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Inflammation of small bronchi. Bronchial Disorders: Understanding Bronchiolitis, Bronchiectasis, and Related Conditions

by alexxlab

What are the main types of bronchial disorders. How do bronchial disorders affect breathing. What causes inflammation in the bronchial tubes. How are bronchial disorders diagnosed and treated. Can bronchial disorders be prevented or managed effectively.

The Anatomy of Bronchi and Their Role in Respiration

The respiratory system is a complex network of organs and tissues that work together to facilitate breathing. At the heart of this system are the bronchi, which play a crucial role in delivering air to and from the lungs. But what exactly are bronchi, and how do they function?

Bronchi are the main airways that branch off from the trachea (windpipe) and lead into the lungs. These tube-like structures are lined with smooth muscle and mucous glands, which help to filter and humidify the air we breathe. As the bronchi enter the lungs, they divide into smaller and smaller branches called bronchioles, ultimately leading to the alveoli where gas exchange occurs.

The importance of healthy bronchi cannot be overstated. When functioning properly, they:

  • Conduct air efficiently to and from the lungs
  • Filter out harmful particles and pathogens
  • Produce mucus to trap irritants
  • Regulate airflow through smooth muscle contractions

However, various conditions can affect the bronchi, leading to breathing difficulties and other respiratory issues. Understanding these bronchial disorders is essential for maintaining optimal respiratory health.

Bronchitis: The Most Common Bronchial Disorder

Among bronchial disorders, bronchitis stands out as the most prevalent. This condition involves inflammation of the bronchial tubes, which can be either acute or chronic. But what distinguishes these two types of bronchitis?

Acute Bronchitis

Acute bronchitis is a temporary inflammation of the bronchi, typically caused by viral infections. It often develops following a cold or flu and usually resolves within a few weeks. Symptoms include:

  • Persistent cough, often with mucus production
  • Chest discomfort or tightness
  • Fatigue
  • Low-grade fever

Chronic Bronchitis

Chronic bronchitis, on the other hand, is a long-term condition characterized by persistent inflammation and excessive mucus production in the bronchial tubes. It is often associated with smoking and is considered a type of chronic obstructive pulmonary disease (COPD). Symptoms of chronic bronchitis include:

  • Chronic cough with mucus production, lasting at least three months a year for two consecutive years
  • Shortness of breath, especially during physical activities
  • Frequent respiratory infections
  • Wheezing

Treatment for bronchitis varies depending on whether it’s acute or chronic. Acute bronchitis often resolves on its own with rest and symptom management, while chronic bronchitis requires long-term management strategies, including smoking cessation, medications, and pulmonary rehabilitation.

Bronchiectasis: When Airways Become Damaged and Dilated

Bronchiectasis is a condition characterized by permanent enlargement of parts of the airways of the lung. This dilation of the bronchi can lead to a range of respiratory symptoms and complications. But what causes bronchiectasis, and how does it affect lung function?

The primary cause of bronchiectasis is damage to the airways, which can result from various factors:

  • Severe or recurrent respiratory infections
  • Underlying conditions like cystic fibrosis or primary ciliary dyskinesia
  • Autoimmune disorders
  • Chronic inflammation

As the airways become damaged and widened, they lose their ability to clear mucus effectively. This leads to a cycle of infection and inflammation that can further damage the bronchi. Symptoms of bronchiectasis include:

  • Chronic cough with large amounts of mucus
  • Recurrent chest infections
  • Shortness of breath
  • Wheezing
  • Chest pain

Diagnosis of bronchiectasis typically involves imaging studies such as high-resolution CT scans, which can reveal the characteristic widening of the airways. Treatment focuses on managing symptoms, preventing further damage, and addressing underlying causes. This may include:

  • Airway clearance techniques
  • Antibiotics to treat infections
  • Bronchodilators to improve airflow
  • Anti-inflammatory medications
  • In severe cases, surgery may be considered

While bronchiectasis is a chronic condition, proper management can significantly improve quality of life and slow disease progression.

Exercise-Induced Bronchospasm: When Physical Activity Triggers Breathing Difficulties

Exercise-induced bronchospasm (EIB), also known as exercise-induced asthma, is a condition where physical activity triggers a narrowing of the airways. This can lead to breathing difficulties during or after exercise. But why does this happen, and who is at risk?

EIB occurs when the airways react to changes in temperature and humidity during rapid breathing associated with exercise. This reaction causes the smooth muscles around the bronchi to constrict, leading to symptoms such as:

  • Wheezing
  • Shortness of breath
  • Chest tightness
  • Coughing
  • Decreased exercise performance

While EIB can affect anyone, it’s particularly common in people with asthma. However, not all people with asthma experience EIB, and not all individuals with EIB have asthma. Other risk factors include:

  • Participating in cold-weather sports
  • Having allergies or a family history of allergies
  • Exposure to air pollution or other irritants

Diagnosis of EIB typically involves lung function tests before and after exercise. Treatment strategies aim to prevent symptoms and may include:

  • Using short-acting bronchodilators before exercise
  • Proper warm-up and cool-down routines
  • Avoiding exercise in cold, dry air when possible
  • Long-term control medications for those with underlying asthma

With proper management, most people with EIB can continue to enjoy physical activities and maintain an active lifestyle.

Bronchiolitis: Inflammation of the Small Airways

Bronchiolitis is an inflammation of the bronchioles, the smallest airways in the lungs. This condition primarily affects infants and young children, but can occasionally occur in adults. What causes bronchiolitis, and how does it differ from other bronchial disorders?

The most common cause of bronchiolitis is respiratory syncytial virus (RSV), although other viruses can also be responsible. The infection leads to inflammation and mucus buildup in the bronchioles, causing breathing difficulties. Symptoms of bronchiolitis include:

  • Runny nose and congestion
  • Cough
  • Rapid breathing
  • Wheezing
  • Difficulty feeding (in infants)
  • Fever

Bronchiolitis is particularly concerning in young children because their airways are smaller and more easily obstructed. Risk factors for severe bronchiolitis include:

  • Premature birth
  • Underlying heart or lung conditions
  • Weakened immune system
  • Exposure to tobacco smoke

Diagnosis is typically based on symptoms and physical examination. Treatment is generally supportive, focusing on maintaining hydration and oxygen levels. In severe cases, hospitalization may be necessary. While most children recover fully from bronchiolitis, some may have an increased risk of developing asthma later in life.

Bronchopulmonary Dysplasia: A Chronic Lung Condition in Premature Infants

Bronchopulmonary dysplasia (BPD) is a serious lung condition that primarily affects premature infants. It is characterized by abnormal development of lung tissue, leading to breathing difficulties and long-term respiratory complications. But what causes BPD, and how does it impact an infant’s development?

BPD typically develops in premature infants who require prolonged mechanical ventilation and oxygen therapy. The exact cause is multifactorial, involving a combination of:

  • Lung immaturity
  • Inflammation
  • Oxidative stress from oxygen therapy
  • Mechanical injury from ventilation

Symptoms of BPD can vary in severity but often include:

  • Rapid, shallow breathing
  • Wheezing or grunting
  • Difficulty feeding
  • Poor weight gain
  • Recurrent respiratory infections

Diagnosis of BPD is typically based on the infant’s gestational age, birth weight, and need for oxygen support at specific time points. Treatment focuses on supporting lung function and promoting growth and development. This may include:

  • Supplemental oxygen
  • Medications to reduce inflammation and improve lung function
  • Nutritional support
  • Prevention of respiratory infections

While BPD can have long-term effects on lung function, many infants show significant improvement over time with proper care and management.

