Bronchitis
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Bronchitis

(Upper Respiratory Tract Infection; Lower Respiratory Tract Infection)

En Español (Spanish Version)

Definition

Bronchitis is inflammation of the air passages (bronchi) of the lungs. It can make breathing difficult and sometimes painful.

Bronchi of Lungs

lungs and bronchioles

© 2008 Nucleus Medical Art, Inc.

  • Acute bronchitis—is a sudden onset of symptoms. It only lasts a short time. There is full recovery of lung function.
  • Chronic bronchitis —involves long-term inflammation, obstruction, and erosion of the bronchi. It is often the result of many years of cigarette smoking . This is a serious medical condition, also called chronic obstructive pulmonary disease (COPD) .
  • Asthmatic bronchitis—sporadic inflammation in people with asthma . It is most common with allergies or environmental irritants.
  • Irritative bronchitis—also called industrial or environmental bronchitis. This is due to chronic contact with items like acids, ammonia, chlorine, minerals, or vegetable dusts.

Causes

The inflammation may be caused by:

  • Bacterial and viral infections
  • Smoking (cigarettes or marijuana)
  • Inhalation of certain respiratory irritants (eg, chemical pollutants or dust), particularly in an occupational setting

Risk Factors

Risk factors increase your chance of developing a disease or condition.

Risk factors for bronchitis include:

  • Smoking
  • Exposure to second-hand smoke
  • Contact with a person infected with bronchitis
  • Viral upper respiratory tract infection ( cold or flu )
  • Asthma
  • Chronic sinusitis
  • Occupational exposures to respiratory inhalants
  • Smog, in susceptible individuals
  • Enlarged tonsils and/or adenoids
  • Malnutrition

Symptoms

Symptoms depend on the type of bronchitis.

Acute Bronchitis

  • Runny nose
  • Malaise
  • Slight fever
  • Back and muscle pain
  • Sore throat
  • Cough, initially dry, then produces mucus that may be thick, yellow, green, blood-streaked
  • Wheezing

Chronic Bronchitis

  • Cough that brings up yellow-green mucus, often worse in the morning
  • Difficulty breathing
  • Bluish tint to lips and skin (in severe cases)
  • Swelling of the feet (in end-stage cases)

Bronchi and Air Sacs of Lungs

© 2008 Nucleus Medical Art, Inc.

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done.

Acute Bronchitis

Tests for acute bronchitis are rare. The following may be recommended for severe or questionable cases:

  • Blood test
  • Chest x-rays —to rule out pneumonia , a complication of bronchitis
  • Pulse oximetry—to measure the amount of oxygen in the blood
  • Bronchoscopy with culture of the sputum

Chronic Bronchitis

Tests for chronic bronchitis may include:

  • Blood test
  • Chest x-rays
  • Pulmonary function tests or spirometry—to evaluate lung function
  • Sputum culture
  • Arterial blood gas—to test for levels of oxygen, carbon dioxide, and acid in the blood
  • Pulse oximetry
  • Bronchoscopy with culture of obtained sputum

Treatment

Acute Bronchitis

Treatment is aimed at relieving the symptoms. It includes:

  • Aspirin or acetaminophen to treat pain and fever
  • Expectorants or cough suppressants
  • Increased fluid intake
  • Cool mist humidification

Antibiotics will not be helpful if the infection is viral.

Questions have been raised about the safety of over-the-counter cough and cold products in children, especially those under two years of age. Some instances of serious harm associated with these products appear to be the result of not following directions regarding dosage or combining preparations with the same active ingredients. Given these concerns, it is best to avoid these products, especially in young children, unless advised otherwise by a doctor.

Chronic Bronchitis

Treatment is based on:

  • Age
  • Overall health
  • Extent of the disease
  • Past response to treatments

Treatment may include:

  • Oral antibiotics and bronchodilators, particularly clarithromycin
    • If you have chronic bronchitis and mild-to-moderate COPD, you may not need antibiotics. If you do need them, a study found that shorter antibiotic treatment (five days or less) is as effective as longer treatment (more than five days).
  • Bronchodilators
  • Oral or intravenous corticosteroid medications
  • Inhaled bronchodilators or corticosteroids
  • Expectorants to loosen secretions
  • Mucolytics
  • Supplemental oxygen
  • Cool mist humidification
  • Lung reduction surgery —removal of the most damaged part of the lungs (in severe cases)
  • Lung transplant (in end-stage cases)

Prevention

To reduce your chance of getting bronchitis:

  • Stop smoking or never start.
  • Avoid passive smoke.
  • Avoid exposure to respiratory irritants.
  • Avoid contact with people who have bronchitis.

RESOURCES:

American Lung Association
http://www.lungusa.org/

Familydoctor.org
http://familydoctor.org/

CANADIAN RESOURCES:

Canadian Family Physician
http://www.cfpc.ca/

The Canadian Lung Association
http://www.lung.ca/

References:

Bishai WR. Macrolide immunomodulatory effects and symptom resolution in acute exacerbation of chronic bronchitis and acute maxillary sinusitis: a focus on clarithromycin. Expert Rev Anti Infect Ther. 2006;4:405-416.

Harrison TR, Fauci AS. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill;1998.

Poole PJ, Black, PN. Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2006;3.

What is COPD. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_WhatIs.html . Accessed July 7, 2008.

* 1 6/4/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Nonprescription cough and cold medicine use in children. Medwatch: 2007 Safety Alerts for Drugs, Biologics, Medical Devices, and Dietary Supplements. US Food and Drug Administration website. Available at: http://www.fda.gov/medwatch/safety/2007/safety07.htm#Cough . Accessed: September 4, 2007.

* 2 6/4/2008 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : El Moussaoui R, Roede BM, Speelman P, Bresser P, Prins JM, Bossuyt PM. Abstract Short-course antibiotic treatment in acute exacerbations of chronic bronchitis and COPD: a meta-analysis of double-blind studies. Thorax. 2008;63:415-422. Epub 2008 Jan 30. Review.



Last reviewed December 2007 by Jill Landis, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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