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Acute bronchitis

What is acute bronchitis?

Air is pulled into the lungs when we breathe, initially passing through the mouth, nose, and larynx (voice box) into the trachea and continues en route to each lung via either the right or left bronchi (the bronchial tree - bronchi, bronchioles, and alveoli). Bronchi are formed as the lower part of the trachea divides into two tubes that lead to the lungs. As the bronchi get farther away from the trachea, each bronchial tube divides and gets smaller (resembling an inverted tree) to provide the air to lung tissue so that it can transfer oxygen to the blood stream and remove carbon dioxide (the waste product of metabolism).
Bronchitis describes inflammation of the bronchial tubes (inflammation = itis). The inflammation causes swelling of the lining of these breathing tubes, narrowing the tubes and promoting secretion of inflammatory fluid.

Acute bronchitis describes the inflammation of the bronchi usually caused by a viral infection, although bacteria and chemicals also may cause acute bronchitis. Bronchiolitisis a term that describes inflammation of the smaller bronchi referred to as bronchioles. In infants, this is usually caused by respiratory syncytial viruses (RSV), and affects the small bronchi and bronchioles more than the large. In adults, other viruses as well as some bacteria can cause bronchiolitis and often manifest as a persistent cough at times productive of small plugs of mucus.

Acute bronchitis is as mentioned above, is a cough that begins suddenly usually due to a viral infection involving the larger airways. Colds (also known as viral upper airway infections) often involve the throat (pharyngitis) and nasal passages, and at times the larynx (resulting in adminished hoarse voice, also known as laryngitis). Symptoms can include a runny nose, nasal stuffiness, and sore throat. Croup usually occurs in infants and young children and involves the voice box and upper large airways (the trachea and large bronchi).

Chronic bronchitis for research purposes is defined as a cough with sputum production for at least three months, two years in a row. Chronic bronchitis is a diagnosis usually made based on clinical findings of a long term persistent cough usually associated with tobacco abuse. From a pathologic standpoint, characteristic microscopic findings involving inflammatory cells in seen in airway tissue samples make the diagnosis. When referring to pulmonary function testing, a decrease in the ratio of the volume of airflow at 1 second when compared to total airflow is less than 70%. This confirms the presence of obstructive airways disease of which chronic bronchitis is one type. Certain findings can be seen on imaging studies (chest X-ray, and CT or MRI of the lungs) to suggest the presence of chronic bronchitis; usually this involves an appearance of thickened tubes.



What causes acute bronchitis?

Acute bronchitis occurs most often due to a viral infection that causes the inner lining of the bronchial tubes to become inflamed and undergo the changes that occur with any inflammation in the body. Common viruses include the rhinovirus, respiratory syncytial virus (RSV), and the influenza virus.

Bacteria can also cause bronchitis (a few examples include,Mycoplasma, Pneumococcus, Klebsiella, Haemophilus).

Chemical irritants (for example, tobacco smoke, gastric reflux, solvents) can cause acute bronchitis.

What are the risk factors for acute bronchitis?

Bronchitis describes inflammation of the bronchial tubes. Smoking is a key risk factor for developing acute bronchitis. Any other illnesses that predispose to similar inflammation also increase that risk (for example, asthma patients and patients allergic to airborne chemicals).

What are the symptoms of acute bronchitis?

Inflammation of the bronchial tubes narrows the inside opening of the bronchial tubes. Narrowing of the bronchial tubes result in increased resistance, this increase makes it more difficult for air to move to and from the lungs. This can cause wheezing, coughing, and shortness of breath. The cough may consist of sputum due to the secretions from the inflamed cells that line the bronchi. By coughing, the body attempts to expel secretions that clog the bronchial tubes. If these secretions contain certain inflammatory cells, discoloration of the mucus may result often in a green or yellow colour. Sometimes the severity of the inflammation may result in some bleeding.

As with any other infection, there may be associated fever, chills, aches, soreness and the general sensation of feeling poorly or malaise.

When does a cold become acute bronchitis?

Anatomically, the larynx divides the upper and lower airways. Colds tend to affect the mouth, throat, and nasal passages while bronchitis describes specific inflammation of the bronchial tubes. The two illnesses can exist at the same time and may be caused by the same virus infection. A cold does not necessarily lead to bronchitis.

When should I call my doctor about my cough?

While a cough can be irritating and interfere with activities such as sleep, by itself, it needs little care. Drinking plenty of fluids to prevent dehydration, humidifying the air, and occasionally medication to suppress the cough are appropriate home care treatments.
However, medical care should be accessed immediately should shortness of breath occur. Fever, chills, wheezing, and signs of dehydration (light-headedness, weakness, and rapid heart rate) are also reasons to seek medical care. Most coughs tend to subside after a few days. If the cough persists and mucus tends to be discoloured, one should seek medical care.

In patients with asthma, wheezing may increase with acute bronchitis. Use of a prescribed albuterol inhaler (Ventolin HFA, Proventil HFA, ProAir) is reasonable; however, asthma patients should contact their health care practitioner if the symptoms of wheezing and shortness of breath do not resolve promptly.

