Bronchitis | Cedars-Sinai

ABOUT

DIAGNOSIS

TREATMENT

Overview

The bronchi are the two main airways that branch down from the trachea (the airway that starts in the back of the throat and goes into the chest). When the parts of the walls of the bronchi become swollen and tender (inflamed), the condition is called bronchitis. The inflammation causes more mucus to be produced, which narrows the airway and makes breathing more difficult.

There are several types of bronchitis:

• Acute bronchitis can last for up to 90 days
• Chronic bronchitis can last for months or sometimes years. If chronic bronchitis decreases the amount of air flowing to the lungs, it is considered to be a sign of chronic obstructive pulmonary disease.
• Infectious bronchitis usually occurs in the winter due to viruses, including the influenza virus. Even after a viral infection has passed, the irritation of the bronchi can continue to cause symptoms. Infectious bronchitis can also be due to bacteria, especially if it follows an upper respiratory viral infection. It is possible to have viral and bacterial bronchitis at the same time.
• Irritative bronchitis (or industrial or environmental bronchitis) is caused by exposure to mineral or vegetable dusts or fumes from strong acids, ammonia, some organic solvents, chlorine, hydrogen sulfide, sulfur dioxide and bromine

Symptoms

Symptoms will vary somewhat depending on the underlying cause of the bronchitis. When the bronchitis is due to an infection the symptoms may include:

• A slight fever of 100 to 101°F with severe bronchitis. The fever may rise to 101 to 102°F and last three to five days even after antibiotics are started.
• A runny nose
• Aches in the back and muscles
• Chills
• Coughing that starts out dry is often the first sign of acute bronchitis. Small amounts of white mucus may be coughed up if the bronchitis is viral. If the color of the mucus changes to green or yellow, it may be a sign that a bacterial infection has also set in. The cough is usually the last symptom to clear up and may last for weeks.
• Feeling tired
• Shortness of breath that can be triggered by inhaling cold, outdoor air or smelling strong odors. This happens because the inflamed bronchi may narrow for short periods of time, cutting down the amount of air that enters the lungs. Wheezing, especially after coughing, is common.
• Sore throat

Bronchitis does not usually lead to serious complications (e.g., acute respiratory failure or pneumonia) unless the patient has a chronic lung disease, such as chronic obstructive pulmonary disease or asthma.

Causes and Risk Factors

An infection or irritating substances, gases or particles in the air can cause acute bronchitis. Smokers and people with chronic lung disease are more prone to repeated attacks of acute bronchitis. This is because the mucus in their airways doesn’t drain well. Others at risk of getting acute bronchitis repeatedly are people with chronic sinus infections or allergies; children with enlarged tonsils and adenoids; and people who don’t eat properly.

Diagnosis

To diagnose bronchitis, a physician performs a physical examination, listens for wheezing with a stethoscope and evaluates symptoms – making sure they are not due to pneumonia. A sample of sputum from a cough may be examined because its color – clear or white versus yellow or green – may suggest whether the bronchitis is due to a viral infection or a bacterial infection, respectively. A chest X-ray may be needed to rule out pneumonia, and if the cough lasts more than two months, a chest X-ray may be done to rule out another lung disease, such as lung cancer.

Treatment

Depending on the symptoms and cause of the bronchitis, treatment options include:

• Antibiotics may be ordered to treat acute bronchitis that appears to be caused by a bacterial infection or for people who have other lung diseases that put them at a greater risk of lung infections
• Bronchodilators, which open up the bronchi, may be used on a short-term basis to open airways and reduce wheezing
• Cool-mist humidifiers or steam vaporizers can be helpful for wheezing or shortness of breath. Leaning over a bathroom sink full of hot water with a towel loosely draped over the head can also be help open the airways.
• Corticosteroids given in an inhaler are sometimes prescribed to help the cough go away, reduce inflammation and make the airways less reactive. They are most often given when the cough remains after the infection is no longer present.
• Cough medicines should be used carefully. While they can be helpful to suppress a dry, bothersome cough, they should not be used to suppress a cough that produces a lot of sputum. When the cough is wet, expectorants can help thin the secretions and make them easier to cough up. When a lot of mucus is present, coughing is important to clear the lungs of fluid.
• For viral bronchitis, antibiotics will not be effective. If influenza causes the bronchitis, treatment with antiviral drugs may be helpful.
• Over-the-counter pain relievers, such as aspirin, acetaminophen or ibuprofen, can be used for pain relief and fever reduction. Children with bronchitis should not be given aspirin; instead they should take acetaminophen or ibuprofen.
• Plenty of fluids – enough to keep the urine pale (except for the first urination of the day, when it is usually darker)
• Rest, especially if a fever is present

© 2000-2022 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

When To Take It Seriously

Pharmacists can debunk the myths and provide the facts about treatment for bronchitis.

