bronchitis

Definition

Bronchitis is an inflammation of the air passages between the nose and the lungs, including the windpipe or trachea and the larger air tubes of the lung that bring air in from the trachea (bronchi). Bronchitis can either be of brief duration (acute) or have a long course (chronic). Acute bronchitis is usually caused by a viral infection, but can also be caused by a bacterial infection and can heal without complications. Chronic bronchitis is a sign of serious lung disease that may be slowed but cannot be cured.

Description

Although acute and chronic bronchitis are both inflammations of the air passages, their causes and treatments are different. Acute bronchitis is most prevalent in winter. It usually follows a viral infection, such as a cold or the flu, and can be accompanied by a secondary bacterial infection. Acute bronchitis resolves within two weeks, although the cough may persist longer. Acute bronchitis, like any upper airway inflammatory process, can increase a person's likelihood of developing pneumonia.

Anyone can get acute bronchitis, but infants, young children, and the elderly are more likely to get the disease because people in these age groups generally have weaker immune systems. Smokers and people with heart or other lung diseases are also at higher risk of developing acute bronchitis. Individuals exposed to chemical fumes or high levels of air pollution also have a greater chance of developing acute bronchitis.

Chronic bronchitis is a major cause of disability and death in the United States. The American Lung Association estimates that about 14 million Americans suffer from the disease. Like acute bronchitis, chronic bronchitis is an inflammation of airways accompanied by coughing and spitting up of phlegm. In chronic bronchitis, these symptoms are present for at least three months in each of two consecutive years.

Chronic bronchitis is caused by inhaling bronchial irritants, especially cigarette smoke. Until recently, more men than women developed chronic bronchitis, but as the number of women who smoke has increased, so has their rate of chronic bronchitis. Because this disease progresses slowly, middle-aged and older people are more likely to be diagnosed with chronic bronchitis.

Chronic bronchitis is one of a group of diseases that fall under the name chronic obstructive pulmonary disease (COPD). Other diseases in this category include emphysema and chronic asthmatic bronchitis. Chronic bronchitis may progress to emphysema, or both diseases may be present together.

— Tish Davidson

1. Chronic or acute inflammation of the mucous membrane of the bronchial tubes.
2. A disease marked by this inflammation.

For more information on bronchitis, visit Britannica.com.

Inflammation of the bronchioles, restricting air flow to and from the lungs. Acute bronchitis is caused by a viral or bacterial infection and is aggravated by physical activity. Chronic bronchitis may be induced by smoking. Aerobic exercise is generally beneficial to sufferers, particularly those who can give up smoking.

An acute or chronic inflammation of the mucous membranes of the tracheobronchial tree.

Definition

Bronchitis is an inflammation of the air passages between the nose and the lungs, including the windpipe, or trachea, and the larger air tubes called bronchi that bring air into the lungs from the trachea. When bronchitis is mild and brief in duration, it is called acute. Chronic bronchitis is recurrent, has a prolonged course, and is often a sign of a serious underlying lung disease.

Description

Acute Bronchitis

Bronchitis is an inflammation of the breathing airways accompanied by coughing and spitting up of phlegm. It can be caused by exposure to a cold or the flu, infection, or irritants. Although the symptoms of acute and chronic bronchitis are similar, their causes and treatments are different. Acute bronchitis is most common in winter. It usually follows an upper respiratory infection, and may be accompanied by a secondary bacterial infection. Acute bronchitis usually resolves within two weeks, although the cough may persist longer. Like any upper airway inflammatory process, acute bronchitis can increase a person's likelihood of developing pneumonia.

Anyone can get acute bronchitis, but infants, young children, and the elderly are more likely to come down with the disease. Smokers and people with heart or lung diseases are at a higher risk of developing acute bronchitis. Individuals exposed to chemical fumes or high levels of air pollution also have a greater chance of developing acute bronchitis.

Chronic Bronchitis

Chronic bronchitis is one of a group of diseases that fall under the name chronic obstructive pulmonary disease (COPD). Other diseases in this category include emphysema and chronic asthmatic bronchitis. Chronic bronchitis is a major cause of disability and death in the United States. The American Lung Association estimates that about 14 million Americans suffer from the disease. Chronic bronchitis shows symptoms similar to acute bronchitis, but it recurs and is present for at least three months a year. Until recently, more men than women developed chronic bronchitis, but as the number of women who smoke has increased, so has their rate of chronic bronchitis. Because this disease progresses slowly, middle-aged and older people are more likely to be diagnosed with chronic bronchitis.

