Bronchitis is an inflammation of the lining of the bronchial tubes, the airways that connect the trachea (windpipe) to the lungs. It is more specifically when the lining of the bronchial tubes becomes inflamed or infected. People with bronchitis breathe less air and oxygen into their lungs; they also have heavy mucus or phlegm forming in their airways. It can be acute or chronic. An acute medical condition occurs quickly and can cause severe symptoms, but it lasts only a short time (no longer than a few weeks). Acute is most often caused by viruses that can infect the respiratory tract and attack the bronchial tubes. Infection by certain bacteria can also cause acute bronchitis. Most people have acute bronchitis at some point in their lives.
Chronic can be mild to severe and is longer lasting from several months to years. With chronic, bronchial tubes continue to be inflamed (red and swollen), irritated, and produce excessive mucus over time. The most common cause of chronic is smoking.
1. Acute Bronchitis:
Acute bronchitis is swelling and inflammation of the main air passages to the lungs. This swelling narrows the airways, making it harder to breathe and causing other symptoms, such as a cough.
Acute bronchitis almost always follows a cold or flu-like infection. The infection is caused by viruses (influenza, parainfluenza, respiratory syncytial virus, rhinovirus, and adenovirus). At first, it affects the nose, sinuses, and throat. Then it spreads to the airways leading to the lungs. Sometimes, bacteria (Mycoplasma, Streptococcus, Bordetella, Moraxella, Haemophilus, and Chlamydia pneumonia) also infect the airways. This is called a secondary infection. In addition, other agents such as tobacco smoke, chemicals, and environmental air pollution may irritate the bronchi and cause acute bronchitis.
The symptoms of acute bronchitis may include:
- Chest discomfort.
- Cough that produces mucus; may be clear or yellow-green.
- Fever, usually low grade.
- Shortness of breath that gets worse with activity.
- Wheezing, in people with asthma.
- Even after acute bronchitis has cleared, a dry and nagging cough may remain for 1 to 4 weeks.
In acute bronchitis, coughing usually lasts between 10 to 20 days. There are no specific tests for acute bronchitis. Certain tests may be required if there is a recurrent or persistent cough that may suggest asthma or chronic bronchitis. Coughing for a period of greater than four weeks may be due to whooping cough (pertussis).
Sputum can be tested to see whooping cough (pertussis) or other illnesses that could be helped by antibiotics. Sputum can also be tested for signs of allergies.
- Chest X-ray
- Pulse oximetry
Acute bronchitis usually resolves its own within a couple of weeks, with complete healing of the airways and return to full function. Hence, treatment aims to control symptoms.
Treatment of acute bronchitis involves:
- Getting adequate rest and fluid intake.
- Use of analgesic and antipyretic medications to relieve muscle aches, pains, headaches, and to reduce fever.
- Use of cough suppressants for a dry cough, but not for a productive cough.
- Use of expectorants for productive cough, to help clear the airways of mucus.
- Stopping smoking and avoidance of other airborne irritants. Bronchitis usually results from a viral infection, so antibiotics are not effective.
Sometimes bacteria may also infect the airways along with the virus.
It is best not to suppress a cough that brings up mucus because coughing helps to remove irritants from the lungs and air passages.
Use bronchodilators like ipratropium bromide, theophylline to open obstructed airways in people who have associated wheezing with their coughing or underlying asthma or COPD.
2. Chronic Bronchitis:
Chronic bronchitis is a long-term, often irreversible respiratory illness. It is a chronic inflammatory condition in the lungs that causes the respiratory passages to be swollen and irritation increases mucus production and damages the lungs.
Bronchitis is considered “chronic” if symptoms continue for three months or longer. Bronchitis caused by allergies can also be classified as chronic bronchitis.
There are many causes of chronic bronchitis, but the main cause is cigarette smoke.
Many other inhaled irritants (for example, smog, industrial pollutants, toxic gases in the environment or workplace, and solvents) can also result in chronic bronchitis.
Viral and bacterial infections that result in acute bronchitis may lead to chronic bronchitis if people have repeated attacks with infectious agents. Also, underlying disease processes (for example, asthma, cystic fibrosis, immunodeficiency, congestive heart failure, familial genetic predisposition to bronchitis, and congenital or acquired dilation of the bronchioles) may cause chronic bronchitis to develop, but these are infrequent causes compared to cigarette smoking.
