Summary

Bronchitis is a disease of the respiratory system. It occurs when the air passages (bronchial tubes) leading from the trachea to the lungs become irritated or inflamed. This can be caused by viral infections such as a cold or the flu, or irritants such as tobacco smoke and industrial fumes.

There are two different types of bronchitis:

• Acute bronchitis

• Chronic

These two types of bronchitis have different origins, symptoms, treatment and methods for prevention. Acute bronchitis is an infection that is usually treated with rest, liquids and over-the-counter medications. Chronic bronchitis is a feature of continually irritated airways and is common among smokers and workers exposed to environmental irritants. The best treatment for chronic bronchitis is avoiding exposure to the irritant by quitting smoking or wearing protective clothing (e.g., a mask) at work.

About bronchitis

Bronchitis is an inflammation of the mucous membranes in the bronchial tubes, which connect the windpipe (trachea) to the lungs. It is a common disease that affects most people at some point in their life. There are two types of bronchitis: acute bronchitis and chronic bronchitis. Although the conditions are similar, acute bronchitis is more common and less severe than chronic bronchitis.

Bronchitis occurs when the bronchial tubes become irritated, either as the result of a viral infection such as influenza (the flu) or because of environmental irritants such as smoke or fumes. This causes the bronchial tubes to swell and produce thick mucus, which lines the tubes. This mucus can block the airways and make it difficult to breath. Bronchitis is characterized by the presence of a persistent cough, which may start as a dry cough but usually develops into a moist cough which produces yellow-green sputum. Severe bronchitis is also often accompanied by a high fever which can last several days.

Acute bronchitis is the type of bronchitis with which most people are familiar. It is a respiratory tract infection that generally resolves within several days or weeks. Acute bronchitis usually occurs after the body has been infected with a cold or the flu. Because the origin of acute bronchitis is usually viral, antibiotics are ineffective at treating the condition. However, antibiotics are often still prescribed for acute bronchitis, making it a common reason for antibiotic abuse. Acute bronchitis is contagious.

Chronic bronchitis is usually related to smoking or other environmental irritants of the airways. It includes a moist cough and an overproduction of mucus. Symptoms of chronic bronchitis usually reoccur until the cause of the condition (e.g., cigarette smoke, occupational irritants) is identified and removed. Chronic bronchitis is defined by the presence of a mucus–producing cough most days of the month for at least three months of the year, for two successive years without any other underlying disease to explain the cough.

Chronic bronchitis is often linked to chronic obstructive pulmonary disease (COPD). COPD refers to chronic, progressive diseases of the lungs, such as emphysema, that reduce airflow over time. COPD is one of the leading causes of death in the United States.

People with chronic bronchitis can sometimes experience a temporary worsening of their condition that produces symptoms similar to acute bronchitis. This is called acute exacerbation of chronic bronchitis (AECB).

Repeated bouts of acute bronchitis should be taken seriously. They may signal lung disorders like chronic bronchitis or asthma, or other conditions such as postnasal drip syndrome or gastroesophageal reflux disorder. Chronic bronchitis is also reported to increase the risk of lung cancer. Anyone who suspects they may have a form of bronchitis should contact a physician for a medical evaluation.

Risk factors and causes of bronchitis

Most people are affected by bronchitis at some point in their life. However, some people are at a higher risk for bronchitis than others. People at high risk of developing bronchitis include:

• Smokers. People who smoke and those who are regularly subjected to secondhand smoke are at a significantly higher risk for both acute and chronic bronchitis than nonsmokers. Tobacco smoke paralyzes many of the natural defenses that the body has to protect itself from infection. Additionally, tobacco smoke causes permanent damage to the respiratory system, which increases the risk for chronic respiratory diseases including chronic bronchitis, emphysema and cancer.

• People with weakened immune systems. Older adults, young children and people with conditions that affect the immune system (e.g., HIV/AIDS, diabetes) are at a higher risk of contracting acute bronchitis.