Causes & Symptoms

Acute Bronchitis

Acute bronchitis usually begins with the symptoms of a cold, such as a runny nose, sneezing, and dry cough. However, the cough soon becomes deep and painful. Coughing brings up a greenish yellow phlegm or sputum. These symptoms may be accompanied by a fever of up to 102°F

(38.8°C). Wheezing after coughing is common. About 90% of acute bronchitis is caused by a bacterial infection.

In uncomplicated acute bronchitis, the fever and most other symptoms, except the cough, disappear after three to five days. Coughing may continue for several weeks. Acute bronchitis is often complicated by a bacterial infection, in which case the fever and a general feeling of illness persist.

Chronic Bronchitis

Chronic bronchitis is caused by inhaling respiratory tract irritants; it may also be due to recurrent bouts of acute bronchitis. The most common cause, however, is the irritation of cigarette smoke. The cells that line the respiratory system contain fine, hair-like outgrowths called cilia. Normally, the cilia of many cells beat rhythmically to move mucus along the airways. When smoke or other irritants are inhaled or when there is irritation from repeated dry coughing, the cilia become paralyzed or snap off and the airways become inflamed, narrowed, and clogged. This leads to difficulty breathing and can progress to the life-threatening disease emphysema. A mild cough is usually the first visible sign of chronic bronchitis. Coughing brings up phlegm, and wheezing and shortness of breath may accompany the cough.

Diagnosis

General

Initial diagnosis of bronchitis is based on observing the patient's symptoms and health history. The physician will do chest examination with a stethoscope for specific sounds that indicate lung inflammation and airway narrowing. A sputum culture may be performed, particularly if the sputum is green or has blood in it, to determine whether a bacterial infection is present and to identify the disease-causing organism so that an appropriate antibiotic can be selected. Occasionally, in diagnosing a chronic lung disorder, the sample of sputum is collected using a procedure called a bronchoscopy.

Chronic Bronchitis

A pulmonary function test is important in diagnosing chronic bronchitis and other variations of COPD. This test uses an instrument called a spirometer to measure the volume of air entering and leaving the lungs. The doctor may do a chest x ray, an electrocardiogram (ECG), and blood tests as well. Other tests may be used to measure how effectively oxygen and carbon dioxide are being exchanged in the lungs.

Treatment

The treatment of chronic bronchitis is complex and depends on the stage of chronic bronchitis and whether other health problems are present. Lifestyle changes, such as quitting smoking and avoiding secondhand smoke or polluted air, are an important first step. Controlled exercise performed on a regular basis is also important.

There are a multitude of botanical and herbal medicines that can be used to treat bronchitis. Examples from aromatherapy include essential oils of any of the following: benzoin, Styrax benzoin; camphor, Cinnamomum camphora;eucalyptus, Eucalyptus globulus;lavender, Lavandula officinalis; pine, Pinus sylvestris; sandalwood, Santalum album; or thyme, Thymus vulgaris. Any one or combination of these oils should be added to water and inhaled in a warm steam. They can also be dabbed on to a cloth, and the aroma can be breathed in deeply through the nose. A mixture of the essential oils of clove, Eugenia aromaticum; cinnamon, Cinnamomum zeylanicum;lemon balm, Melissa officianalis; and lavender, Lavandula officinalis, is reported to be particularly effective when taken as a steam inhalation.

Herbalists recommend taking a tea, syrup or tincture of any of the following: mullein, Verbascum thapsus;coltsfoot, Tussilago farfara; aniseed, Pimpinella anisum;hyssop, Hyssopus officinalis; elecampane, Inula helenium; and garlic, Allium sativum. The Chinese herb ephedra, also called ma huang or Ephedra sinica, may be recommended as long as heart disease or high blood pressure is not a problem. Ephedra is only used in herbal combinations and when coughing and wheezing are present. There are many remedies in traditional Chinese medicine for coughing and phlegm.

Recommended homeopathic remedies include Aconite 6c, Kali bichromicum 6c, and Phosphorus 6c.

Acupuncture can be useful in preventing chronic bronchitis attacks and in resolving colds that lead to acute attacks.

