Bronchitis is a common diagnosis in patients with a persistent cough. Read this article to gain essential knowledge about this illness.
The cough is one of the most common aims to visit a primary care physician. So, it is vital to know the disease and identify its symptoms. I will guide you to acquire an integrative knowledge about the treatment. By reading this article, you would gain insights into aspects of the disease from a physician’s perspective.
What is bronchitis?
Bronchitis is a condition of acute or chronic swelling of the bronchi. The bronchi are part of the lower respiratory airways, and they are the continuation of the trachea to the lungs. The bronchi are the breathing tubes in the lung. They are functioning as a passage for the air but not in the breathing. The alveoli, which is a very tiny structure composing the lung, is where the oxygen truly gets to the blood vessels. Please remember these structures because they are core for understanding what is next.
The inflammation of the bronchi may seem obvious, but when a patient enters the medical consultation, the doctor does not have a microscope on its eyes to see-through the lungs. In light of this, the doctors have definitions of bronchitis that are “clinical” this means that by joining your background, symptoms, and body examination, most of the diagnosis can be made.
Characteristically, acute bronchitis is an inflammation of the lower airway, including trachea and bronchi, that do not affect the alveoli. However, for chronic bronchitis, there is inflammation in the same structures, yes, but there are requirements.
Typically, a doctor defines chronic bronchitis in a patient having cough with mucus, at least three months each year, for two years. The chronic inflammation of the bronchi causes swelling of its glands and bronchi’s walls, which causes the air passage to narrow. This swelling could be in association with other changes in the lung’s structure that carries more and severe disease.
The reason for this division is that acute and chronic bronchitis have very different and defined causes. Therefore, by differentiating between them, you will find helpful resources to understand the extent each one can have.
What causes it?
Inflammation can be by multiple sources, such as infections, allergic diseases, and irritant substances (as cigarette smoke or air pollution). As a direct cause, upper respiratory tract infection by viruses is the leading reason for acute bronchitis, while cigarette smoking is the same for chronic bronchitis.
Regarding acute bronchitis, respiratory viruses explain the disease in nine of every ten patients. These viruses are in many other conditions that affect the nose and throat and are the same ones that could descend to the bronchi. I will mention you most of them, the rhinovirus, enterovirus, influenza A and B, parainfluenza, coronavirus, human metapneumovirus, and respiratory syncytial virus. They attack the upper respiratory tract causing other very-known diseases such as the flu, common cold, pharyngitis, sinusitis, and pneumonia.
The remaining patients with acute bronchitis could either get a bacterial infection or irritation by air pollutants or tobacco smoke. The bacterial infection is more common than the irritation. There are widespread bacteria that cause other illnesses as well in the respiratory tract, with implications here as Mycoplasma pneumonia. Nevertheless, Bordetella pertussis that was uncommon at some period, should capture absolute attention. Even more, if the person did not receive a vaccine against it. This bacteria causes a special presentation of the disease called “whooping cough,” which is severe.
Chronic bronchitis has more than 80% of its cases by cigarette smoking. However, the respiratory infections also play a prominent role here by causing exacerbations of the condition (I will explain it further). The air pollution has a significant burden in the areas where it exists. This situation causes chronic bronchitis and high economic and healthcare burden.
Who affects each type of bronchitis?
Acute bronchitis is among the five top reasons why people see their doctor in the world, that is astonishing. It can affect people of all ages, but children below five years acquire it more often. On the contrary, chronic bronchitis mostly affects people with more than fifty years. The collection of information is tricky because bronchitis has symptoms that overlap with other prevalent diseases as a common cold. However, the estimation is that it affects nearly five percent of the population in the United States.
As you could see, both expressions of bronchitis widely affect the population. Each one also has its preferences of who affects. The problem comes when chronic bronchitis exacerbates, because of its resemblance to acute bronchitis. For that concern, the interest of asking for how long the person has had that cough would earn more value in people over fifty years.
What are the symptoms?
