Bronchitis

Overview

A cough that won't quit

If you've ever had a cough that felt as though it started down in your toes, and started coughing and couldn’t stop, you may have had bronchitis. Bronchitis is a condition in which the bronchi (tubes connecting the windpipe with the lungs) become inflamed, usually because of an infection. The deep, persistent cough is usually experienced due to mucus being produced in the membranes that line the airways. Bronchitis can be either acute (short duration) or chronic (recurring), depending on how long you’ve had it and how serious the damage to your airways.

Acute bronchitis usually develops in cold weather when a cold or flu virus has attacked your airways. In some cases, this is accompanied by a secondary bacterial infection. With self-treatment, the cold-like symptoms of acute bronchitis will usually subside within three to four days; the deep cough may last as long as three weeks. Since treating acute bronchitis involves using traditional cold remedies, it is important to remember that children under 18 years of age should not be given aspirin because of the risk of contracting Reye's syndrome (an often fatal disease of the brain).

Chronic bronchitis is the repeated inflammation of the inner lining of the bronchi, caused by infection, allergy, or persistent irritation. If you have experienced repeated episodes of uncontrolled coughing, accompanied by excessive mucus, which lasted for three or more months and recurred for at least two years, you may have chronic bronchitis. The most frequent underlying cause chronic bronchitis is tobacco smoke. Other causes include allergens and air pollution. If you suspect that you have chronic bronchitis, consult your doctor. The complications of this disease can be serious, including bacterial lung infection (pneumonia).

Detailed Description

Acute bronchitis is generally caused by an infection, possibly a virus or bacteria, or by an environmental pollutant such as tobacco smoke attacking and inflaming the mucous membranes within the windpipe or the air passages in your respiratory tract. It sometimes develops after a cold, sinus infection, or other respiratory infection. It is not usually associated with fever, although airflow may be hampered. Acute bronchitis is usually self-limiting, as most cases are due to viral infections.

Chronic bronchitis results from repeated irritation (or infection) of the bronchial tubes. The underlying culprit is most often tobacco smoke. Allergies and pollution can make it worse. Because chronic bronchitis can cause irreversible damage to the lungs and heart, it's much more serious than acute bronchitis. Untreated chronic bronchitis may eventually cause pulmonary emphysema (destruction of the lung’s air sacs), especially in smokers. Unlike acute bronchitis, chronic bronchitis is not contagious. Chronic bronchitis often reduces life expectancy if a person smokes and doesn't stop, or if there is an additional chronic disease.

Characteristics of Bronchitis

The start of a cough usually signals the beginning of bronchitis, but acute bronchitis is characterized by a cough that produces little or no sputum (mucus) and is very deep and persistent. There is a feeling of pressure behind the breastbone or a burning sensation in the chest. In some cases you may be uncomfortable breathing or you may wheeze. Acute or infectious bronchitis often starts with symptoms of a common cold: runny nose, tiredness, chills, and back and muscle aches. There is usually no fever, although there may be a low-grade fever (less than 101°F), muscle aches and a sore throat.

Chronic bronchitis is characterized by a deep cough that brings up thick mucus or phlegm. In the early stages you may experience shortness of breath when exercising or moving and, in the later stages, shortness of breath while at rest. Hemoptysis (coughing up of blood) may also be present especially when an infection is present.

How Common Is Bronchitis?

Chronic bronchitis affects approximately 14 million people, or 5% of the population, making it the seventh-ranking chronic condition in the nation. Acute bronchitis occurs in people of all ages, including children and the elderly. Chronic bronchitis usually appears in people older than age 40, and is more common in women than men. All forms of bronchitis caused more than 3,200 deaths in 1995.

Conventional Treatment

Treatment Goals

Goals of treatment for acute bronchitis aim to control coughing, induce mucus liquefaction, and contain bronchial infections. With treatment, acute bronchitis is usually curable within one week. If your you have complications, it may take longer.

Goals for the treatment of chronic bronchitis include minimization of irritation to the lungs, prudent control of coughing, liquefaction of mucus, suppression of acute recurrent bronchial infections, and bronchodilator therapy (medicines that open up the bronchial passages) to ease breathing. Chronic bronchitis can be cured if it has not progressed too far. If left untreated, chronic bronchitis will cause permanent damage to the respiratory tract.

Treatment Overview

Both acute and chronic bronchitis is usually treated on an outpatient basis unless complications develop due to other severe diseases. You can also effectively treat symptoms at home using prescribed medications or several alternative health methods.