Diagnosis and Treatment of Bronchial Disorders

Accurate diagnosis and appropriate treatment are crucial for managing bronchial disorders effectively. But how do healthcare providers diagnose these conditions, and what treatment options are available?

Diagnostic Approaches

Diagnosis of bronchial disorders typically involves a combination of:

  • Medical history and physical examination
  • Pulmonary function tests
  • Imaging studies (X-rays, CT scans)
  • Blood tests to check for infections or inflammatory markers
  • Bronchoscopy in some cases

Treatment Strategies

Treatment varies depending on the specific disorder and its severity. Common approaches include:

  • Medications (bronchodilators, corticosteroids, antibiotics)
  • Airway clearance techniques
  • Oxygen therapy
  • Pulmonary rehabilitation
  • Lifestyle modifications (e.g., smoking cessation)

In some cases, surgical interventions may be necessary. The goal of treatment is to manage symptoms, prevent complications, and improve quality of life.

Prevention and Management of Bronchial Disorders

While not all bronchial disorders can be prevented, there are steps that can be taken to reduce risk and manage existing conditions effectively. What are some key strategies for prevention and management?

  • Avoid smoking and exposure to secondhand smoke
  • Practice good hygiene to prevent respiratory infections
  • Maintain a healthy diet and exercise routine
  • Manage underlying conditions like asthma or allergies
  • Avoid environmental irritants when possible
  • Get vaccinated against respiratory infections like influenza and pneumococcal disease
  • Follow prescribed treatment plans for existing conditions

For those with chronic bronchial disorders, ongoing management is crucial. This may involve regular check-ups, adherence to medication regimens, and participation in pulmonary rehabilitation programs. By working closely with healthcare providers and adopting healthy lifestyle habits, many people with bronchial disorders can maintain good quality of life and minimize the impact of their condition.

Understanding bronchial disorders is essential for recognizing symptoms early and seeking appropriate care. Whether it’s bronchitis, bronchiectasis, or a less common condition like bronchopulmonary dysplasia, proper diagnosis and management can make a significant difference in outcomes and quality of life. By staying informed and proactive about respiratory health, individuals can breathe easier and enjoy better overall well-being.

Bronchial Disorders | Bronchiectasis | Bronchiolitis

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When you breathe in, the air travels down through your trachea (windpipe). It then goes through two tubes to your lungs. These tubes are your bronchi. Bronchial disorders can make it hard for you to breathe.

The most common problem with the bronchi is bronchitis, an inflammation of the tubes. It can be acute or chronic. Other problems include:

  • Bronchiectasis – a condition in which damage to the airways causes them to widen and become flabby and scarred
  • Exercise-induced bronchospasm – a breathing problem that happens when your airways shrink while you are exercising
  • Bronchiolitis – an inflammation of the small airways that branch off from the bronchi
  • Bronchopulmonary dysplasia – a chronic lung condition in infants, most often premature infants

  • Bronchiectasis

    (American Lung Association)

  • Bronchiolitis

    (American Academy of Family Physicians)

    Also in Spanish

  • Bronchiolitis

    (Mayo Foundation for Medical Education and Research)

  • Bronchopulmonary Dysplasia (BPD)

    (National Heart, Lung, and Blood Institute)

  • Exercise-Induced Bronchospasm

    (American Academy of Family Physicians)

    Also in Spanish

  • What Is Bronchiectasis?

    (National Heart, Lung, and Blood Institute)

  • Bronchiolitis Obliterans

    (National Jewish Health)

  • Flavorings-Related Lung Disease

    (National Institute for Occupational Safety and Health)

  • ClinicalTrials. gov: Bronchial Diseases

    (National Institutes of Health)

  • ClinicalTrials.gov: Bronchiectasis

    (National Institutes of Health)

  • ClinicalTrials. gov: Bronchiolitis

    (National Institutes of Health)

  • Article: Tear gas exposure and its association with respiratory emergencies in infants. ..

  • Article: Anatomical Variants Identified on Computed Tomography of Oropharyngeal Carcinoma Patients.

  • Article: Balloon Bronchoplasty for the Treatment of Bronchial Stenosis After Lung Transplantation:. ..

  • Bronchial Disorders — see more articles

  • Bronchi, Bronchial Tree, and Lungs

    (National Cancer Institute)

  • How the Lungs Work

    (National Heart, Lung, and Blood Institute)

    Also in Spanish

  • American Lung Association

  • National Heart, Lung, and Blood Institute

  • Bronchiolitis (For Parents)

    (Nemours Foundation)

    Also in Spanish

  • Bronchiolitis: What Parents Should Know

    (American Academy of Pediatrics)

  • What Are Newborn Breathing Conditions?

    (National Heart, Lung, and Blood Institute)

Acute Bronchitis – StatPearls – NCBI Bookshelf

Continuing Education Activity

Acute bronchitis is the inflammation of the lining of the bronchi. It is a common presentation in emergency departments, urgent care centers, and primary care offices. In the United States, acute bronchitis is among the top ten most common illnesses among outpatients; about five percent of adults have an episode of acute bronchitis each year. This activity reviews the evaluation and management of patients with acute bronchitis and highlights the role of the interprofessional team in caring for patients with this condition.

Objectives:

  • Describe the presentation of a patient with acute bronchitis.

  • Explain how to distinguish acute bronchitis from pneumonia.

  • Outline the management and treatment options for acute bronchitis.

  • Summarize the importance of the interprofessional team in caring for and counseling patients with acute bronchitis.

Access free multiple choice questions on this topic.

Introduction

Acute bronchitis is an inflammation of the large airways of the lung. It is a common clinical presentation to emergency departments, urgent care centers, and primary care offices. About 5% of adults have an episode of acute bronchitis each year. An estimated 90% of these seek medical advice for the same. In the United States, acute bronchitis is among the top ten most common illnesses among outpatients.[1][2][3]

Etiology

Acute bronchitis is caused by infection of the large airways commonly due to viruses and is usually self-limiting. Bacterial infection is uncommon. Approximately 95% of acute bronchitis in healthy adults is secondary to viruses. It can sometimes be caused by allergens, irritants, and bacteria. Irritants include smoke inhalation, polluted air inhalation, dust, among others.[4]

Epidemiology

Acute bronchitis is one of the common presentations in any healthcare setting. It is estimated that every year, 5% of the general population reports an episode of acute bronchitis, accounting for more than 10 million office visits yearly. [5] Like most of the viral diseases of the respiratory tract, acute bronchitis is commonly seen during the flu season. In the United States, flu season is common during autumn and winter. It can follow any viral upper respiratory infection (URI). The common pathogens are respiratory syncytial virus, influenza virus A and B, parainfluenza, rhinovirus, and other similar viruses.

Factors like a history of smoking, living in a polluted place, crowding, and a history of asthma, are all risk factors for acute bronchitis. In some people, acute bronchitis can be triggered by particular allergens like pollens, perfume, and vapors.