For a mild case of acute bronchitis over-the-counter remedies of homeopathic medicine, traditional Chinese medicine, and Ayurveda are widely available and quite helpful. Practitioners of these disciplines can be very effective and should be consulted in dealing with more severe or chronic cases. Hydrotherapy and massage with tapping and cupping is also recommended in bronchitis to loosen mucus, improve breathing, and heighten the immune response to the condition.

The juice of a lemon squeezed into a cup of water should be consumed to clear out mucus. Hot, spicy foods can help open the air passages. These foods include garlic, onions, chili peppers, and horseradish, and should be consumed liberally.

Allopathic Treatment

Acute Bronchitis

When no secondary infection is present, acute bronchitis is treated in the same way as the common cold. Home care includes drinking plenty of fluids, resting, not smoking, increasing moisture in the air with a cool mist humidifier, and taking acetaminophen (Datril, Tylenol, Panadol) for fever and pain. Aspirin should not be given to children because of its association with seizures in children. Cough syrups are recommended to reduce coughing, soothe irritation, and increase expectoration of mucus.

It is important for mucus to be cleared from the lungs. The use of cough suppressants should be limited because when coughing is suppressed, the mucus accumulates in the plugged airways and may become a breeding ground for pneumonia bacteria. If the patient is coughing up phlegm, the cough should be allowed to continue to bring up mucus and irritants from the lungs. Cough medicines with expectorants may, therefore, be helpful. Expectorant cough medicines are used to thin the mucus in the lungs, making it easier to cough up and expel. People who are unsure about what type of medications are in over-the-counter cough syrups should ask their pharmacist for an explanation.

If a secondary bacterial infection is present, the infection may be treated with an antibiotic. Patients need to take the entire amount of antibiotic prescribed. However, in 2002, a new study showed that antibiotics really don't do anything to help acute bronchitis. The drug is mostly prescribed to make the physician and the patient feel like they are "doing something." Inn a double blind study, treatment with cough suppressant medication and inhaled albuterol reported the same improvement as those patients who took antibiotics.

Chronic Bronchitis

Drug therapy uses bronchodilators to relax the muscles of the bronchial tubes and allow increased airflow. They can be taken by mouth or inhaled using a nebulizer. Common bronchodilators include albuterol (Ventolin, Proventil, Apo-Salvent) and metaproterenol (Alupent, Orciprenaline, Metaprel, Dey-Dose). Anti-inflammatory medications are added to reduce swelling of the airway tissue. Corticosteroids, such as prednisone, can be taken orally or intravenously. Other steroids are inhaled. Medications are also given to reduce the quantity of mucus. As the disease progresses, the patient may need supplemental oxygen. A one-time pneumonia vaccination may also be recommended.

In 2002, a new drug therapy was approved to treat chronic bronchitis, as well as other pulmonary diseases. Called Severent Diskus, or salmeterol, it is a long-acting bronchodilator that can be inhaled twice a day and will last for 12 hours. It works well for patients with the chronic form of bronchitis, but is not intended for use in acute episodes.

Expected Results

When treated, acute bronchitis normally resolves in one to two weeks without complications, although a cough may continue for several more weeks. Unfortunately, there is no cure for chronic bronchitis, and the disease can often lead to or coexist with emphysema. On the whole, all forms of COPD are a leading cause of death.

Prevention

The best way to prevent bronchitis is not to begin smoking or to stop smoking. Smokers are 10 times more likely to die of COPD than non-smokers. Smokers who stop show improvement in lung function. Other preventative steps include avoiding chemical and environmental irritants, such as air pollution, and maintaining good overall health.

Supplementation with vitamins A, C, and E, zinc and bioflavonoids may also be helpful in preventing recurrence and secondary infections. Dairy products, sugar foods and eggs should be avoided, as they may increase the tendency to form mucus in the lungs.

Resources

Books

The Burton Goldberg Group. Alternative Medicine: The Definitive Guide. Washington: Future Medicine Publishing, 1995.

The Editors of Time-Life Books. The Medical Advisor: The Complete Guide to Alternative and Conventional Treatments. VA: Time-Life, Inc., 1996.

Periodicals

Evans, AT, S Husain, and L Durairaj. "Antibiotics Won't Do Anything for Acute Bronchitis." Formulary (June 2002): 286.

Mechcatie, Elizabeth. "New & Approved." Family Practice News (May 15, 2002):18–21.