There are several important distinctions in the way each type of bronchitis is contracted. Acute bronchitis is generally infectious and caused by viruses, whereas chronic bronchitis is usually caused by smoking or environmental irritants and is not contagious. Thus, acute bronchitis is more likely to occur during winter months, when viral infections are more easily spread from person to person. Chronic bronchitis is more likely to occur among people living or working in environments where they are exposed to high levels of pollutants or chemicals. 

Causes of acute bronchitis include:

• Viral infection. Contracting a viral infection such as a cold or the flu is one of the most common causes of acute bronchitis. People who develop bronchitis as a result of these upper respiratory infections may also have symptoms similar to a cold or the flu, including a fever.

  

• Bacterial infection. Bacteria such as Chlamydia pneumoniae and mycoplasma pneumoniae can cause acute bronchitis and pneumonia. Bronchitis caused by chlamydia pneumoniae and mycoplasma pneumoniae is more common in children and young adults, and often produces only mild symptoms. Bacteria such as Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis may cause acute bronchitis in middle-aged and older adults.

• Pertussis (whooping cough). Whooping cough is an inflammation of the lining of breathing passages characterized by a persistent and violent cough, which can lead to bronchitis. Whooping cough is no longer as common as it once was as the result of an aggressive immunization campaign, but the number of cases of whooping cough have been slowly increasing over the last 20 years. This is related to decreasing level of immunity to pertussis in previously immunized patients.

• Acute exacerbation of chronic bronchitis (AECB). This type of bronchitis may be more severe than other types because the bronchial tubes have already been damaged by chronic bronchitis. It occurs in people with chronic bronchitis who contract viral infections.  

Causes of chronic bronchitis include:

• Tobacco smoke and other environmental irritants. Tobacco smoke, including secondhand smoke, irritates the airways in adults and children. It is harmful to lung health and may contribute to the development of bronchitis, pneumonia, ear infections and sudden infant death syndrome (SIDS) in children. Also, workers with exposure to metalworking fluids, swine confinement facilities, production of flavorings, pesticides and other irritants may experience bronchitis and other respiratory problems. The use of protective clothing, including gloves and masks, may be helpful in reducing exposure to these environmental irritants.

• Chronic obstructive pulmonary disease (COPD). This disease obstructs air flow in the lungs, and includes emphysema and chronic bronchitis. People with this condition have long-term damage and blockage of the breathing tubes. COPD is common among older adults, especially those who are or were smokers.

• Air pollution/chemicals in the air. Some chemicals in the air, such as ozone, contribute to airway irritation. Continual exposure to these substances may be detrimental to lung health and contribute to chronic bronchitis. Small pollutant particles settle in to the narrow passages of the lungs, which may contribute to a cough and an increased production of mucus.

Signs and symptoms of bronchitis

The signs and symptoms of acute and chronic bronchitis, while similar, have some important differences. The origin of the two types of bronchitis: acute bronchitis and chronic bronchitis.

Acute bronchitis is a condition that often accompanies a cold or the flu. Symptoms may reflect the cause of the infection. For example, bronchitis that is caused by the flu virus results in symptoms similar to the flu, including fever. Bronchitis caused by colds may produce milder symptoms. Typical signs and symptoms of acute bronchitis include:

• Moist cough
• Cough that produces yellow or green sputum
• Sore chest
• Breathlessness
• Wheezing
• Fatigue

Most cases of this type of bronchitis clear up within a few days. However, a dry, nagging cough may continue for several weeks or months.

Chronic bronchitis is a condition in which signs and symptoms do not come on suddenly, nor do they go away. The symptoms of chronic bronchitis are similar to acute bronchitis, although there is rarely a fever. In addition to the symptoms of acute bronchitis, chronic bronchitis often includes:

• Regular coughing and excessive mucus production
• Cough that is worse in the morning and in damp, cold weather
• Symptoms that worsen with high air pollution and during smoking
• Frequent respiratory infections (e.g., colds, the flu)
• Swelling of the legs, ankles or feet
• Blue-tinged lips from cyanosis (lack of oxygen)

As the condition worsens, patients may find themselves becoming increasingly short of breath. As a result, they may have difficulty walking and participating in physical activities.