The major risk factor for individuals to develop chronic bronchitis are; Tobacco smoking and second – hand tobacco smoke exposure, repeated exposure to pollutants (especially airborne materials such as ammonia, sulfur dioxide, chlorine, bromine, hydrogen sulfide), dust, repeated attack of acute bronchitis or pneumonia, and gastric reflux (by inhalation of gastric contents).
The disease is caused by an interaction between noxious inhaled agents and host factors, such as genetic predisposition or respiratory infections which cause injury or irritation to the respiratory epithelium of the walls and lumen of the bronchi and bronchioles. Chronic inflammation, edema, temporary bronchospasm, and increased production of mucus by goblet cells are the result. As a consequence, airflow into and out of the lungs is reduced, sometimes to a dramatic degree.
Most cases of chronic bronchitis are caused by smoking cigarettes or other tobacco products, although other examples of noxious agents include fumes from cleaning products and solvents, dust from occupational exposure, and air pollution. Ammonia, sulfur dioxide, chlorine, bromine, and hydrogen sulfide are especially harmful pollutants that are linked to respiratory diseases.
Chronic bronchitis must be distinguished from common allergies which also cause mucus hypersecretion and coughing fits. When chronic bronchitis progresses to include the pathologic changes of emphysema, it is often referred to as COPD.
- Bluish skin due to lack of oxygen (cyanosis).
- Breathing difficulty including wheezing and shortness of breath.
- Cough and sputum production are the most common symptoms; they usually last for at least 3 months and occur daily. The intensity of coughing and the amount and frequency of sputum production vary from patient to patient. Sputum may be clear, yellowish, greenish, or occasionally, blood-tinged.
- Fever may indicate a secondary viral or bacterial lung infection.
- Muscles around the ribs sink in as the child tries to breathe in (called intercostal retractions).
- Infant’s nostrils get wide when breathing
- Rapid breathing (tachypnea).
In addition, symptoms of sore throat, muscle aches, nasal congestion, and headaches can accompany the major symptoms. Severe coughing may cause chest pain.
It includes past and current smoking habits and lives with someone who smokes, any history of on-the-job exposure to airborne irritants, and any family history of respiratory diseases, such as cystic fibrosis or emphysema.
Physical exams include wheezes (high-pitched sounds that occur when air is pushed out through constricted airways), and rales (small rattling sounds that result when air moves through airways filled with fluid). The vibration from the chest percussion helps to determine the size and condition of the lungs.
- Complete blood cell count (CBC).
- Arterial blood gases (ABG) test.
- Chest X-ray.
The goal of therapy for chronic bronchitis is to relieve symptoms, prevent complications and slow the progression of the disease. Quitting smoking is the most important and most successful treatment for chronic bronchitis, since continuing to use tobacco will only further damage the lungs.
Medications used for the treatment of bronchitis are:
Bronchodilator: Salmeterol, Albuterol, Metaproterenol and Formoterol
Anticholinergic: Ipratropium bromide and Tiotropium
Steroids: Prednisone, Dexamethasone
PDE4 inhibitors: Roflumilast
Antibiotics: Macrolides, Azithromycin sulfonamides, Tetracyclines, Trimethoprim, and Fluoroquinolones
Vaccines: Patients with chronic bronchitis should receive a flu shot annually and a pneumonia shot every five to seven years to prevent infections.
Oxygen Therapy: As a patient’s disease progresses, they may find it increasingly difficult to breathe on their own and may require supplemental oxygen.
Surgery: Lung volume reduction surgery, during which small wedges of damaged lung tissue are removed, may be recommended for some patients with chronic bronchitis.
Pulmonary Rehabilitation: An important part of chronic bronchitis treatment is pulmonary rehabilitation, which includes education, nutrition counseling, learning special breathing techniques, help with quitting smoking, and starting an exercise regimen. Because people with chronic bronchitis are often physically uncomfortable, they may avoid any kind of physical activity. However, regular physical activity can improve a patient’s health and well-being.
Cough suppressants: Cough suppressants such as dextromethorphan may help reduce cough symptoms.
The majority of instances of chronic bronchitis can be prevented by quit smoking and avoiding second-hand smoke.
Flu and pneumococcal vaccines can help to prevent repeated infections that may lead to the disease.
Certain industries (for example, chemical, textile, thermal, etc.) and farm workers are often associated with air-borne chemicals and dust; avoiding air-borne chemicals and dust with appropriate masks may prevent or reduce the individual’s chance of developing chronic bronchitis.
Good control of asthma may prevent chronic bronchitis from developing. The genetic predisposition to chronic bronchitis is not currently preventable.
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