When the infection is bacterial, the isolated pathogens are usually the same as those responsible for community-acquired pneumonia, for example, Streptococcus
pneumonia and Staphylococcus
aureus.[6][7]

Pathophysiology

Acute bronchitis is the result of acute inflammation of the bronchi secondary to various triggers, most commonly viral infection, allergens, pollutants, etc. Inflammation of the bronchial wall leads to mucosal thickening, epithelial-cell desquamation, and denudation of the basement membrane. At times, a viral upper respiratory infection can progress to infection of the lower respiratory tract resulting in acute bronchitis.[8]

History and Physical

Patients with acute bronchitis present with a productive cough, malaise, difficulty breathing, and wheezing. Usually, their cough is the predominant complaint and the sputum is clear or yellowish, although sometimes it can be purulent. Purulent sputum does not correlate with bacterial infection or antibiotic use.[9] Cough after acute bronchitis typically persists for 10 to 20 days but occasionally may last for 4 or more weeks. The median duration of cough after acute bronchitis is 18 days.[10] Paroxysms of cough accompanied by inspiratory whoop or post-tussive emesis should raise concerns for pertussis. A prodrome of upper respiratory infection (URI) symptoms like runny nose, sore throat, fever, and malaise are common. A low-grade fever may be present as well. High-grade fevers in the setting of acute bronchitis are unusual and further diagnostic workup is required.

On physical exam, lung auscultation may be significant for wheezing; pneumonia should be suspected when rales, rhonchi, or egophony are appreciated. Tachycardia can be present reflecting fever as well as dehydration secondary to the viral illness. The rest of the systems are typically within normal limits.

Evaluation

Acute bronchitis is a clinical diagnosis based on history, past medical history, lung exam, and other physical findings. Oxygen saturation plays an important role in judging the severity of the disease along with the pulse rate, temperature, and respiratory rate. No further workup is needed if vital signs are normal and there are no exam findings suggestive of pneumonia. An exception to this rule is elderly patients >75 years old. Also, further workup is needed when pneumonia is suspected, the clinical diagnosis is in question, or in cases of high suspicion for influenza or pertussis.  

Chest x-ray (CXR) findings are not specific and are typically normal. Occasionally, the chest x-ray demonstrates increased interstitial markings consistent with the thickening of bronchial walls. A chest x-ray differentiates pneumonia from acute bronchitis when infiltrates are seen. Evidence-based guidelines from the American College of Chest Physicians (ACCP) recommend obtaining a CXR only when heart rate > 100/min, respiratory rate >24 breaths/min, oral body temperature > 38 degrees C, and chest examination findings of egophony or fremitus.[5]

A complete blood count and chemistry may be ordered as a workup for fever. The white blood count might be mildly elevated in some cases of acute bronchitis. Blood chemistry can reflect dehydration changes.

Routine use of rapid microbiological testing is not cost-effective and would not change management except during influenza season and in cases with high suspicion of pertussis or other bacterial infection. Gram stain and bacterial sputum cultures are specifically discouraged as bacteria are rarely the causative agent.  

Spirometry, when performed, demonstrates transient bronchial hyperresponsiveness in 40% of patients with acute bronchitis. Reversibility of FEV1 >15% is reported in 17% of patients.[5] Airflow obstruction and bronchial hyperresponsiveness typically resolve in 6 weeks.

Treatment / Management

Acute bronchitis is self-limiting and treatment is typically symptomatic and supportive therapy. For cough relief, nonpharmacological and pharmacological therapy should be offered. Nonpharmacological therapy includes hot tea, honey, ginger, throat lozenges, etc. No clinical trials evaluated the efficacy of these interventions. Antitussive agents like dextromethorphan and codeine are frequently used in clinical practice to suppress cough based on their effectiveness in chronic bronchitis and studies on cough in the common cold. No randomized trials exist to evaluate their effectiveness in acute bronchitis. Codeine should be avoided due to its addictive potential. Data on the use of a mucolytic agent is conflicting.  

Beta-agonists are routinely used in acute bronchitis patients with wheezing. Small randomized control trials on beta-agonists for cough in acute bronchitis had mixed results. A Cochrane review of five trials demonstrated no significant benefit of beta-agonists on daily cough except for a small benefit in a subgroup of patients with wheezing and airflow obstruction at baseline.[11] A more recent Cochrane review demonstrated similar results.[12] 

Analgesic and antipyretic agents may be used to treat associated malaise, myalgia, and fever. Prednisone or other steroids can be given to help with the inflammation as well. Although there is not enough evidence showing their benefit, they are useful in patients with underlying chronic obstructive pulmonary disease (COPD) or asthma. Typically the steroid is used as short-term burst therapy. Sometimes a longer tapering dose of steroids might be warranted, especially in patients with underlying asthma or COPD.[13][14]

ACCP guidelines recommend against antibiotic use in simple acute bronchitis in otherwise healthy adults. A Cochrane review of nine randomized, controlled trials of antibiotic agents showed a minor reduction in the total duration of cough (0.6 days). The decrease in the number of days of illness was not significant per this review.[15] Hence antibiotic use should be avoided in simple cases considering the cost of antibiotics, the growing global problem of antibiotic resistance, and the possible side effects of antibiotic usage. Multiple other international medical societies recommend against antibiotic use in viral acute bronchitis. Despite these recommendations, a large proportion of patients with acute bronchitis are prescribed antibiotics. No data exist to justify the prospect of cough being less severe or less prolonged with antibiotic therapy. Antimicrobial therapy is recommended when a treatable pathogen is identified such as influenza or pertussis. In patients with influenza infection, oseltamivir or zanamivir should be promptly started. Macrolides are the treatment of choice for pertussis along with 5 days of isolation. It is interesting to note that whooping cough is only present in a minority of patients with pertussis. 

Procalcitonin might be useful in deciding on antibiotic use when the diagnosis of acute bronchitis is uncertain. A meta-analysis demonstrated procalcitonin-guided antibiotic therapy reduced antibiotic exposure and improved survival.[16]

Lifestyle modification like smoking cessation and the avoidance of allergens and pollutants play an important role in the avoidance of recurrence and complications. Flu vaccine and pneumonia vaccine are especially recommended in special groups including adults older than 65, children younger than two years (older than six months), pregnant women, and residents of nursing homes and long-term care facilities. People with asthma, COPD, and other immunocompromised adults are also at higher risk of developing complications. Recurrence is seen in up to a third of the cases of acute bronchitis.

In summary, the data for the use of beta-agonists, steroids, and mucolytic agents, especially in patients with no underlying COPD and asthma, is lacking. Treatment should be guided by the individual response to them and reported benefit, as well as, weighing risk and benefit in each case.

Differential Diagnosis

Other causes of acute cough should be considered especially when a cough persists for longer than 3 weeks. 

  • Asthma: Acute asthma is misdiagnosed as acute bronchitis in approximately one-third of the patients who present with acute cough.

