Definition

Bronchitis is inflammation of the air passages (bronchi) of the lungs. It can make breathing difficult and sometimes painful.

• Acute bronchitis—This is a sudden onset of symptoms. The condition lasts only a short time, and there is full recovery of lung function.
• Chronic bronchitis—This involves long-term inflammation, obstruction, and degeneration of the bronchi. It is often the result of many years of cigarette smoking. This is a serious medical condition, also called chronic obstructive pulmonary disease (COPD).
• Asthmatic bronchitis—This condition involves intermittent inflammation of the airways in people with underlying asthma. It is most commonly associated with allergies or environmental irritants.
• Irritative bronchitis—Also called industrial or environmental bronchitis, this is due to chronic exposure to substances such as acids, ammonia, chlorine, minerals, or vegetable dusts.

	Chronic Bronchitis
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Causes

The inflammation may be caused by:

• Bacterial and viral infections
• Smoking (cigarettes or marijuana)
• Inhalation of certain respiratory irritants (ie, chemical pollutants or dust), particularly in an occupational setting

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors 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 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)

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam.

Acute Bronchitis

Tests for acute bronchitis are not usually needed. However, for severe or questionable cases, the following may be recommended:

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

Chronic Bronchitis

Tests for chronic bronchitis 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

In most cases, antibiotics are not necessary because the infection is viral, not bacterial.

Questions have been raised about the safety of over-the-counter cough and cold products in children, especially those under two years of age. Some instances of serious harm associated with these products appear to be the result of not following directions regarding dosage or combining preparations with the same active ingredients. Given these concerns, it is best to avoid these products, especially in young children, unless advised otherwise by a physician.*

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
• Bronchodilators
• Oral or intravenous corticosteroid medications
• 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)

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:

BC Health Guide
http://www.bchealthguide.org/

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's Principles of Internal Medicine. 14th ed. McGraw-Hill; 1998.

National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/.

Poole PJ, Black, PN. Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2006 Jul 19;3.

Updated Treatment section on 9/4/2007 according to the following study, as cited by DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: 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.

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