Treatment for acute bronchitis differs slightly from the treatment for chronic bronchitis. For acute bronchitis, a doctor can prescribe bronchodilators or antibiotics to fight bacterial infections.

Chronic bronchitis treatment primarily aims at reducing irritation in the bronchial tubes, opening up the air passages in the lungs with bronchodilators, and using expectorants to thin the mucus so it can be coughed up more easily. Cough suppressants are taken as needed. Treatment must also include reducing exposure to the air pollutants that caused the bronchial irritation.

Symptoms such as fever and general malaise can be effectively treated with aspirin or acetaminophen and increased fluids. Resting and drinking plenty of fluids can help. Consult a physician for treatment if you have chronic lung disease or if complications occur such as a fever, chest pain, shortness of breath even when you're resting, blood appearing in your sputum, or vomiting. In children, if the child feels very ill, has a high fever or breathing difficulty, call your doctor immediately. If you have chronic bronchitis, you should also ask your doctor about getting vaccinated against influenza and pneumococcal pneumonia.

Antibiotics are commonly prescribed to treat bronchitis; however, many physicians feel that most cases do not require antibiotics. Increasingly, physicians encourage patients with acute bronchitis to use alternative methods to promote expectoration of mucus and to build immune function.

Drug Therapy

Drugs most commonly prescribed

These tend to be the drugs of choice for acute bronchitis:

Antibiotics

Amoxicillin
http://www.nmihi.com/a/amoxicillin.html

On-Label Efficacy

Augmentin

On-Label Efficacy

Bactrim
http://www.nmihi.com/t/co-trimoxazole.html

On-Label Efficacy

Biaxin

On-Label Efficacy

Cipro
http://www.nmihi.com/c/ciprofloxacin.html

On-Label Efficacy

buy Levaquin

On-Label Efficacy

Zithromax
http://www.nmihi.com/a/azithromycin.html

On-Label Efficacy

doxycycline

On-Label Efficacy
  • Cough suppressants
  • Bronchodilators
  • Decongestants
  • Fever-reducing analgesics such as aspirin

The drugs of choice for chronic bronchitis include the above drugs as well as:

Singulair
http://www.nmihi.com/m/montelukast.html

Off-Label Efficacy

Prednisone
http://www.nmihi.com/p/prednisone.html

On-Label Efficacy

Atrovent

On-Label Efficacy

albuterol

On-Label Efficacy

Possible Complications

Possible complications of acute bronchitis are:

  • Bacterial lung infections (pneumonia)
  • Chronic bronchitis

Possible complications of chronic bronchitis include:

  • Recurrent pneumonia
  • Chronic obstructive pulmonary disease (COPD), which is incurable

Quality of Life

Bronchitis, acute or chronic is easily treatable. One's quality of life need not suffer if the illness is given attention and not neglected. Since the symptoms of bronchitis, when treated, last only a short time, it is no more disruptive to one's life than a flu or cold.

Considerations for Children and Adolescents

Don't give aspirin or any medication containing salicylates to anyone age 18 or younger unless directed by a physician, because of its association with Reye's syndrome, a potentially fatal condition.

Considerations for Older People

The causes of breathing difficulties in older people are initially difficult to diagnose since asthma, chronic bronchitis, and emphysema have similar symptoms. However, simple tests of pulmonary function can assist diagnosis. Thus, it is important for older people to consult their physicians regarding breathing difficulties, especially because heart disease can cause similar symptoms.

Your immune system becomes less effective as you age, which opens the way for viral, bacterial, and other infections, as well as immune disorders and allergies. Also, characteristic signs of bronchitis may be absent in older people. An increased possibility of pneumonia is one complication of bronchitis. Bronchitis can be a serious illness in older people, particularly if it is part of influenza, so it is important that you consult with a physician if you suspect that you have bronchitis.

Bronchitis

Last updated 23 May 2012

Synonyms

  • COPD (chronic obstructive pulmonary disease)
  • COLD (chronic obstructive lung disease)
  • OAD (obstructive airway disease)

Causes

Established Causes

  • Viruses, bacteria, and bacteria-like organisms
  • Tobacco and other smoke
  • Chronic sinus infection
  • Bronchiectasis (a chronic inflammatory lung condition)
  • Allergies
  • In children, enlarged tonsils and adenoids
  • Different kinds of dust
  • Fumes from strong acids, ammonia, some organic solvents, chlorine, hydrogen sulfide, bromine, sulfur dioxide
  • Air pollution irritants ozone and nitrogen dioxide
  • Occupational exposure (commonly found among coal miners, grain handlers, and metal molders)