For acute bronchitis, cough is the main symptom. As I said before, it usually begins with a viral respiratory infection, from which it can be challenging to differentiate from at the beginning. However, as the disease progresses, a typical infection would not have a cough that lasts more than five days, so when the patient surpass this deadline, the doctor starts to think in other sources as bronchitis.
Patients with acute bronchitis suffer from cough approximately for two to three weeks. The cough can have or not have mucus of any color (green, yellow, or clear), and it does not indicate any particular viral or bacterial infection. It is not usual to have a fever with this condition, if it appears, your doctor would think in another diagnosis as lung disease.
Other common symptoms of acute bronchitis are the ones found in common upper respiratory infections like the cold or the flu; the list includes sore throat, runny nose, stuffy nose, headache, and muscle aches. Other rarer symptoms could appear in particular situations, such as nausea, vomiting, diarrhea, malaise, and chest tightness.
For chronic bronchitis, it is a bit different. First, for thinking about having it, some history of tobacco smoking or exposure to lung irritants must exist. Then, the interrogation on which symptoms and their length is having the patient. The productive cough usually starts only in the winter months for then becoming perpetual. With time, the presence of mucus, which changes its color from clear to yellow (see the image of sputum or mucus, below), becomes frequent and incapacitating. There could be other symptoms if the patient has COPD; please see that section below.
How do you diagnose bronchitis?
Despite that the diagnosis of bronchitis is clinical, some observations of the doctor at the physical exam and cheap and easy-access exams are core for doing so. In acute bronchitis, the doctor’s findings comprise normal, or redness in the throat, lymph nodes swelling, runny nose, and when the chest auscultation, there are sounds (wheezes) that change with an active cough.
Nevertheless, the acute bronchitis diagnosis is also considered an exclusion diagnosis. What does this mean? Of the many possible conditions that could be causing the symptoms of the patient, the doctor always wants to discard the most dangerous disease. Therefore, due to the resemblance of bronchitis to other conditions, most of the exams are for ruling them out. The threatening conditions include asthma, exacerbation of COPD, heart problems, or pneumonia.
The primary blood analysis is currently the marker of possible bacterial infections in bronchitis or pneumonia. The utilization of chest radiography is for ruling out pneumonia. Typically this infection would show slight or significant changes in this exam, changing the diagnosis from bronchitis towards pneumonia if present.
However, the vital signs that are the ones telling your doctor how well your body is handling whatever disease. If they are ok, then maybe your doctor, even if you are presenting symptoms, would not make you pass through all these exams. The vital signs are the frequency of heartbeats and breaths within one minute, and the saturation of oxygen in the blood. As in everything in life, there is always an exception, and this time is for the elderly (over 75 years). Given that they do not display typical symptoms (often any at all), the thorough examination of them is mandatory, including chest radiography.
What is the relationship between chronic bronchitis and COPD?
Chronic obstructive pulmonary disease (COPD) is a chronic ailment where there is a deterioration of the lung, an overall decrease in its capacity to function. Classically, it has three conditions, which are the mainstay of the structural changes within the lung that cause the disease. One of them is chronic bronchitis, and it is core for developing the disease in most of the cases.
A patient with chronic bronchitis that does not receive a diagnosis and treatment, over time, could develop COPD. In fact, patients with chronic bronchitis and an underlying COPD, besides chronic cough, have worse symptoms like difficulty breathing, and the tip of their fingers become blue due to the lack of oxygen. Could a person have COPD without chronic bronchitis? Yes, it is not the most common scenario, but a patient may have COPD caused in a vast proportion by the other two pillars of the disease.
Nevertheless, patients with chronic bronchitis and emphysema (another pillar of the disease) are the most common scenario in COPD. They would have alterations of both the bronchi (the highway that uses the air to get to the lung) and lung tissue (where the alveoli reside and perform the breathing process).
You may want to see: COPD
What is the difference between acute bronchitis and pneumonia?
The bronchitis is the inflammation of the bronchi, while pneumonia is the inflammation of the lung (mostly by lung infection). The best explanation for why it is so important to differentiate between them, it is in the treatment section. Pneumonia has way more complications, and usually, the infection needs aggressive treatment. On the contrary, acute bronchitis does not have that scenario.