Pharmacists can debunk the myths and provide the facts about treatment for bronchitis

Bronchitis is a condition that develops due to the swelling (from irritation or infection) of your lungs’ airways, known as bronchi. This swelling makes breathing very difficult due to the narrowing and irritation of the airways. Mucus buildup and coughing are also common with bronchitis.

Although the symptoms may be similar, there are 2 very distinct forms of bronchitis: acute and chronic. Each one has different causes and treatments.

Acute Bronchitis

Acute bronchitis (sometimes called a “chest cold”) is temporary and is usually caused by a virus. Acute bronchitis is not common with bacterial infections.

The classic symptom of acute bronchitis is a persistent, nagging cough that could last for several weeks. It is also common for thick mucus to be coughed up that may be discolored (normally mucus is clear). Other symptoms to watch out for are fever, tiredness, runny nose, chest congestion, chills, wheezing sounds when breathing, shortness of breath, and sore throat.

This illness is usually selftreatable and self-limited, which means it will run its course over time. Treatment involves relieving your symptoms. Because this illness is usually caused by a virus, antibiotics are not useful, because they only treat infections caused by bacteria.

Over-the-counter medications can be used to treat your symptoms. Acetaminophen lowers fever. You can use cough suppressants (eg, dextromethorphan) if you have a dry, hacking cough that does not produce any mucus, especially if your cough interferes with your sleep. Expectorants (eg, guaifenesin) can help you cough up mucus in your airways. Drinking plenty of water also helps by thinning mucus, making it easier to clear. Contact your doctor if you experience any of these symptoms, so that other illnesses, such as asthma or pneumonia, can be ruled out:

• You have a fever (>100.4°F) that does not decrease within 1 week
• You have chest pain with significant shortness of breath
• Your coughing and wheezing continues longer than 1 month
• You cough up blood
• You experience significant weakness that does not improve

Remember to always consult your doctor when treating children younger than 2 years, because it is best to avoid overthe-counter cough and cold medication in young children without specific guidance.

Chronic Bronchitis

Chronic bronchitis is defined as a nagging cough that is present for 3 months out of the year for 2 consecutive years. It is part of a more serious breathing disorder called chronic obstructive pulmonary disease. Chronic bronchitis is a constant irritation of the airways that has caused permanent damage to the lungs over time.

Smoking is the most common cause of chronic bronchitis because of the permanent damage it can do to your lungs. Other causes include repeated infections or exposure to pollutants.

Chronic bronchitis is not reversible. The goal of treatment is to improve quality of life and prevent complications. Therapy is targeted at opening your airways and reducing swelling to make breathing easier and slow down the progression of the disease.

Inhaled bronchodilators and corticosteroids are the types of drugs most often used to manage chronic bronchitis. Bronchodilators open up your airways to allow more air to pass through. Corticosteroids reduce airway swelling. These medications require a prescription and need to be monitored so you are receive the best dose with the fewest side effects.

In severe cases, treatment with additional oxygen or even surgery may be required. At worst, a complete lung transplant may be necessary.

Final Thought

Both acute and chronic bronchitis must be taken seriously. If you have any questions or concerns, contact your doctor or pharmacist for more information.

RELATED

• Approach Respiratory Illnesses Rationally
• Pneumonia Prevention Is Possible

Mr. Fox is a PharmD candidate at Raabe College of Pharmacy, Ohio Northern University. Dr. Prescott is senior vice president of clinical and scientific affairs for Pharmacy Times.

Bronchitis

Bronchitis is an inflammation of the lower respiratory tract (bronchi), which carries air into the lungs. Inflammation causes swelling, narrowing of the lumen of the bronchi, increased sputum formation.

Distinguish between acute bronchitis and chronic obstructive pulmonary disease (COPD). They have a different mechanism of development, a different course, which requires, accordingly, a different approach to treatment.

Acute bronchitis is very common and is most often caused by viruses, rarely by bacteria, and even less often by fungal infection or toxins. The prognosis for acute bronchitis is favorable – almost all cases end in complete recovery. The illness usually lasts for about 10 days, although a person can cough for several more weeks.

COPD damages not only the bronchi, but also lung tissue. Pathological changes develop for a long time, are irreversible, significantly disrupt breathing and, as a result, the work of the whole organism. The main cause of COPD is smoking. The prognosis for COPD is generally unfavorable, but modern methods of treatment can alleviate the condition of patients with COPD.