Tiep, Brian L. "Disease Management of COPD with Pulmonary Rehabilitation." Chest (December 1997).

Organizations

National Heart, Lung, and Blood Institute Information Center. P.O. Box 30105, Bethesda, MD 20824-0105.

National Jewish Center for Immunology and Respiratory Medicine. 1400 Jackson Street, Denver, CO 80206.

[Article by: Patience Paradox; Teresa G. Odle]

Definition

Bronchitis is an inflammation of the air passages between the nose and the lungs, including the windpipe or trachea and the larger air tubes of the lung that bring air in from the trachea (bronchi). Bronchitis can either be of brief duration (acute) or have a long course (chronic). Acute bronchitis is usually caused by a viral infection but can also be caused by a bacterial infection and can heal without complications. Chronic bronchitis is a sign of serious lung disease that may be slowed but cannot be cured. This form is found almost exclusively in adult smokers. Bronchitis in children is often misdiagnosed as asthma.

Description

Acute bronchitis is most prevalent in winter. It is most often caused by a viral infection and may be accompanied by a secondary bacterial infection. Acute bronchitis resolves within two weeks, although the cough may persist longer. Acute bronchitis, like any upper airway inflammatory process, can increase a child's likelihood of developing pneumonia.

Demographics

Acute bronchitis is one of the more common illnesses affecting preschool and school-age children. It is more commonly diagnosed among children under age five than any other age group. It occurs more often in young males. It can occur anytime but is more frequent during the winter months. In otherwise healthy children complications are few.

Causes and Symptoms

Acute bronchitis usually begins with the symptoms of a cold, such as a runny nose, sneezing, and dry cough. However, the cough soon becomes deep and painful. Coughing brings up a greenish yellow phlegm or sputum. These symptoms may be accompanied by a fever of up to 102°F (38.8°C). Wheezing after coughing is common.

In uncomplicated acute bronchitis, the fever and most other symptoms, except the cough, disappear after three to five days. Coughing may continue for several weeks. Acute bronchitis is often complicated by a bacterial infection, in which case the fever and a general feeling of illness persist. To be cured, the bacterial infection should be treated with antibiotics. A cough that does not go away may be a sign of another problem such as asthma or pneumonia.

Physical findings of acute bronchitis vary with the age of the child, and the stage of the disease, but may include the following:

• runny nose
• dry, hacking unproductive cough that may change to a loose cough with increased mucus
• sore throat
• back and other muscle pains
• chills and low grade fever
• headache and general malaise (feeling unwell)

Diagnosis

Initial diagnosis of bronchitis is based on observing the child's symptoms and health history. The physician will listen to the child's chest with a stethoscope for specific sounds that indicate lung inflammation, such as moist rales and crackling, and wheezing, that indicate airway narrowing. Moist rales is a bubbling sound heard with a stethoscope that is caused by fluid secretion in the bronchial tubes.

A sputum culture may be performed, particularly if the sputum is green or has blood in it, to determine whether a bacterial infection is present and to identify the disease-causing organism so that an appropriate antibiotic can be selected. Normally, the patient will be asked to cough deeply then spit the material that comes up from the lungs (sputum) into a cup. This sample is then grown in the laboratory to determine which organisms are present. The results are available in two to three days.

Occasionally, in diagnosing a chronic lung disorder, the sample of sputum is collected using a procedure called a bronchoscopy. In this procedure, the patient is given a local anesthetic, and a tube is passed into the airways to collect a sputum sample.

To better determine what type of obstructive lung disease a patient has, the doctor may do a chest x ray and order blood tests. Other tests may be used to measure how effectively oxygen and carbon dioxide are exchanged in the lungs.

Treatment

When no secondary infection is present, acute bronchitis is treated in the same way as the common cold. Home care includes drinking plenty of fluids, resting, not smoking, increasing moisture in the air with a cool mist humidifier, and taking acetaminophen (Datril, Tylenol, Panadol) for fever and pain. Aspirin should not be given to children because of its association with the serious illness Reye's syndrome.

Cough suppressants are used only when the cough is dry and produces no sputum. If the patient is coughing up phlegm, the cough should be allowed to continue. The purpose of the cough is to bring up extra mucus and irritants from the lungs. When coughing is suppressed, the mucus accumulates in the plugged airways and can become a breeding ground for pneumonia bacteria.

