcast brought to by the University of Maryland Medical System. We look forward to you joining us again. I'm Joey Wahler.