  • Acute/chronic sinusitis

  • Bronchiolitis

  • COPD

  • Gastroesophageal reflux disease (GERD)

  • Viral pharyngitis

  • Heart failure

  • Pulmonary embolism

Prognosis

Acute bronchitis is self-limiting and resolves with symptomatic treatment in most instances. Secondary pneumonia is possible. Rare cases of acute respiratory distress syndrome and respiratory failure have been reported in the literature.[17][18]

Complications

  • Secondary pneumonia

  • Respiratory distress

  • Days missed of school/work

Deterrence and Patient Education

Patients with acute bronchitis should be made aware of the importance of lifestyle modifications including smoking cessation and the avoidance of allergens and pollutants to lower their risk of recurrence and complications. Influenza and pneumonia immunizations are especially recommended in special groups including adults older than 65, children younger than two years (older than six months), pregnant women, and residents of nursing homes and long-term care facilities. Patients should also be provided education regarding the risks of prescribing antibiotics when they are not indicated including antibiotic resistance, cost, and potential side effects.

Pearls and Other Issues

Sometimes secondary pneumonia can develop. This is usually indicated by worsening symptoms, productive cough, and fever. In such cases, a chest x-ray is indicated. This is especially important in immunocompromised adults, the elderly population, infants and newborns, and smokers. Pulmonary emboli should always be in differentials in a patient with a cough and shortness of breath. Sometimes aggressive coughing can lead to spontaneous pneumothorax and or spontaneous pneumomediastinum. Hence any acute worsening of symptoms usually requires a chest x-ray.

Enhancing Healthcare Team Outcomes

Acute bronchitis is a very common disorder that frequently presents to emergency departments and primary care offices. It is a very common cause of absenteeism from work and school. The condition is best managed by an interprofessional team that includes a primary care provider, a nurse, a pharmacist, and a pulmonologist. The key is coordinating patient education. The nursing staff should be tasked to work with patients to stop smoking and avoid exposure to secondhand smoke. The nurses should encourage individuals to get influenza and pneumococcal vaccines to reduce morbidity. The nurses should monitor patients for compliance and report back to the clinical team leader patients that are non-compliant with smoking cessation. In addition, the nurse and pharmacist should encourage hand washing to limit the spread of micro-organisms.

For those patients whose cough persists, the nurses should monitor for the possibility of atypical pneumonia or pneumonia that requires antibiotic therapy. In these cases, the nurse should arrange a follow-up visit with the clinical team for re-assessment. If an antibiotic is deemed necessary, the pharmacist should evaluate for drug-drug interaction and allergy prior to filling the prescription. If there are any concerns, the pharmacist should make the clinical team aware of potential problems before the drug is dispensed.

The outcomes of patients with acute bronchitis are good; however, it is a common reason for absenteeism from work. In some patients with underlying COPD and other lung problems, acute bronchitis can have high morbidity. Patients whose symptoms persist for more than six weeks need to be re-evaluated to ensure that the diagnosis is correct. [Level 5][19][20]

Review Questions

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References

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Adams PF, Hendershot GE, Marano MA., Centers for Disease Control and Prevention/National Center for Health Statistics. Current estimates from the National Health Interview Survey, 1996. Vital Health Stat 10. 1999 Oct;(200):1-203. [PubMed: 15782448]

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Saust LT, Bjerrum L, Siersma V, Arpi M, Hansen MP. Quality assessment in general practice: diagnosis and antibiotic treatment of acute respiratory tract infections. Scand J Prim Health Care. 2018 Dec;36(4):372-379. [PMC free article: PMC6381521] [PubMed: 30296885]

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Tanner M, Karen Roddis J. Antibiotics for acute bronchitis. Nurs Stand. 2018 Feb 28;32(27):41-43. [PubMed: 29488727]

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Kronman MP, Zhou C, Mangione-Smith R. Bacterial prevalence and antimicrobial prescribing trends for acute respiratory tract infections. Pediatrics. 2014 Oct;134(4):e956-65. [PubMed: 25225144]

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Bai L, Su X, Zhao D, Zhang Y, Cheng Q, Zhang H, Wang S, Xie M, Su H. Exposure to traffic-related air pollution and acute bronchitis in children: season and age as modifiers. J Epidemiol Community Health. 2018 May;72(5):426-433. [PubMed: 29440305]

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Altiner A, Wilm S, Däubener W, Bormann C, Pentzek M, Abholz HH, Scherer M. Sputum colour for diagnosis of a bacterial infection in patients with acute cough. Scand J Prim Health Care. 2009;27(2):70-3. [PMC free article: PMC3410464] [PubMed: 19242860]

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Ward JI, Cherry JD, Chang SJ, Partridge S, Lee H, Treanor J, Greenberg DP, Keitel W, Barenkamp S, Bernstein DI, Edelman R, Edwards K. , APERT Study Group. Efficacy of an acellular pertussis vaccine among adolescents and adults. N Engl J Med. 2005 Oct 13;353(15):1555-63. [PubMed: 16221778]

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Smucny J, Becker L, Glazier R. Beta2-agonists for acute bronchitis. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD001726. [PubMed: 17054140]

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Becker LA, Hom J, Villasis-Keever M, van der Wouden JC. Beta2-agonists for acute cough or a clinical diagnosis of acute bronchitis. Cochrane Database Syst Rev. 2015 Sep 03;2015(9):CD001726. [PMC free article: PMC7078572] [PubMed: 26333656]

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Smith DRM, Dolk FCK, Pouwels KB, Christie M, Robotham JV, Smieszek T. Defining the appropriateness and inappropriateness of antibiotic prescribing in primary care. J Antimicrob Chemother. 2018 Feb 01;73(suppl_2):ii11-ii18. [PMC free article: PMC5890733] [PubMed: 29490061]

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Llor C, Bjerrum L. Antibiotic prescribing for acute bronchitis. Expert Rev Anti Infect Ther. 2016 Jul;14(7):633-42. [PubMed: 27219826]

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Bettoncelli G, Blasi F, Brusasco V, Centanni S, Corrado A, De Benedetto F, De Michele F, Di Maria GU, Donner CF, Falcone F, Mereu C, Nardini S, Pasqua F, Polverino M, Rossi A, Sanguinetti CM. The clinical and integrated management of COPD. Sarcoidosis Vasc Diffuse Lung Dis. 2014 May 12;31 Suppl 1:3-21. [PubMed: 24820963]

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Palmer R, Anon JB, Gallagher P. Pediatric cough: what the otolaryngologist needs to know. Curr Opin Otolaryngol Head Neck Surg. 2011 Jun;19(3):204-9. [PubMed: 21499103]

Disclosure: Anumeha Singh declares no relevant financial relationships with ineligible companies.

Disclosure: Akshay Avula declares no relevant financial relationships with ineligible companies.

Disclosure: Elise Zahn declares no relevant financial relationships with ineligible companies.

Pathology of small bronchi

00:00

Igor Evgenievich Tyurin Doctor of Medical Sciences:

– I am pleased to give the floor to Irina Alexandrovna to continue the conversation about the pathology of the small bronchi. Please.

Irina Aleksandrovna Sokolina , candidate of medical sciences:

– Good day, dear colleagues!

Today my message will be devoted to two pathological conditions: bronchiectasis and related pathological conditions and pathology of the small bronchi.

Let’s start with bronchiectasis. We partially touched on this topic at our last meeting, but let me remind you once again that bronchiectasis is defined as local and irreversible dilatation of the bronchi.

Primary bronchiectasis is distinguished, which develops mainly in early childhood. They are caused by acute infectious diseases of the bronchopulmonary system. The left lung is affected 1.5 – 2 times more often than the right. A third of patients may experience bilateral lesions.