Synonyms Russian

Acute bronchitis, chronic bronchitis, chronic obstructive pulmonary disease, COPD, bronchiolitis, chronic lung disease, chronic obstructive pulmonary disease, COPD, chronic nonspecific lung disease

Synonyms English

Chronic bronchitis, bronchiolitis, chronic airway inflammation, COPD, chronic obstructive pulmonary disease, chronic bronchitis, chronic obstructive airway disease, COAD, chronic obstructive lung disease, COLD, acute bronchitis, chest cold.

Symptoms

The main symptoms of acute bronchitis and COPD are:

• cough,
• shortness of breath,
• chest tightness.

Acute bronchitis often occurs after SARS or influenza, so it may be accompanied by fever, weakness, malaise and other non-specific signs of infection. Cough in acute bronchitis lasts from 10 days to several weeks, in COPD – for 3 months a year for at least 2 years.

General information about the disease

The bronchi are breathing tubes through which air enters the lungs, while being moistened, cleansed and warmed. Their wall consists of several layers and contains cartilaginous rings, muscle fibers. From the inside, the bronchi are lined with a membrane covered with a layer of mucus, which is produced by goblet cells. Cleansing of the bronchi occurs due to the movement of the processes of the ciliated cells of the mucous membrane. After passing through the bronchi, the air enters the alveoli – the structural elements of the lung tissue, where gas exchange occurs.

In acute bronchitis, the bronchi are damaged by microbes and toxins, the cells of the mucous membrane are destroyed, as a result, the movement of cilia is disturbed, goblet cells and bronchial glands secrete a very large amount of mucus that stagnates, the lumen of the bronchi decreases, small bronchi can become blocked. The mucous membrane swells, becomes inflamed. All this leads to coughing, difficulty breathing. In acute bronchitis, these processes, as a rule, undergo a reverse change within three weeks.

The main cause of COPD is smoking, less often long-term exposure to dust containing cadmium, lead, silicon, organic dust, ammonia fumes, chlorine, hydrogen sulfide, phosgene and other toxic substances. In COPD, the symptoms of the disease occur already with significant structural changes in the lungs. Unlike acute bronchitis, not only the bronchi are damaged, but also the alveoli – their walls become thinner, collapse, become less elastic. The walls of the bronchioles are compressed, the walls of the bronchi thicken, deform, and airway obstruction occurs. COPD can lead to severe pulmonary and cardiovascular complications and is one of the leading causes of death worldwide.

Who is at risk?

• Smokers.
• Elderly people.
• Children.
• People who are immunosuppressed due to another acute or chronic illness.
• Those who often come into contact with chemicals and toxins at work (chemists, metallurgists, railway workers, miners).

Diagnosis

The diagnosis of bronchitis is based on the presence of relevant symptoms, medical examination, and the results of diagnostic procedures.

Laboratory diagnostics

• Complete blood count (without leukocyte formula and ESR) with leukocyte formula. In acute bronchitis, the number of leukocytes can be increased, mainly due to neutrophils. With COPD, there are usually no changes in the complete blood count.
• ESR – erythrocyte sedimentation rate. In acute bronchitis, it can be increased.
• C-reactive protein. May be elevated in acute bronchitis.
• General sputum analysis. Sputum examination is necessary to exclude a number of lung diseases: cancer, tuberculosis, pneumonia, etc.

Other research methods

• Chest X-ray. Used to rule out other lung conditions that can cause coughing, or complications of bronchitis such as pneumonia. In uncomplicated bronchitis, there are usually no changes on the radiograph. In COPD, the bronchi can become deformed.
• Bronchoscopy. It is carried out to examine the mucous membrane for the presence of deformations. To do this, use a special device – a bronchoscope. It consists of a flexible rod equipped with a video camera, a light and a manipulator for taking a sample of bronchial tissue, and allows direct examination of the bronchi.
• Spirometry. During the study, the patient takes a deep breath, and then quickly exhales into a special device – a spirometer. This test is done to look for signs of asthma or emphysema, in which there are signs of air retention in the lungs.

Treatment

Treatment of bronchitis depends on the cause that caused it, the type of bronchitis, the severity of the patient’s condition.

Acute bronchitis requires bed rest, plenty of warm drink, air humidification in the apartment. As a rule, it is successfully treated at home. Hospitalization is required only in severe cases or for young children. For the treatment of acute bronchitis, antibiotics are used (in the case of a bacterial nature of bronchitis), mucolytics (drugs that thin sputum), in some cases, antitussive drugs and bronchodilators (drugs that expand the lumen of the bronchi).

Treatment for COPD does not lead to a complete restoration of the patency and structure of the lungs – this disease is steadily progressing, despite therapy. However, it helps to reduce the main manifestations of the disease, slow down its development and allows the patient to lead a more active lifestyle.

COPD can be treated with glucocorticosteroids, oxygen therapy, possibly surgical treatment.