How is acute bronchitis diagnosed?

Acute bronchitis is usually diagnosed through patient history and physical examination.

Patient history

The health care practitioner may ask the following questions about the symptoms:

1.What symptoms exist?
2.When did they start?
3.Is there a related fever?
4.Is sputum being brought up by coughing?
5.Is the sputum or colour-tinted?
6.Is there any blood tinge?
7.Does the person smoke?
8.Is there a history of asthma or COPD?
9.Does the patient take any medications or inhalers that are used to treat underlying illnesses?
10.What has the patient done to treat the symptoms?
11.Were these measures successful?

Physical examination

The health care practitioner may examine of the patient's upper airways to look for signs of ear, nose, or throat infection including redness of the tympanic membranes (ear drums), runny nose, and post nasal drip. Redness of the throat or swelling and pus on the tonsils can help distinguish common cold, tonsillitis, and acute bronchitis symptoms. The neck may be palpated or felt to check for swollen lymph nodes. Listening to the lungs may reveal decreased air entry and wheezing.

A chest X-ray may be considered by the health care practitioner if there is a concern that a pneumonia or infection of lung tissue is present.

Blood tests are usually not helpful; occasionally, cultures of sputum are done if a bacterial pathogen is suspected.

What are the treatments for acute bronchitis?

Decreasing inflammation is the goal for treating acute bronchitis.

Albuterol inhalation, either with a hand held device (meter dosed inhaler, MDI) or nebulizer will help dilate the bronchial tubes.

Short-term steroid therapy will help minimize inflammation within the bronchial tubes. Prednisone is a common prescription medication that enhances the anti-inflammatory effects of the steroids produced within the body by the adrenal glands. Topical inhaled steroids may also be of benefit with fewer potential side effects.

It is important to keep the patient comfortable by treating fever with acetaminophen or ibuprofen. Drinking plenty of fluid will keep the patient well hydrated and hydration keeps secretions into the bronchial tubes more liquid and easier to expel.

Antibiotics are not necessarily indicated for the treatment of acute bronchitis.

Occasionally they may be prescribed should a bacterial infection be present in addition to the usual virus that causes acute bronchitis. However, most acute bronchitis is caused by viruses and no antibiotics are needed.

Although good hydration will help remove secretions into the bronchi, other treatments (for example, Mucinex, Robitussin and others that contain guaifenesin) can help clear secretions though this is often a highly variable finding.

Cough is a very violent action that results in dynamic collapse of the airways. This collapse results in the walls of the airways banging against one another. This action of cough can cause further inflammation and help perpetuate the problem by sustaining and increasing inflammation. Cough suppression with cough drops or other liquid suppressants (for example, Vicks 44, Halls, and cough syrups that contain dextromethorphan) help to break this vicious cycle. In addition, if the person smokes, they should stop. If the acute bronchitis is being caused by inhaled smoke or chemicals, the patient should be removed from these irritant sources.

Can I treat acute bronchitis at home?

The treatment of acute bronchitis is geared toward prevention, control, and relief of symptoms (supportive care). In some cases, the following is all that is needed:

drink plenty of fluids to maintain proper hydration (avoiding dehydration and humidify air);

and use of acetaminophen and ibuprofen to treat fever and decrease the inflammatory response.

The treatments section above covers those actions that can usually be done at home. However, people with medical conditions such as high blood pressure should be careful to choose those products approved for patients with pressure because some cough/cold formulations may further increase a person's blood pressure to elevated or dangerous levels. People with diabetes should also choose cough that will not affect their blood glucose levels. If individuals are unsure which products are safe, they should contact their primary health care practitioner for advice.

For patients with underlying lung disease such as asthma or COPD, increased use of albuterol or similar inhaled medications may be indicated. However, the health care practitioner should be contacted when a patient considers altering their medication usage.

What are the complications of acute bronchitis?

Acute bronchitis usually resolves spontaneously (about 2-3 weeks) with supportive care. If wheezing and shortness of breath occurs the patient should seek medical care.
In patients who have underlying lung conditions, the inflammation can cause lung tissue to function improperly. Pneumonia or infection of the lung tissue itself may develop.

Acute Bronchitis at a Glance

Acute bronchitis describes an infection and inflammation of the breathing tubes leading to cough and occasional wheezing.

Treatment is supportive keeping fever under control and the patient well hydrated.
Wheezing is often treated with inhaled albuterol, either by puffer (HFA) or nebulizer.
Steroid medication may be used short term to help decrease the inflammation within the bronchial tubes.

Patients with underlying lung diseases such as asthma or COPD may be at greater risk of developing acute bronchitis.

Antibiotics are not commonly prescribed for acute bronchitis but may be prescribed if specifically indicated.

REFERENCES:; "Bronchitis, Acute and Chronic."; "Bronchitis."

Reference: Harrison's Principles of Internal Medicine. Braumwald E, Fauci AS, et al. 17th Edition. 2007. McGraw Hill