Risk Factors

General risk factors for acute bronchitis include:

  • Smoking
  • Chronic obstructive pulmonary disease (COPD)
  • Exposure to irritating fumes and/or dust in the environment
  • Cold, humid weather
  • Recent illnesses that may have lowered resistance
  • Recent exposure to respiratory illness
  • Poor nutrition

General risk factors for chronic bronchitis include:

  • Smoking
  • Exposure to irritating fumes and/or dust in the environment
  • Any lung illness that has lowered resistance
  • Family history of tuberculosis or other diseases of the respiratory tract
  • Obesity
  • Crowded living conditions
  • Gastroesophageal reflux disease
  • Tracheostomy
  • Alcoholism
  • Bronchopulmonary allergy

In addition to smokers, who are most likely to develop this disease, higher rates of chronic bronchitis are found among coal miners, grain handlers, metal molders, and other workers exposed to dust.


Symptoms & Diagnosis

Signs for acute and chronic bronchitis differ significantly. If you have acute bronchitis, your symptoms might include:

  • Deep, persistent cough that has little or no sputum
  • Feeling of pressure behind the breastbone or a burning sensation in the chest
  • Runny nose, chills, low-grade fever (usually less than 101°F)
  • Sore throat
  • Back and muscle aches
  • Wheezing
  • Fatigue

Symptoms for chronic bronchitis include:

  • A deep, thick-mucus-producing cough that persists for three months of the year, for at least two successive years
  • Shortness of breath when exercising or moving
  • Hemoptysis (coughing up blood)
  • Sputum (mucus) that is thick and difficult to cough up
  • Shortness of breath when at rest (in later stages)

Conditions That May Be Mistaken for Bronchitis

Bronchitis can be confused with other conditions, including:

  • Colds and flu
  • Acute sinus infection
  • Cystic fibrosis
  • Bronchopneumonia
  • Bronchiectasis (a chronic inflammatory lung condition)
  • Reactive airway disease
  • Bacterial tracheitis (inflammation of the trachea)
  • Lung cancer

How Bronchitis Is Diagnosed

A diagnosis of bronchitis is usually made on the basis of symptoms and the appearance of the coughed-up sputum. If symptoms persist, a chest X-ray may be needed to be sure the person has not developed pneumonia or decreased lung function. Pulmonary function tests show decreased airflow, and in severe cases, decreased oxygen levels.

Laboratory Tests

For acute and chronic bronchitis, laboratory diagnoses include:

  • White blood cell count
  • Sputum culture
  • Gram stain
  • Serological studies

Imaging

Chest X-rays may be taken to rule out other diseases or complications.

Alternative care

Supplements

Vitamin C: Several studies show that it reduces cold symptoms, and a recent review of studies by researchers at the New Jersey Medical School in Newark calls vitamin C useful in treating allergies and asthma. Herbalists also recommend it for bronchitis.

Herbs

  • Echinacea and goldenseal: immune-enhancing herbs. Bronchitis can be a signal of a weakened immune system, so you may be able to stimulate yours with these herbs. (Echinacea may cause temporary numbing of your tongue, but don't be alarmed — the effect is harmless.)
  • Coltsfoot: WARNING — don't use this! Once widely recommended in traditional herbal medicine to treat coughs, this plant has since been discovered to contain pyrrolizidine alkaloids, which may cause liver damage. Herb expert Varro Tyler, Ph.D., warns against using it, although it is found in throat lozenges in some health food stores

Self care & Prevention

Preventing Bronchitis

To help prevent bronchitis:

  • Avoid exposure to irritants (fumes, secondhand smoke), mold, pollen, and pollutants
  • Avoid exposure to extremely cold weather and minimize contact with patients recovering from respiratory illness
  • Stop smoking
  • Get vaccinated: The influenza virus vaccine together with a streptococcal pneumonia vaccine is advisable for high-risk individuals, particularly children and older people

Self-Care Measures

  • If you smoke, quit. Smoking is by far the leading cause of chronic bronchitis. For help quitting, consult your physician.
  • Avoid other people's cigarette smoke.
  • Avoid respiratory irritants, including dust, chemical fumes, and cold air.
  • Invest in a humidifier, since dry air can trigger coughing. But be sure to clean your humidifier regularly with bleach to prevent the growth of bacteria.
  • Stay as active as you can, but don't overexert yourself.
  • Drink plenty of liquids. Fluids help keep your bronchial mucus thin, making it easier to cough up.
  • Sucking on medicated lozenges or hard candies can help keep the throat moist, making you less likely to cough.