The most common localization of primary bronchiectasis is the basal segments of the lower lobes, or the middle lobe and lingular segments.

In practice (especially in adult patients), secondary bronchiectasis is more common, which form and develop as complications of other pathological processes of the respiratory system. These are, first of all, tuberculous processes, inflammatory processes.

Secondary bronchiectasis includes the so-called atelectatic bronchiectasis, which Igor Evgenievich referred to. They occur in the zone of partial or complete atelectasis and develop as a result of infection of the bronchial secretion, distal to the site of obstruction.

02:00

Radiographic signs of bronchiectasis depend on the condition of the surrounding lung parenchyma. It may not be changed, the airiness may be disturbed, it may be, on the contrary, compacted.

Most often, we detect the expansion of the lumen of the bronchi, if, for example, there are compactions of the lung tissue around, due to inflammatory or fibrous changes, as in the right picture. The expansion of the lumen of the bronchi is revealed: their walls look like thick parallel lines, and in the cross section, bronchiectasis usually look like annular cells with a diameter of up to 1 centimeter.

If the lung tissue remains airy, it is difficult to detect bronchiectasis, especially if they are limited. We see local areas of cellular and severe deformation of the pulmonary pattern.

Here we see that in direct projection, behind the shadow of the heart, these changes are not visible. They are better detected in the study in the lateral projection, which is why it is necessary to take pictures in two projections. This is a standard research technique for the pathology of the chest organs.

With a significant expansion, with the formation of cystic or saccular bronchiectasis, we can see thin-walled cavities of a round or oval shape. This is more common in congenital pathological conditions such as cystic fibrosis.

In such large bronchiectasis during exacerbation, inflammation, we can see horizontal levels of fluid. This is an important sign of bronchiectasis.

Thus, we can divide the radiological signs of bronchiectasis into direct and indirect symptoms.

Of course, a change in bronchial patency in one way or another affects the airiness of the lung tissue. This may show up:

  • share reduction,
  • convergence of the lumen of the segmental bronchi,
  • thickening of their walls,
  • formation of peribronchial sclerosis,
  • depletion of the lung pattern in neighboring lobes due to compensatory increase in airiness,
  • deformation of the contours of the diaphragm and interlobar fissures.

04:42

For a long time, bronchography was the method of diagnosing bronchiectasis. But now, in connection with the introduction of computed tomography, this has become the main method for diagnosing bronchiectasis.

They are detected by computed tomography in almost 100% of cases. Especially with high-resolution computed tomography, which we discussed in great detail at our last meeting.

The main CT signs of bronchiectasis are the expansion of the lumen of the bronchus, the absence of a normal decrease in its diameter towards the periphery, and visible lumen of the bronchi in the cortical parts of the lungs.

There are three types of bronchiectasis according to the form.

Cylindrical bronchiectasis. We can talk about them when the ratio of the diameter of the bronchus to the diameter of the artery is greater than one. This is usually manifested by a symptom which has a very poetic name: the symptom of the “ring with a stone. ”

The air ring itself is the bronchi (here we see it on both slides). The stone is the pulmonary artery. Most often, such bronchiectasis is formed in chronic bronchitis. Infectious processes play an important role in their formation.

Varicose (fusiform) bronchiectasis have the form of uneven (varicose) expansion of the bronchial lumen. Moreover, the walls of bronchiectasis, as a rule, are thickened due to chronic recurrent inflammatory processes. That is due to peribronchial sclerosis.

More often, fusiform bronchiectasis can end in a cystic expansion of its lumen: the so-called saccular bronchiectasis. Often they reveal horizontal levels of liquid.

The three main types of bronchiectasis that we detect.

07:10

Direct pathological processes that are associated with the formation of bronchiectasis.

Of these, primarily cystic fibrosis (cystic fibrosis, as it is also defined). This is a hereditary disease that is characterized by a systemic lesion of the exocrine glands, causing a violation of the respiratory system in combination with a disease of the digestive system.

There are several clinical forms. Including a mixed pulmonary-intestinal form, which is observed in the vast majority of patients, and an isolated bronchopulmonary form.

In the pathogenesis of the formation of bronchiectasis in this pathology: low water content in bronchial secretions, impaired mucociliary clearance, stagnation of secretions in the bronchi, development of secondary recurrent inflammation.

It must be said that cystic fibrosis is a two-way process. It is more often localized in the upper lobe of the right lung. Multiple bronchiectasis are determined – mixed and varicose. In later stages – cystic or saccular. Retention cysts, bronchiolectasias.

Since the process is characterized by recurrent exacerbations, a secret often stagnates in them. We see these changes in the form of filled bronchi. Of course, this is accompanied by uneven airiness of the lung tissue with areas of valvular swelling.

Pseudomonas aeruginosa is often a relapse and exacerbation of the infectious process in such patients.

Computed tomography is of great importance in cystic fibrosis. Especially when observing patients in dynamics, since it allows you to determine the activity of the inflammatory process.

The second congenital pathology, which is associated with the formation of bronchiectasis and due to impaired mucociliary clearance, is Kartagener’s syndrome. It is characterized by the reverse arrangement of internal organs.

We see bronchiectasis in this patient. On the right – pronounced changes in the lower lobe of the right lung, volume reduction, the presence of bronchiectasis, bronchiolectasis with signs of inflammation. Some of them are filled with content. There are also changes in the upper lobe of the left lung.

09:49

Detection of bronchiectasis is of great importance in patients with long-term asthma because they may be a reflection of a complication that may occur in these patients – allergic bronchopulmonary aspergillosis (ABPA).

In the pathogenesis of ABPA, colonization by fungi of the respiratory tract (usually bronchi of medium caliber), vascular damage with eosinophilic infiltration and the formation of bronchocentric granulomas are important. As a result, the development of bronchiectasis, bronchial obstruction, pneumofibrosis.

In the diagnostic criteria for ABPA, as we see, in addition to clinical and laboratory data, the detection of proximal bronchiectasis is of great importance. The use of computed tomography in this situation is of great clinical importance, since these changes are well detected using this method.

In this case, an example of a patient with bronchial asthma is given – a long-term sufferer, who is on glucocorticosteroid therapy. Plain radiograph shows changes in the upper lobe of the right lung. Here’s what they look like on x-rays.

We see that these changes are in the form of a V-shaped filled structure. On the tomograms, it is very clearly visible just the dilated and filled bronchi. In this case, by the type of retention cyst.

This is what confirmed ABLA cases look like. Proximal bronchiectasis is revealed – dilated segmental and subsegmental bronchi. Some of them may be filled with pathological contents.

When eosinophils in the blood become heavier and increase in patients with bronchial asthma, it is advisable to perform a computed tomography study to detect proximal bronchiectasis, which may be a reflection of ABPA.

I would also like to draw attention to such a pathology as atypical mycobacterial infection (not tuberculosis mycobacterial infection). These are processes that develop in patients of the older age group: older than 45-50 years. They are characterized by recurrent bronchopulmonary pathology. The most common pathogen causing bronchiectasis is Mycobacterium avium.

Mostly such processes are localized in the middle lobe and in the reed segments. A recurrent bronchopulmonary process with localization in these segments may suggest that this may be caused by a non-tuberculous (atypical) mycobacterial infection and requires clarification.