Expectorant cough medicines, unlike cough suppressants, do not stop the cough. Instead they are used to thin the mucus in the lungs, making it easier to cough up. This type of cough medicine may be helpful to individuals suffering from bronchitis. People who are unsure about what type of medications are in over-the-counter cough syrups should ask their pharmacist for an explanation.

If a secondary bacterial infection is present, the infection is treated with an antibiotic. Patients need to take the entire amount of antibiotic prescribed. Stopping the antibiotic early can lead to a return of the infection. Tetracycline or ampicillin is often used to treat adults. Other possibilities include trimethoprim/sulfamethoxazole (Bactrim or Septra) and the newer erythromycin-like drugs, such as azithromycin (Zithromax) and clarithromycin (Biaxin). Children under age eight are usually given amoxicillin (Amoxil, Pentamox, Sumox, Trimox) because tetracycline discolors permanent teeth that have not yet come in.

For some children with acute bronchitis, doctors may prescribe medicines often used to treat asthma. These medicines can help open the bronchial tubes and clear out mucus. Bronchial dilators are usually given with an inhaler. An inhaler sprays the medicine right into the bronchial tree.

Prognosis

When treated, acute bronchitis normally resolves in one to two weeks without complications, although a cough may continue for several more weeks. The progression of chronic bronchitis, on the other hand, may be slowed, but an initial improvement in symptoms may be achieved.

Prevention

Parents should make sure their children are getting adequate nutrition and rest to boost their immunity during cold and flu season. Children should be taught to wash their hands regularly to avoid spreading bacteria and viruses. Other preventative steps include avoiding chemical and environmental irritants, such as air pollution. Immunizations against certain types of pneumonia (as well as influenza) are an important preventative measure for the very young or those children with chronic diseases.

Parental Concerns

Parents should encourage fluids by frequent offers of small amounts of the child's favorite liquids. Humidifiers should produce moist air to keep mucus from drying and to make it easier for the child to breathe. The child should be checked for signs of dehydration, including daily weights. Acetaminophen is given for temperatures over 101°F (38.3°C). Quiet activity provides a diversion for the sick child.

In caring for a child with acute bronchitis, parents should make the following observations:

• Is there a decrease in coughing and mucus production?
• Does the child have periods of rest and sleep?
• Is the child's intake enough for his or her age?
• Has the child kept a normal body temperature for 24 hours?

Parents should be aware that there is a significant association between high levels of air pollution, smoking, and increased incidence of chronic bronchitis. Air pollutants aggravate chronic pulmonary disease in children and cause decreased pulmonary performance in exercising children and teenagers. Teenagers should be questioned and taught about the ill effects of smoking either tobacco or marijuana. Teenagers should also be questioned about industrial fumes or automobile exhaust exposure at school or work.

Resources

Books

Acute Bronchitis: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego, CA: Icon Group International, 2004.

Bronchitis: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego, CA: Icon Group International, 2003.

Ivker, Robert S. Sinus Survival: The Holistic Medical Treatment for Allergies, Bronchitis, Colds, and Sinus. East Rutherford, NJ: Penguin Group, 2000.

Wright, Jill. Asthma and Bronchitis. Northfield, IL: How to Books, 2004.

Organizations

American Lung Association. 1740 Broadway, New York, NY 10019. Web site: www.lungusa.org.

National Heart, Lung, and Blood Institute. PO Box 30105, Bethesda, MD 20824–0105. Web site: www.nhlbi.nih.gov.

National Jewish Center for Immunology and Respiratory Medicine. 1400 Jackson St., Denver, CO 80206. Web site: www.nationaljewish.org/main.html.

Web Sites

"Bronchitis." MedlinePlus. Available online at www.nlm.nih.gov/medlineplus/bronchitis.html (accessed December 17, 2004).

[Article by: Aliene Linwood, RN, DPA, FACHE; Tish Davidson, AM]

The term "bronchitis" refers to the inflammation of medium-sized and large airways in the lung (bronchi). Bronchitis is distinguished from bronchiolitis (inflammation of small airways that lack cartilage and mucus-secreting glands in their walls) and from bronchiectasis (permanent dilation and destruction of bronchi associated with chronic cough productive of purulent sputum). Although bronchial asthma is a chronic inflammatory airway disease, it is not considered under the heading of bronchitis.

