Bronchitis

(Upper Respiratory Tract Infection; Lower Respiratory Tract Infection)

Definition

The bronchi are air passages of the lungs. Bronchitis is inflammation of the bronchi. It can make breathing difficult. It can also be painful.

Bronchi of Lungs

There are different types of bronchitis, such as:

Acute bronchitis—This is a sudden onset of symptoms. It only lasts a short time. There is full recovery of lung function.
Chronic bronchitis—This is a long term condition. It causes obstruction and erosion of the lungs. It is often the result of many years of cigarette smoking. This is a serious condition. It is a type of chronic obstructive pulmonary disease (COPD).
Asthmatic bronchitis—It occurs in people with asthma during an asthma attack. It is most common with allergies.
Irritative bronchitis—This is due to frequent contact with certain irritants. This often happens because of work setting (also known as industrial or environmental bronchitis).

Causes

The inflammation may be caused by:

Bacterial and viral infections
Smoking (cigarettes or marijuana)
Inhalation of certain respiratory irritants (usually in work setting) such as:
- Ammonia
- Chlorine
- Minerals
- Vegetable dusts

Risk Factors

Risk factors for bronchitis include:

Smoking
Exposure to second-hand smoke
Contact with a person infected with bronchitis
Viral upper respiratory tract infection (cold or flu)
Asthma
Chronic sinusitis
Occupational exposures to respiratory inhalants
Smog, in susceptible individuals
Enlarged tonsils and/or adenoids
Malnutrition

Symptoms

Symptoms will depend on the type of bronchitis.

Acute Bronchitis

Runny nose
Malaise
Slight fever
Back and muscle pain
Sore throat
Cough, initially dry, then produces mucus that may be thick, yellow, green, blood-streaked
Wheezing

Chronic Bronchitis

Cough that brings up yellow-green mucus, often worse in the morning
Difficulty breathing
Bluish tint to lips and skin (in severe cases)
Swelling of the feet (in end-stage cases)

Bronchi and Air Sacs of Lungs

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done.

Acute Bronchitis

Tests are rare. The following may be recommended for severe or questionable cases:

Blood test
Chest x-rays—to rule out pneumonia, a complication of bronchitis
Pulse oximetry—to measure the amount of oxygen in the blood
Bronchoscopy with culture of the sputum

Chronic Bronchitis

Tests may include:

Blood test
Chest x-rays
Pulmonary function tests or spirometry—to evaluate lung function
Sputum culture
Arterial blood gas—to test for levels of oxygen, carbon dioxide, and acid in the blood
Pulse oximetry
Bronchoscopy with culture of obtained sputum

Treatment

Acute Bronchitis

Treatment is aimed at relieving the symptoms. It includes:

Aspirin or acetaminophen to treat pain and fever
Expectorants or cough suppressants
Increased fluid intake
Cool mist humidification
Herbs and supplements—Pelargonium sidoides extract may help resolve symptoms in patients with acute bronchitis

Antibiotics will not be helpful if the infection is viral.

There are some concerns about the safety of over-the-counter cough and cold products. The concern is highest for children under two years of age. It is best to avoid these, especially in young children. Talk to your doctor about medicine options.

Chronic Bronchitis

Treatment is based on:

Age
Overall health
Extent of the disease
Past response to treatments

Treatment may include:

Oral antibiotics and bronchodilators, particularly clarithromycin
- If you have chronic bronchitis and mild-to-moderate COPD, you may not need antibiotics.
- A study found that shorter antibiotic treatment (five days or less) is as effective as longer treatment (more than five days).
Bronchodilators
Oral or intravenous corticosteroid medicines
Inhaled bronchodilators or corticosteroids
Expectorants to loosen secretions
Mucolytics
Supplemental oxygen
Cool mist humidification
Lung reduction surgery—removal of the most damaged part of the lungs (in severe cases)
Lung transplant (in end-stage cases)

If you are diagnosed with bronchitis, follow your doctor's instructions.

Prevention

To reduce your chance of getting bronchitis:

Stop smoking or never start.
Avoid passive smoke.
Avoid exposure to respiratory irritants.
Avoid contact with people who have bronchitis.

RESOURCES:

American Lung Association
http://www.lungusa.org/

Familydoctor.org
http://familydoctor.org/

CANADIAN RESOURCES:

Canadian Family Physician
http://www.cfpc.ca/

The Canadian Lung Association
http://www.lung.ca/

REFERENCES:

Bishai WR. Macrolide immunomodulatory effects and symptom resolution in acute exacerbation of chronic bronchitis and acute maxillary sinusitis: a focus on clarithromycin. Expert Rev Anti Infect Ther. 2006;4:405-416.

Harrison TR, Fauci AS. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill;1998.

Poole PJ, Black, PN. Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2006;3.

Smith S, Fahey T, Smucny J, Becker L. Antibiotics for acute bronchitis. Cochrane Database Syst Rev. 2009;CD000245.

What is COPD. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.n.... Accessed July 7, 2008.

6/4/2007 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Nonprescription cough and cold medicine use in children. Medwatch: 2007 Safety Alerts for Drugs, Biologics, Medical Devices, and Dietary Supplements. US Food and Drug Administration website. Available at: http://www.fda.gov/medwatch/safety/2007/safety07.htm#Cough. Accessed: September 4, 2007.

6/4/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: El Moussaoui R, Roede BM, Speelman P, Bresser P, Prins JM, Bossuyt PM. Abstract Short-course antibiotic treatment in acute exacerbations of chronic bronchitis and COPD: a meta-analysis of double-blind studies. Thorax. 2008;63:415-422. Epub 2008 Jan 30. Review.

10/14/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Timmer A, Gunther J, Rucker G, Motschall E, Antes G, Kern WV. Pelargonium sidoides extract for acute respiratory tract infections. Cochrane Database Syst Rev. 2008;(3):CD006323.

Last reviewed September 2009 by Christine Colpitts, CRT, MA
Last Updated: 9/30/09

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