13:10

In this patient, we see changes in the middle lobe of the right lung, which are manifested by a cellular-severe deformity of the lung pattern, some volumetric decrease in the middle lobe. Computed tomography shows varicose and cystic bronchiectasis with severe peribronchial inflammatory and sclerotic changes.

I wanted to draw your attention to bronchiectasis. Of course, it is logical that post-inflammatory and post-tuberculosis processes lead to this. But in these two conditions – non-tuberculous mycobacterial infection and ABPA – the use of computed tomography in the diagnosis of this pathology is of great importance.

Bronchiolitis or pathology of the small bronchi.

Bronchiolitis is defined as an exudative or productive sclerotic inflammation of the small airways (bronchioles) that results in partial or complete obstruction.

Anatomy of bronchioles.

Bronchioles are small bronchi, from which the terminal and respiratory bronchioles are isolated. The diameter of the bronchioles does not exceed 2-3 mm. A feature of the anatomical structure of bronchioles is that their wall does not contain cartilaginous plates.

At the same time, terminal and respiratory bronchioles are isolated. Terminal bronchioles regulate airflow. These are the airways. Respiratory bronchioles are involved in gas exchange.

15:03

(Slide show) .

There are several classifications of bronchiolitis. But from the point of view of radiation diagnostics, the so-called pathohistological classification of bronchiolitis, in which acute (exudative) bronchiolitis is isolated, will be most acceptable to us. The main reason for their formation are infectious processes, inhalation of gases. Morphologically, epithelial necrosis, edema and infiltration of the wall occur there. Such bronchiolitis in the clinical picture is characterized by an acute onset. With inadequate treatment, chronicity of the process may occur, or inflammation may involute (if the treatment is timely).

Chronic (or productive sclerotic) bronchiolitis. There are constrictive and proliferative. Constrictive bronchiolitis is characterized by peribronchiolar fibrosis and narrowing of the lumen. It includes such histological forms as obliterating, respiratory, follicular bronchiolitis, panbronchiolitis. This form of damage to the small bronchi occurs with systemic diseases of the connective tissue, post-infectious conditions with inadequate treatment, the state after transplantation of organs and tissues.

Proliferative bronchiolitis is characterized by productive inflammation and proliferation of granulation tissue or organizing exudate. Proliferative bronchiolitis is bronchiolitis obliterans with organizing pneumonia. This form of bronchiolitis can occur with interstitial connective tissue diseases, or idiopathic.

(Slide show) .

Clinical manifestations of bronchiolitis. Basically, there are two leading symptoms – progressive shortness of breath and non-productive cough. But in the diagnosis of this condition, of course, the data of the anamnesis are of great importance. Indication of acute respiratory diseases, inhalation of toxic gases, organic, inorganic dust. Taking medication. The presence of concomitant pathology, such as collagenoses, bronchial asthma.

As for the ethnic factor, the so-called diffuse panbronchiolitis is described, which develops among the inhabitants of the Pacific region in connection with the migration of the population. This may be true in other geographic areas as well.

17:52

Physical findings are very poor in bronchiolitis. It may be dry wheezing. Spirometry – these functions of external respiration depend on the genetic form of bronchiolitis. So, basically, constrictive bronchiolitis, which are characterized by peribronchiolar fibrosis. They are characterized by the development of obstructive disorders. Moreover, in practice, such patients do not respond or respond poorly to a test with bronchodilators. And with the proliterative form of bronchiolitis, the restrictive nature of the violation of the function of external respiration is usually encountered.

(Slide show) .

Unfortunately, X-ray changes are detected in no more than half of the patients, mainly in severe forms. They can be manifested either by areas of increased airiness of the lung tissue (as we see in the right picture), or by areas of compaction of the lung tissue, or by an increase in the lung pattern.

(Slide show) .

Therefore, of course, high-resolution computed tomography plays a leading role in the diagnosis of bronchiolitis. We mention this pathology more and more often, we talk about bronchiolitis precisely in connection with the development of computed tomography, since we have been able to identify these changes.

Let me remind you that in a standard examination, with high-resolution computed tomography, we do not see small bronchi, bronchioles. We begin to see them when some pathological process occurs there.

(Slide show) .

We can divide the symptoms of bronchiolitis into direct symptoms when we directly see these altered bronchioles. This can occur due to the thickening of their walls, the clearance on the contents. Or centrilobular foci.

Finally, indirect signs of bronchiolitis are uneven airiness of the lung tissue.

20:15

(Slide show) .

A direct symptom of bronchiolitis is the symptom of “tree in buds” or “willow twig”. This symptom is literally translated from English and has no analogue in Russian yet. It has an appearance on computed tomograms in the form of Y-, -V-structures, which are detected at a distance of 2–5 millimeters from the costal pleura. The morphological basis of this symptom is the thickening of the wall of the bronchioles or the accumulation of secretions in the lumen of the bronchioles.

Unfortunately, we can state that such changes are taking place there. But the etiology of this secret (fungal, tuberculous, bacterial), unfortunately, we cannot differentiate. Based on the totality of some signs and changes in the lung tissue, anamnesis, we can assume this. And the sign of damage to the bronchi, bronchioles, the symptom of a “tree in the kidneys” looks like these Y- and -V-structures.

(Slide show) .

It is this symptom that usually occurs in infectious bronchiolitis and is caused by infectious processes, which may include bacterial infections (more often we see this with mycoplasmal pneumonia), with tuberculosis and non-tuberculous mycobacterial infections. Viral etiology is usually found in adenoviruses, respiratory syncyal viruses. In children, this virus is usually one of the causes of such acute infectious bronchiolitis. With a fungal infection – bronchopulmonary aspergillosis.

Tree bud symptom is very common in infectious bronchiolitis.

(Slide show) .

It must be said that this symptom is potentially reversible with adequate treatment. Here we see the involution of pathological changes. Here are signs of bronchiolitis, and, by the way, bronchiectasis – the so-called incoming bronchiectasis, which occur during inflammation. Already against the background of adequate treatment, we see that most of the so-called bronchiectasis is no longer detected. And bronchiectasis is an irreversible change. Therefore, usually, if we see such pronounced inflammatory changes, then we write about bronchiectasis with caution, because then this may simply not be detected.

23:01

(Slide show) .

Such changes, the symptom of “a tree in the kidneys” can also occur in congenital pathology, in which bronchioles are also involved in the process. This is also a symptom of Kartagener (which we talked about) and cystic fibrosis.

(Slide show) .

Diffuse panbronchiolitis is a rare disease in the Pacific. It is characterized by the development of an immune response. There is a mononuclear infiltration of bronchioles, alveolar ducts and alveoli. Clinically manifested by cough, sputum, shortness of breath. Usually characterized by the addition of a bacterial infection.

Here we see such pronounced changes, which are caused by inflammation of the bronchioles and small bronchi, and bronchi of medium caliber. This is manifested by thickening of the walls of the bronchi, the expansion of their lumen, the expansion of the lumen of the bronchioles. Here, the arrow shows how almost near the pleura we see what a wide lumen of bronchioles, thickening of the walls. Bronchial lumens are filled with contents.

(Slide show) .

Two symptoms (as I said) are tree in bud and centrilobular ground glass lesions. They have the appearance of poorly defined centrilobular foci of low density. Their morphological basis is areas of peribronchiolar inflammation.