Acute bronchitis is usually an infectious disease caused by viruses (influenza A and B, parainfluenza, the common cold viruses [rhinovirus and coronavirus], adenovirus, and respiratory syncytial virus). Infrequently, acute bronchitis is caused by inhalation of toxic gases and products of combustion or by aspiration of foreign material. Acute infectious bronchitis is a self-limited illness characterized by cough, sputum production, and, in most cases, symptoms of an upper respiratory tract infection (sore throat, and nose and sinus congestion). Inflammation of the trachea usually occurs together with inflammation of the bronchi, so the term "tracheobronchitis" is sometimes used. The majority of cases occur during the winter. In most cases, symptoms clear spontaneously within one week. In about 10 percent of cases, acute bronchitis can be traced to infection by nonviral agents including Mycoplasma pneumoniae, Chlamydia pneumoniae, and Bordetella pertussis. Diagnostic tests to determine the specific organism responsible for acute bronchitis are impractical, so therapy is usually empiric.

Treatment of acute bronchitis consists of symptomatic relief with cough suppressant medication (antitussives), pain relief with nonsteroidal anti-inflammatory drugs, and decongestants if nasal and sinus congestion is present. Antibiotics against bacterial organisms are not indicated in the treatment of acute bronchitis. If acute bronchitis occurs during a community outbreak of influenza A or B infection, influenza is likely and may be managed with new antiviral drugs that shorten the duration of illness. This therapy is effective, however, only if begun within two days of the onset of symptoms. Expense and limitation of the symptomatic benefit to one to two days render such antiviral therapy controversial.

A few patients with acute bronchitis suffer from persistent cough beyond seven to ten days, requiring management with inhaled bronchodilators such as albuterol. Persistent cough along with sore throat (pharyngitis) may suggest infection from Mycoplasma pneumoniae or Chlamydia pneumoniae, prompting treatment with an antibiotic (doxycycline, erythromycin, clarithromycin, or azithromycin). A persistent, violent, barking cough may be a clue to infection from Bordetella pertussis. This fairly common problem may respond to a one- or two-week course of antibiotic treatment with erythromycin. A cough that persists for more than three weeks is termed "chronic cough." Occasionally chronic cough follows an episode of acute bronchitis. More likely, however, chronic cough is caused by some type of under-lying chronic lung disease, bronchial asthma, postnasal drip, or gastroesophageal reflux disease.

It is important to distinguish acute bronchitis from pneumonia. Patients with pneumonia usually have fever, chills, and a more severe illness than is seen with acute bronchitis, and the chest X-ray reveals a shadow (lung infiltrate) that is lacking in acute bronchitis. Acute bronchitis should also be distinguished from an attack of bronchial asthma and from acute exacerbation of chronic obstructive pulmonary disease (COPD).

Chronic bronchitis is characterized by chronic or recurrent excess bronchial mucus secretion. About 12.5 million Americans are thought to suffer from chronic bronchitis, and the morbidity, mortality, and economic impact of this condition (and of emphysema) are immense. Chronic bronchial inflammation results in a persistent cough, which by definition occurs most days for at least three months of the year for at least two successive years. The cough is typically productive of varying amounts and appearance of phlegm (sputum). Other diseases that are associated with excessive mucus secretion, such as chronic sinusitis with post-nasal drip, asthma, lung cancer, tuberculosis, and bronchiectasis, must not be confused with chronic bronchitis. Patients with "simple chronic bronchitis" lack airflow obstruction on pulmonary function tests (spirometry), whereas those with "chronic obstructive bronchitis" have reduced air-flow rates. Both types of chronic bronchitis are closely linked to cigarette smoking.

Chronic obstructive bronchitis is one of two types of COPD, the other being emphysema. Some, but not all, patients with simple chronic bronchitis progress to the chronic obstructive form. Most patients with chronic obstructive bronchitis also have emphysema. Chronic asthmatic bronchitis is an overlap condition with features of both chronic bronchitis and bronchial asthma. Industrial bronchitis is a type of chronic bronchitis associated with occupational exposure to dusts.

Patients with chronic obstructive bronchitis usually have a daily cough, sputum production, shortness of breath (dyspnea), and sometimes wheezing. These symptoms typically appear in the age range from forty-five to sixty and gradually progress, particularly if cigarette smoking continues. In advanced cases, chronic respiratory failure may occur. Acute exacerbations of chronic bronchitis are intermittent episodes of increasing cough with discolored sputum, shortness of breath, and wheezing that typically occur one or two times each year. Viral or bacterial infection is a common cause of these episodes.

