Acute bronchitis

Definition

Acute bronchitis is inflammation of the main airways to the lungs called the bronchi. It is usually caused by an infection. Symptoms of acute bronchitis may last several weeks. 

See also chronic bronchitis.

Causes, incidence, and risk factors

Acute bronchitis is one of the most common medical conditions seen in a doctor's office. It is primarily caused by a virus that infects the respiratory system. There are a number of different respiratory viruses that can do this, including the rhinovirus, which causes the common cold. 

The classic symptoms of bronchitis may mimic a cold. A tickle in the back of the throat progresses into a dry, irritating cough. But as the infection gets worse, a person may cough up thick, yellow mucus that may (rarely) be streaked with blood.

Sometimes the symptoms of bronchitis do not appear until the underlying viral infection has gone away, and a secondary bacteria infection causes the coughing symptoms of bronchitis.

Whooping cough and sinusitis may cause symptoms similar to bronchitis. It is important to see your health care provider to get a correct diagnosis.

You have a higher risk for getting bronchitis if you've had a recent illness or viral respiratory infection (which reduce your ability to fight off infections), or if you have chronic lung problems such as asthma, cystic fibrosis, or chronic obstructive pulmonary disease. You are also at higher risk for bronchitis if you smoke.

Symptoms

• Cough
  • Stays steady or gets increasingly worse for 10 days to 2 weeks
  • Worse at night
  • Starts out dry and irritating, but becomes increasing loose over time
  • May cough up mucus. (Younger kids usually can't cough this up; they swallow it.)
  • In very rare cases, patients may cough up blood (blood streaked sputum). See a doctor if this happens.
  • Lasts for less than 6-8 weeks
• Shortness of breath
• Wheezing
• "Rattle" sensation in chest
• General ill feeling (malaise )
• Slight fever
• Tickle feeling in back of throat that leads to soreness
• Chest pain, soreness, and constricted feeling in the chest
• Poor sleep
• Chills (uncommon)

Signs and tests

A diagnosis of acute bronchitis is made by reviewing a patient's current health and medical history. A physical examination and chest x-ray help rule out the presence of pneumonia.

Treatment

The goal of treatment is to relieve the symptoms. 

In otherwise healthy people, antibiotics should only be prescribed after 10-14 days of persistent cough. At that point, a bacterial infection or presence of sinusitis should be considered.

Medications called bronchodilators that open constricted air passages in the lungs (albuterol) are prescribed for patients with wheezing.

Decongestants (such as pseudoephedrine) may also help alleviate the symptoms of bronchitis. Medications that liquefy mucus secretions (mucolytic agents, like guaifenesin) may also be prescribed, but how well they work remains uncertain.

The patient will also be told to rest, increase humidity (using a cool mist humidifier) to soothe air passages, and increase fluid intake to stay hydrated and to thin mucous lung secretions.

Expectations (prognosis)

Symptoms usually abate within 7 to 14 days in the absence of prior chronic pulmonary disease. However, in some patients, it commonly takes much longer for the cough to go completely away.

Complications

Pneumonia is a possible complication. The presence of sinusitis must also be considered. Patients with asthma or other lung conditions may have a worsening of symptoms.

Calling your health care provider

Call your health care provider if  you have symptoms of acute bronchitis.

Call your health care provider if you are being treated for acute bronchitis and:

• Symptoms last longer than two weeks
• Breathlessness or wheezing develops
• You cough up blood

Prevention

Good handwashing is one of the best ways to avoid exposure to viruses and other respiratory infections.

Since flu viruses have been shown to be a significant cause of bronchitis, getting a flu shot may also help prevent acute bronchitis.

Minimize exposure to cold, damp environments which, combined with air pollution or tobacco smoke, may make people more susceptible to bronchitis.

References

Knutson D. Diagnosis and Management of Acute Bronchitis. Am Fam Physician. May 2002; 65(10): 2039-44.

Aagaard E. Management of Acute Bronchitis in Healthy Adults. Infect Dis Clin North Am. Dec 2004; 18(4): 919-37.

American Academy of Pediatrics. Cough Illness/Bronchitis. In: Pickering LK, ed. Red Book: 2003 Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003:696.

Illustrations

Lungs

Bronchitis

Lung anatomy

Bronchitis and Normal Condition in Tertiary Bronchus

Respiratory system

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