“Tree in buds” – this is mainly inside the bronchi and wall. Here it is peribronchial inflammation without signs of lumen expansion and filling with bronchial secretions. Pathological processes that can lead to this are hypersensitivity pneumonia, respiratory bronchiolitis, follicular bronchiolitis.

24:59

(Slide show) .

Hypersensitivity pneumonitis (or, as we called it, exogenous allergic alveolitis) is in most cases a disease that develops as an allergic reaction to the inhalation of gases, some kind of toxic damaging factor of an allergic reaction. As a rule, bronchioles are also involved in the process. Most often, we see in the acute-subacute or acute phase multiple centrilobular foci of low density, with blurry contours, like ground glass. This is a very characteristic sign of hypersensitivity pneumonitis.

(Slide show) .

Follicular bronchiolitis is more common in children. It is characterized by hyperplasia of lymphoid tissue in the walls of bronchioles with the formation of follicles. May also be seen in patients with rheumatoid arthritis.

(Slide show) .

Respiratory bronchiolitis is bronchiolitis that develops in smokers. It must be said that in the initial stage, these changes do not manifest themselves in any way and are detected only with computed tomography. The median age at which this bronchiolitis develops is 35 years. The disease (as I said) is associated with smoking.

There is an ingrowth of granulation tissue into the respiratory bronchioles, which contains pigmented alveolar macrophages. Computed tomography reveals such small centrilobular ground-glass lesions. They are indicated (some of them) by arrows. They are multiple-multiple. If you look, there are a lot of these centers here. At the same time, we see that the walls of the bronchi are completely normal. They may be slightly thickened, but not thickened.

These changes, as a rule, are localized in the upper parts of the lungs, but can also be combined with centriacinar emphysema. This bronchiolitis develops (as I said), mainly in smokers and is detected only with a CT scan.

27:10

(Slide show) .

Finally, an indirect sign of bronchiole damage is the so-called mosaic density, or mosaic perfusion, which looks like a combination of areas of increased and decreased density in the lung tissue. It occurs as a result of changes in the small bronchi, followed by reflex vasoconstriction and redistribution of blood to healthy areas of the lung tissue. These changes must be differentiated from the ground glass symptom. We haven’t talked about this symptom yet. I think in the future we will touch on this symptom in the differential diagnosis.

(Slide show) .

Exhaled. With such an uneven airiness of the lung tissue, these changes are better detected during an exhalation examination in the form of the so-called “air trap” symptom.

(Slide show) .

This symptom is very characteristic of bronchiolitis obliterans, in which we see an uneven mosaic density of the lung tissue, which is due to areas of swelling, and is clearly visible during exhalation.

(Slide show) .

In case of post-inflammatory changes, with chronicity of the process, changes in the type of obliterating bronchiolitis may occur. The type of Swyer-James syndrome that develops in children after a viral infection. As a rule, these changes are characterized by unilateral lesion and lobar lesion. These changes must, of course, be differentiated from emphysema, because they are based not on the destruction of lung tissue, but on the development of this bronchiolitis and subsequent increased airiness of the lung parenchyma.

In this case (we see) this is usually manifested radiographically, by an increase in the airiness of the lung tissue. We see the same thing in computed tomography, that in this case there is a lesion of the lower lobe of the left lung. The volume of the share has been increased. Air is increased. The vascular bed is disreduced. Separate cylindrical bronchiectasis can occur against this background.

29:22

(Slide show) .

The last thing I would like to touch upon is bronchiolitis obliterans with organizing pneumonia. In 70% of the development of this condition, the cause, as a rule, is not established. In 30%, similar changes can occur with systemic diseases of the connective tissue, with drug therapy.

The mean age of development of this pathology is 55 years. There is an overgrowth of polypoid granulation tissue in the bronchioles. Clinically characterized by unproductive cough, shortness of breath. It can be detected in the form of subfebrile fever (especially with drug therapy).

Computed tomography results in bilateral areas of lung tissue compaction, which are located mainly in the cortical regions of the lungs. The thickening of the walls of the bronchi, the expansion of their lumen in the areas of compaction can be detected.

The main distinguishing feature of bronchiolitis obliterans with organizing pneumonia from protracted pneumonia is usually bilateral changes and the absence of the effect of antibiotic therapy.

(Slide show) .

Here is an example of bronchiolitis obliterans with organizing pneumonia. We see bilateral changes, mainly in the form of areas of compaction of the lung tissue in the subpleural regions. The degree of these changes may be different against the background of these compacted areas. We see the air gaps of the bronchi. Against the background of conventional antibiotic therapy, involution of such changes does not occur.

(Slide show) .

Thus, in the differential diagnosis of bronchiolitis, the data of anamnesis, clinical picture, data, first of all, of the function of external respiration are of great importance. High-resolution computed tomography plays a decisive role in detection and differential diagnosis. Here, differential diagnosis is already built on a predominant basis.

If this is a symptom of a “tree in the kidneys”, then local or diffuse changes are detected. If these are centrilobular foci, it matters here whether the person is a smoker or a non-smoker. The third sign is the mosaic airiness of the lung parenchyma. The most accurate diagnosis is established using morphological verification.

(Slide show) .

Thus, computed tomography is currently the main method for diagnosing the pathology of small bronchi, in general, in the diagnosis of pathology of the bronchi. If we talk about the pathology of bronchioles, then the main symptoms are the symptom of a “tree in the kidneys” and centrilobular foci, and uneven airiness of the lung parenchyma.

Differential diagnosis is based on the history, clinical picture, respiratory function and histological examination.

Thank you for your attention.

32:30

types, causes, symptoms, signs, diagnosis, treatment, prevention in children and adults

Acute bronchitis

Chronic bronchitis

Occupational bronchitis

Diagnosis

Complications

900 04 Treatment

Prognosis and prevention

Bronchitis is a disease affecting the lower respiratory tract with inflammation of the bronchial mucosa. The inflammatory process can develop only in one part or affect the entire bronchial tree. The main difference from pneumonia is the absence of involvement in the pathological process of the alveoli.

The duration of the disease can be acute and chronic with exacerbations.

Cough with sputum is the main symptom that allows to suspect a pathology, which often causes shortness of breath. Bronchitis is one of the most common reasons for all visits to the doctor.

Acute bronchitis

Many respiratory diseases, and this is SARS and influenza, often occur with manifestations of acute bronchitis. The main pathogens are viruses: rhinoviruses, enteroviruses, coronaviruses, adenoviruses. They account for 90% of all cases. At the same time, rhinoviruses and enteroviruses give a mild course, but coronaviruses and adenoviruses can cause severe complications.

Bacterial causes of bronchitis are much less common and are usually caused by a variety of bacteria. It is noted that during exacerbation of chronic bronchitis, bacteria in the sputum are excreted much more often than in the acute form.

Acute bronchitis can be caused by allergens, as well as exposure to dust, polluted or smoky air.

Bronchitis of the lungs can also be mixed, when infectious and physico-chemical factors are combined, as well as unspecified, when it is not possible to determine what caused the development of the disease.

According to the area of ​​inflammation, bronchitis in children and adults can be divided into:

  • tracheobronchitis;
  • with lesions of medium or small bronchi;
  • bronchiolitis.

The main symptom of acute bronchitis is a cough that occurs with existing manifestations of SARS or another infection. The temperature with bronchitis rises moderately, weakness, a runny nose appear, and the state of health worsens.