Diagnosis methods for bronchitis

To diagnose bronchitis, a physician will review a patient’s medical history and perform a physical examination that includes listening to the chest with a stethoscope. The symptoms of acute bronchitis are similar to those of pneumonia so a physician may also recommend a chest x–ray to rule out that possibility. A sputum culture, which checks for the presence of bacteria in coughed–up mucus, may also be performed.

Additional tests may be performed to identify other potential causes for bronchitis symptoms. A pulmonary function test (PFT) may be necessary. The PFT is a painless and noninvasive test that measures lung function. A PFT involves the patient exhaling into a spirometer, a device that measures the volume of air exhaled from the lungs and determines how quickly the patient can exhale recently inhaled air from the lungs. The PFT results will indicate to the physician the state of the patient’s lung function.

Treatment and prevention of bronchitis

Acute bronchitis is usually caused by a viral infection, thus antibiotics are not usually effective. Treatment for most cases of acute bronchitis is similar to that for the flu, which includes getting plenty of rest, liquids and ensuring adequate humidity in the environment. Warm, moist air may help relieve a cough and loosens mucus in the airways.

Over–the–counter (OTC) cough medications may also be helpful. However, cough suppressants are not usually recommended because coughing helps clear the respiratory tract of mucus. They may be used (in mild doses) when the ability to sleep is interrupted by coughing.

OTC pain relievers, such as acetaminophen, can also be used to reduce fever. Aspirin should never be given to children or teenagers, due to the risk of developing Reye syndrome, a quick-acting and life-threatening condition associated with the use of aspirin in children and teens after a viral infection. Patients are advised to consult their physician before taking any type of medication, including OTC remedies.

Antibiotics may be required to treat acute bronchitis caused by bacterial infection. Antibiotics may also be used to treat patients at risk of serious complications as a result of acute bronchitis.

One of the easiest ways to prevent transmission of the viruses that can cause acute bronchitis is by practicing good hygiene. This includes washing hands after coughing or sneezing, or after coming into contact with a person with an infection. It is also important to cover the nose and mouth when sneezing or coughing. The spread of a virus can also be prevented by not sharing items such as towels, eating utensils, bottles or beverage containers with others. Tissues should be promptly disposed of after use and hands should be washed after handling used tissues.

Also, because acute bronchitis may be a result of the flu, getting an annual flu shot may offer protection and prevention of this condition. An annual pneumonia shot may be helpful in preventing bronchitis and protecting the lungs in older adults, or patients with risk factors like diabetes, heart disease or emphysema.

The treatment of chronic bronchitis is aimed at reducing the irritation in the bronchial tubes. This may be accomplished by quitting smoking or eliminating the environmental irritants that are disturbing and irritating the airways. If environmental irritants are occurring at work, wearing a mask to protect the patient from polluted air may be helpful. Patients should also avoid other irritants, such as aerosol products (e.g., hairspray, spray paint, spray deodorant). If there is a tendency for the patient to experience a closing up of the airways, bronchodilator drugs may be prescribed to help relax and open up the air passages. Corticosteroids may also be recommended to help reduce the swelling of airway passages. In severe to extreme cases, oxygen therapy or lung transplant surgery may be needed.

Chronic bronchitis is often neglected until it is in an advanced state, and frequently the lungs have been seriously injured by the time the patient consults a physician. Chronic bronchitis patients should work with a physician to develop and follow a plan for a healthy lifestyle to help prevent this condition. This includes a diet of nutritious food, getting regular exercise and quitting smoking. Vaccinations for the flu and pneumonia may also help improve the body’s overall resistance to infection.

Questions for your doctor regarding bronchitis 

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about bronchitis:

1. Do my symptoms indicate bronchitis?

2. What tests will you use to determine if I have bronchitis?

3. What over-the-counter medications may be effective to relieve symptoms?

4. Will I need an antibiotic? What are my treatment options?

5. When can I expect to see an improvement in symptoms?

6. Does bronchitis pose a danger to my overall health?

7. Should I contact you if my symptoms become worse? Under what circumstances should I go to the hospital?

8. Is my bronchitis contagious?

9. Can you recommend techniques to help me quit smoking?

10. Would I benefit from the flu and pneumonia vaccinations?

Source: http://yourtotalhealth.ivillage.com/bronchitis.html