Medical management of chronic bronchitis includes general measures such as patient education, smoking cessation, improved nutrition, exercise, and immunization against infection by influenza virus and Streptococcus pneumoniae. Complete elimination of cigarette smoking is essential and has been proven to slow the rate of decline in pulmonary function that occurs over time. Patients with chronic obstructive bronchitis are treated with bronchodilator drugs such as inhaled ipratropium bromide and albuterol and occasionally with oral theophylline. Supplemental oxygen is prescribed for patients with low arterial blood-oxygen levels (hypoxemia), and antibiotics are often given for significant acute exacerbations. Other management strategies that are recommended for emphysema are also appropriate for chronic obstructive bronchitis because of the over-lap of these two conditions.

(SEE ALSO: Acute Respiratory Diseases; Asthma; Influenza)

Bibliography

American Thoracic Society (1995). "Standards for the Diagnosis and Care of Patients with Chronic Obstructive Pulmonary Disease." American Journal of Respiratory and Critical Care Medicine 152(5):S77– S120.

Anthonisen, N. R.; Manfreda, J.; Warren, C. P. W.; Hershfield, E. S.; Harding, G. K. M.; and Nelson, N. A. (1987). "Antibiotic Therapy of Acute Exacerbations of Chronic Obstructive Pulmonary Disease." Annals of Internal Medicine 106(2):196–204.

Sethi, S. (2000). "Infectious Etiology of Acute Exacerbations of Chronic Bronchitis." Chest 117(5):380S–385S.

Snow, V.; Mottur-Pilson, C.; and Gonzales, R. (2001). "Principles of Appropriate Antibiotic Use for Treatment of Acute Bronchitis in Adults." Annals of Internal Medicine 134:518–520.

— JOHN L. STAUFFER

Inflammation of the bronchi resulting in restricted air flow to the lungs. It is marked by a hacking cough, which attempts to clear the tubes. Acute bronchitis is due to a viral or bacterial infection, and is aggravated by physical activity. Chronic bronchitis is associated with tobacco smoking. A planned programme of aerobic exercise, particularly in those who give up smoking, can improve pulmonary function and is used to manage the illness.

Inflammation of one or more bronchi. Signs of acute bronchitis include fever and an irritating cough.
Bronchitis may be either an acute or chronic disorder and frequently involves the trachea as well as the bronchi (tracheobronchitis). The acute stage of the disease often is an extension of an upper respiratory infection which is usually viral in origin. Causes other than infectious agents are physical and chemical irritants that are inhaled in air polluted by dust, industrial fumes and powdered feeds. The important clinical signs indicative of bronchitis are cough and the ease of stimulating a cough by compression of the trachea, and bronchial tones on auscultation of the base of the lungs. At necropsy the case may be classified as catarrhal, eosinophilic, fibronecrotic, purulent or ulcerative.

• avian infectious b. — caused by coronavirus. There are many serotypes. Causes gasping and rales, heavy mortality and rapid spread in young birds up to 4 weeks of age. Called also gasping disease.
• infectious equine b. — see equine influenza.
• parasitic b. — see lungworm.

Bronchitis
Classification and external resources
This diagram shows Acute bronchitis.
ICD-10	J20.-J21., J42.
ICD-9	466, 491
DiseasesDB	29135
MedlinePlus	001087
eMedicine	article/297108
MeSH	D001991

This article needs additional citations for verification. Please help improve this article by adding reliable references. Unsourced material may be challenged and removed. (July 2009)

Bronchitis is inflammation of the mucous membranes of the bronchi, the airways that carry airflow from the trachea into the lungs. Bronchitis can be classified into two categories, acute and chronic, each of which has unique etiologies, pathologies, and therapies.

Acute bronchitis is characterized by the development of a cough, with or without the production of sputum, mucus that is expectorated (coughed up) from the respiratory tract. Acute bronchitis often occurs during the course of an acute viral illness such as the common cold or influenza. Viruses cause about 90% of cases of acute bronchitis while bacteria account for less than 10%.^[1]

Chronic bronchitis, a type of chronic obstructive pulmonary disease, is characterized by the presence of a productive cough that lasts for 3 months or more per year for at least 2 years. Chronic bronchitis most often develops due to recurrent injury to the airways caused by inhaled irritants. Cigarette smoking is the most common cause, followed by air pollution and occupational exposure to irritants, and cold air.