At first the cough is dry, there is little sputum, and the coughing attacks become especially painful at night. After 3-4 days, a dry cough is replaced by a wet one, with copious sputum discharge.

In a mild course of the disease, shortness of breath is not observed. If it appears over time, then this indicates damage to the small bronchi, which leads to obstructive bronchitis.

The general condition of the patient during treatment normalizes in a few days, and the cough may persist for another 2-3 weeks. If the temperature does not subside, but only rises, and the general condition noticeably worsens, this indicates the addition of a bacterial infection and the development of complications.

Chronic bronchitis

This diagnosis is made in case of cough with sputum for at least 3 months a year for 2 years or even more. The most common cause of chronic bronchitis is smoking. The main symptoms are a prolonged cough, shortness of breath may join. The cough is usually loose, beginning in the morning after sleep. A little sputum comes out. At the same time, in the cold season and in wet weather, the cough intensifies, but almost completely stops in the summer.

The general state of health does not change in any way, and the cough itself in smokers does not cause any concern and is habitual throughout life.

One of the characteristic features of this disease is the alternation of periods of exacerbation and remission.

People with symptoms of chronic bronchitis are more likely than others to suffer from acute respiratory infections or acute respiratory viral infections, while the risk of damage to the lower parts of the bronchial tree and the development of pneumonia increases several times.

In the future, during the period of exacerbation of bronchitis, the symptoms become more pronounced. The cough is greatly intensified, manifested by seizures, becomes hoarse, tearing the throat, without sputum discharge. Other symptoms appear – constant weakness, fatigue, night sweats. With exertion, shortness of breath begins to appear.

Occupational bronchitis

This type of chronic bronchitis develops in people of certain professions. Such people at work constantly deal with finely dispersed substances that enter the lungs when breathing.

This form of bronchitis, for example, often develops in people associated with the production of asbestos, coal, latex, talc, while working with cotton, silica.

Prolonged contact and inhalation of these substances irritate the lung tissue, accumulate in the lungs, which causes inflammation and coughing. With regular exposure to these factors, in the absence of treatment, chronic obstructive pulmonary disease (COPD) often develops.

Another bronchitis without fever – dust. It is also a chronic occupational lung disease that begins to develop when inhaling air containing an increased concentration of dust. Most often, miners suffer from it.

Diagnostics

Before starting treatment, it is necessary to diagnose bronchitis in order to understand its origin and find the causative agent of the disease (if any).

The main diagnostic procedures are:

  • general blood and urine test;
  • blood biochemistry;
  • X-ray of the chest organs or computed tomography – according to indications for the differential diagnosis of the disease and the identification of probable complications;
  • spirometry or peak flow;
  • if necessary, bronchoscopy or bronchography;
  • ECG, and if necessary – ultrasound of the heart;
  • microbiological sputum analysis.

To exclude hypoxia, especially if bronchiolitis is suspected, it is recommended to monitor saturation.

Differential diagnosis and complications

The symptoms of bronchitis often resemble those of pneumonia. Therefore, first of all, differential diagnosis with this dangerous disease is required. The main differences between pneumonia are respiratory failure, persistent fever, lesions in the lungs on the x-ray.

The most common complication of acute bronchitis is bronchopneumonia. It develops with a decrease in local immunity, lack of proper treatment, as well as with the addition of a bacterial infection.

In the case of chronic bronchitis, the risks of other lung diseases increase: COPD, bronchial asthma, emphysema and bronchiectasis, the likelihood of complications of acute respiratory infections in the form of bacterial pneumonia increases significantly.

Also, against the background of chronic lung diseases, disorders of the cardiovascular system are possible – hypertension, pulmonary hypertension.

Treatment

Therapy will depend on the presence or absence of complications, as well as the general condition of the patient.

Uncomplicated acute viral bronchitis

The therapy is carried out on an outpatient basis. Hospitalization is required only in case of development of respiratory failure and possible accession of pneumonia.

Signs of possible complications will be:

  • high temperature above 38 °C, pain in the chest, and the symptoms do not go away, increase over 2-3 days;
  • the appearance of shortness of breath, shortness of breath begins to develop with minimal physical exertion, at rest;
  • cough with bloody sputum;
  • children’s age;
  • the presence of concomitant serious diseases.

Cough with bronchitis is not so easy to cure. The main goals of treatment are to relieve symptoms of the disease and maintain immunity. Bronchitis without coughing is very rare.

Today, the most effective methods of treating acute bronchitis of viral etiology are:

  • antivirals;
  • paracetamol or ibuprofen – in case of temperature increase above 38 °C;
  • copious warm drink;
  • frequent airing of the room, the creation of good indicators of humidity and temperature. This noticeably facilitates breathing and improves the excretion of sputum;
  • smoking cessation;
  • mucolytic or antitussive drugs (depending on the type of cough).

Antibiotics for bronchitis of viral origin are not prescribed, since they are absolutely ineffective.

Acute obstructive bronchitis

Therapy of this type of inflammation has some features. Treatment is recommended to be carried out using a device that sprays the drug into the respiratory tract – a nebulizer.

For inhalation, solutions of mucolytics (ambroxol, acetylcysteine), bronchodilators (fenoterol and ipratropium bromide) are used. They are mixed with saline and help prevent the development of bronchial edema, which is important for preventing shortness of breath. In some cases, inhaled corticosteroids may be recommended for treatment. The duration of the course and the frequency of use of drugs are recommended only by a doctor.

Bacterial bronchitis

In the treatment of this type of disease, it is recommended to use antibacterial agents that are prescribed by the attending physician. A number of antibiotics can be prescribed as inhalations through a nebulizer. In addition, symptomatic therapy is recommended to improve sputum discharge.

A special group are patients at risk – those who are over 75 years of age, have severe comorbidities or are using immunosuppressive therapy. For them, the dosage of drugs is prescribed individually.

Chronic bronchitis

With the development of this course of the disease, long-term and individually selected treatment is required. There is no single cure for bronchitis for everyone: each treatment plan is made depending on the age of the patient, the symptoms present, the severity of their manifestation and the duration of the course.

In case of exacerbation and the appearance of purulent sputum, antibiotics can be prescribed, but this is done only according to the results of a sputum sensitivity test. They help to fight sputum with bronchitis, drugs that thin it and help to cough up.

If chronic bronchitis is allergic, antihistamines are prescribed. Recommended warm plentiful alkaline drink, breathing exercises, physiotherapy. Vitamin and mineral complexes may be prescribed.

After an exacerbation, a spa treatment is recommended. It is also important to identify and eliminate the provoking factor that led to the development of the disease in its chronic form.

Prognosis and prevention

With proper and timely treatment of bronchitis, the prognosis is favorable. Usually, full recovery occurs within 2-3 weeks from the onset of symptoms. However, a cough in a quarter of all patients can persist for another one, and in some cases two months.

Effective measures to prevent bronchitis include:

  • washing hands with soap, rinsing the nose and mouth with saline solution;
  • vaccination against bronchopulmonary infections;
  • smoking cessation;
  • proper nutrition with adequate protein content;
  • hardening.

It is also advisable to air the room hourly, do wet cleaning, control humidity and air temperature.

The author of the article:

Ivanova Natalya Vladimirovna

therapist

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