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Bronchitis

Definition

Bronchitis is an inflammation of the main air passages to the lungs. Bronchitis may be short-lived (acute) or chronic, meaning that it lasts a long time and often recurs.

Causes, incidence, and risk factors

Acute bronchitis generally follows a viral respiratory infection. Initially, it affects your nose, sinuses, and throat and then spreads to the lungs. Sometimes, you may get another (secondary) bacterial infection in the airways.This means that bacteria infect the airways, in addition to the virus.

People at risk for acute bronchitis include:

Elderly, infants, and young children
Smokers
People with heart or lung disease

Chronic bronchitis is a long-term condition. People have a cough that produces excessive mucus. To be diagnosed with chronic bronchitis, you must have a cough with mucus most days of the month for at least 3 months.

Chronic bronchitis is also known as chronic obstructive pulmonary disease, or COPD for short. (Emphysema is another type of COPD.) As the condition gets worse, you become increasingly short of breath, have difficulty walking or exerting yourself physically, and may need supplemental oxygen on a regular basis.

Cigarette smoke, including long-term exposure to second-hand smoke, is the main cause of chronic bronchitis. The severity of the disease often relates to how much you smoked or how long you were exposed to the smoke.

The following things can make bronchitis worse: Air pollution, certain occupations (like coal mining, textile manufacturing, or grain handling), infection, and allergies.

Symptoms

The symptoms of either type of bronchitis include:

Cough that produces mucus; if yellow-green in color, you are more likely to have a bacterial infection
Shortness of breath worsened by exertion or mild activity
Wheezing
Fatigue
Fever -- usually low
Chest discomfort

Even after acute bronchitis has cleared, you may have a dry, nagging cough that lingers for several weeks.

Additional symptoms of chronic bronchitis include:

Frequent respiratory infections (such as colds or the flu)
Ankle, feet, and leg swelling
Blue-tinged lips from low levels of oxygen

Signs and tests

Rales (abnormal sounds in the lungs) or other abnormal breathing sounds may be heard by your doctor on lung examination with a stethoscope.
Pulmonary (lung) function tests provide information useful for diagnosis and prognosis.
Pulse oximetry is a device connected to your finger that displays the amount of oxygen in your blood.
Arterial blood gas is a more exact (but more painful and invasive) measurement of oxygen and carbon dioxide levels.
Chest x-ray
Sputum samples may be taken, to check for evidence of inflammation or bacterial infection .

Treatment

For acute bronchitis caused by a virus, you DO NOT need antibiotics. The infection will generally clear on its own within one week. Take the following steps for some relief:

Take aspirin or acetaminophen (Tylenol) if you have a fever. DO NOT give aspirin to children .
Rest.
Drink plenty of fluids.
Use a humidifier or steam in the bathroom.
DO NOT smoke.

If your symptoms do not improve, your doctor may prescribe an inhaler to open your airways. If your doctor thinks that you have a secondary bacterial infection, antibiotics will be prescribed.

For chronic bronchitis, the most important step you can take is to QUIT smoking. If caught early enough, you can reverse the damage to your lungs. Other important steps include:

Limit your exposure to pollutants and other lung irritants.
Get a flu vaccine each year and a pneumococcal vaccine as directed by your doctor.
Attend a respiratory training program that includes physical activity and breathing exercises. Your doctor can recommend a medically appropriate and well-supervised program. If it is early in your disease process, you can likely exercise on your own; talk to your doctor about safety.

Your doctor will usually prescribe inhaled medicines for chronic bronchitis. These drugs, which include bronchodilators like albuterol and ipratropium, open your constricted airways and aid in the clearance of mucus. An oral bronchodilator called theophylline and steroids (either inhaled or by mouth) are often necessary as well. If you have an active infection, your doctor will put you on antibiotics and sometimes recommend regular antibiotics to prevent infection.

If you have low oxygen levels, home oxygen will be used.

Expectations (prognosis)

For acute bronchitis, symptoms usually resolve within 7 to 10 days if you do not have an underlying lung disorder. However, a dry, hacking cough can linger for a number of months.

The chance for recovery is poor for people with advanced chronic bronchitis. Early recognition and treatment, combined with smoking cessation, significantly improve the chance of a good outcome.

Complications

Pneumonia can develop from either acute or chronic bronchitis. If you have chronic bronchitis, you are susceptible to recurrent respiratory infections. You may also develop:

Right-sided heart failure or cor pulmonale
Emphysema
Pulmonary hypertension

Calling your health care provider

Call your doctor if:

You are coughing up blood.
You have a high fever or shaking chills.
You have a low-grade fever for three or more days.
You have thick, greenish mucus, especially if it has a bad smell.
You feel short of breath or have chest pain.
You have an underlying chronic illness, like heart or lung disease.
You have a cough most days of the month or you have a frequently recurring cough.

Prevention

Wash your hands (and your children's hands) frequently to avoid spreading viruses and other infections.
DO NOT smoke.
Get an annual flu vaccine and a pneumococcal vaccine as directed by your doctor.
Minimize exposure to air and other pollutants.

References

Murray JF, Nadel JA. Textbook of Respiratory Medicine. 3rd ed. Philadelphia, PA: WB Saunders; 2000; 1215-1216.

Macfarlane J, Holmes W, Gard P, Thornhill D, Macfarlane R, Hubbard R. Providing patient information reduces antibiotic use in acute bronchitis. Evidence-based Healthcare. 2002; 6(3): 130.

Radon K. Passive smoke exposure: a risk factor for chronic bronchitis and asthma in adults? Chest. 2002; 122(3): 1086-1090.