The alveoli are for excellence, the place where breathing occurs. The inflammation of it is the exact definition of pneumonia. When the inflammation occurs, alveoli space fills up with a liquid that is not normally there. So, when a person with pneumonia breathes the doctor should listen to rales/crackles, that a person with bronchitis doesn’t have. Furthermore, the pneumonia infection show changes in a standard chest X-ray, that bronchitis does not have, as a consolidation, among others.
You may want to see: Pneumonia
How long does acute bronchitis last?
The cough could last up to ten to twenty days, and approximately half of the patients would cough up mucus. The mucus can be of any color (yellow, green, clear, and so on), and it is not a direct indication of having a bacteria infection that requires an antibiotic. Please always talk to your doctor.
What are the possible complications?
They are not that uncommon; in fact, one in every ten patients with acute bronchitis could get one of them. The bacterial superinfection is when a viral microorganism, gets overlapped by a bacterial infection that makes it worse. There are pneumonia, chronic bronchitis, reactive airway disease (wheezing, cough, and shortness of breath), and coughing up blood, as the other possible complications.
What is bronchitis treatment?
The cornerstone of the treatment is lessening the symptoms. The therapy should aid to relieve either the mucus production or narrowing of the bronchial tubes. The antibiotic usage is currently not a recommendation at any point unless the bacteria Bordetella pertussis is present. This situation concurs with the fact that viral microorganisms mainly cause this affection, and they do not need antibiotics. Indeed, antibiotics in this circumstance could hinder more the case. The use of antibiotics, when it is not required, should not be taken lightly due to its harmful effects on the body. Despite this, antibiotics are commonly prescribed for this mainly viral condition, which is totally wrong.
Over-the-counter medications such as paracetamol, ibuprofen, anti-allergic, and decongestants yield conflicting results regarding their efficacy. What does this mean? There is not a strong proof that these over the counter medication produce relief of the symptoms in comparison to doing nothing.
Nevertheless, the cough suppressants with Dextromethorphan in contrary to the one containing codeine has yielded a significant reduction in the cough frequency. Expectorants containing Guaifenesin are meant to clear the airways from the thick mucus secretions. They also have shown considerable relief of symptoms in patients. Given that, anti-cough medications are not recommended for children below four years. Honey has raised as an option with positive results in them.
If other symptoms besides cough as shortness of breath are present, and your physician finds something called “wheezing sounds” when listening to your chest. The inhaled medication of Beta 2 agonists helps dilate the bronchi narrowing, and reduce symptoms. Patients with chronic bronchitis also benefit from inhaled treatment—two types of inhaled therapy of short-acting period for acute exacerbations. Also, a brief prescription of corticosteroids has shown to be useful.
Who could benefit from antibiotics?
Despite the recommendation against the antibiotic use, specific people could benefit from it. The elderly (over 65 years) or older adults with other diseases as diabetes, heart problems, taking steroids, or recent hospitalizations. Patients with chronic bronchitis that are suffering from acute exacerbations also have improved their symptoms with antibiotics.
Regarding the type of antibiotic used, many of them have shown great success. The list includes macrolides, quinolones, and amoxicillin plus clavulanate. The duration of therapy has also changed from the traditional one. Right now is a formal recommendation five-days treatment than the classical antibiotic regimen of more than five days.
What can you do to avoid getting bronchitis?
The patients that follow these recommendations substantially reduce their chances of getting both acute or chronic bronchitis. Firstly, the avoidance of smoking cigarette, or breathing nearby someone that is doing so. The influenza virus causes a significant proportion of the viral infection every year that prompt bronchitis; therefore, receiving the flu shot between October and December would be highly beneficial. Also, every person aging more than 65 years or carrying a chronic condition should take the pneumonia vaccine as recommended by your doctor.
I think I have bronchitis What can I do?
Because this condition has two very different ways of presentation, here it is an acute bronchitis symptoms checker, and for chronic bronchitis, here it is a COPD symptoms checker. Both of them would help you to assess how likely it is that your symptoms are of each condition. It is free, and would only take you a few minutes.