Chronic bronchitis in outpatient practice: unsolved diagnostic problems and therapeutic challenges

Chronic non-obstructive bronchitis (CB) represents an independent clinical condition characterized by high prevalence and a considerable contribution to respiratory morbidity, alongside a significant economic burden. Despite its seemingly benign nature, the management of patients with CB in primary health care is fraught with numerous challenges that require a systematic analysis. Objective of the review. To analyze the primary challenges in diagnosing and treating chronic bronchitis in outpatient settings and to propose strategies to optimize healthcare delivery informed by contemporary national and international guidelines and expert consensus. Materials and methods. A review of publications was conducted using the PubMed, eLibrary, and CyberLeninka databases for the period from 1999 to 2026. The search utilized key terms such as «chronic bronchitis,» «chronic cough,» «outpatient practice,» «underdiagnosis,» «overdiagnosis,» «quality of life,» «economic burden,» «smoking cessation,» «differential diagnosis,» and «rational pharmacotherapy,» including their Russian-language equivalents. Additionally, current clinical guidelines, national protocols, and international consensus documents were reviewed. Results. The prevalence of CB is significantly underestimated; the incidence of productive cough ranges from 10% to 27%, whereas the formal diagnosis is confirmed in only 2.6% to 4.1% of the population. The condition substantially affects the quality of life and is an independent risk factor for chronic obstructive pulmonary disease. The economic implications of CB encompass both direct medical expenses and substantial indirect costs linked to temporary disability and presenteeism. Among the challenges faced in outpatient management of CB are misdiagnosis—including both overdiagnosis and underdiagnosis—insufficient utilization of spirometry, inappropriate antibiotic prescriptions, the neglect of non-pharmacological treatment modalities, a lack of standardized protocols, and various organizational barriers. Conclusion. To enhance outpatient care for chronic bronchitis, it is essential to implement a comprehensive set of measures that include increasing physicians' awareness of differential diagnosis, integrating spirometry into routine clinical practice, developing standardized clinical protocols, promoting active smoking cessation programs, and establishing a framework for ongoing monitoring. Targeted healthcare management strategies are required to mitigate the burden of this condition.