Contents 1 Acute bronchitis 2 Chronic bronchitis 3 References 4 External links

Acute bronchitis

Main article: Acute bronchitis

Acute bronchitis is most often caused by viruses that infect the epithelium of the bronchi, resulting in inflammation and increased secretion of mucus. Cough, a common symptom of acute bronchitis, develops in an attempt to expel the excess mucus from the lungs. Other common symptoms include sore throat, runny nose, nasal congestion (coryza), low-grade fever, malaise, and the production of sputum.^[1]

Acute bronchitis often develops during the course of an upper respiratory infection (URI) such as the common cold or influenza.^[1] About 90% of cases of acute bronchitis are caused by viruses, including rhinoviruses, adenoviruses, and influenza. Bacteria, including Mycoplasma pneumoniae, Chlamydia pneumoniae, and Bordetella pertussis, account for about 10% of cases.^[1]

Treatment for acute bronchitis is primarily symptomatic. Non-steroidal anti-inflammatory drugs (NSAIDs) may be used to treat fever and sore throat. Decongestants can be useful in patients with nasal congestion, and expectorants may be used to loosen mucus and increase expulsion of sputum. Cough suppressants may be used if the cough interferes with sleep or is bothersome, although coughing may be useful in expelling sputum from the airways. Even with no treatment, most cases of acute bronchitis resolve quickly.^[1]

Only about 5-10% of bronchitis cases are caused by a bacterial infection. Most cases of bronchitis are caused by a viral infection and are "self-limited" and resolve themselves in a few weeks.^[2] As most cases of acute bronchitis are caused by viruses, antibiotics should not be used since they are only effective against bacteria. Using antibiotics in patients who do not have bacterial infections promotes the development of antibiotic-resistant bacteria, which may lead to greater morbidity and mortality. Antibiotics should only be prescribed if microscopic examination of Gram stained sputum shows large numbers of bacteria present.^[1]

Chronic bronchitis

Main article: Chronic bronchitis

Chronic bronchitis, a type of chronic obstructive pulmonary disease, is defined by a productive cough that lasts for 3 months or more per year for at least 2 years^[3]. Other symptoms may include wheezing and shortness of breath, especially upon exertion. The cough is often worse soon after awakening, and the sputum produced may have a yellow or green color and may be streaked with blood.^[1]

Chronic bronchitis is caused by recurring injury or irritation to the respiratory epithelium of the bronchi, resulting in chronic inflammation, edema (swelling), and increased production of mucus by goblet cells.^[1] Airflow into and out of the lungs is partly blocked because of the swelling and extra mucus in the bronchi or due to reversible bronchospasm.^[4]

Most cases of chronic bronchitis are caused by smoking cigarettes or other forms of tobacco. Chronic inhalation of irritating fumes or dust from occupational exposure or air pollution may also be causative. About 5% of the population has chronic bronchitis, and it is two times more common in males than females.^[1]

Chronic bronchitis is treated symptomatically. Inflammation and edema of the respiratory epithelium may be reduced with inhaled corticosteroids. Wheezing and shortness of breath can be treated by reducing bronchospasm (reversible narrowing of smaller bronchi due to constriction of the smooth muscle) with bronchodilators such as inhaled β-Adrenergic agonists (e.g., albuterol) and inhaled anticholinergics (e.g., ipratropium bromide). Hypoxemia, too little oxygen in the blood, can be treated with supplemental oxygen.^[1] However, oxygen supplementation can result in decreased respiratory drive leading to increased blood levels of carbon dioxide and subsequent respiratory acidosis.

The most effective method of preventing chronic bronchitis and other forms of COPD is to avoid smoking cigarettes and other forms of tobacco.^[1]

On pulmonary tests, a bronchitic (bronchitis) may present a decreased FEV1 and FEV1/FVC. However, unlike the other common obstructive disorders, asthma and emphysema, bronchitis rarely causes a high residual volume. This is because the air flow obstruction found in bronchitis is due to increased resistance, which does not generally cause the airways to collapse prematurely and trap air in the lungs.^{[citation needed]}

References

1. ^ ^{a b c d e f g h i j k} Cohen, Jonathan and William Powderly. Infectious Diseases. 2nd ed. Mosby (Elsevier), 2004. "Chapter 33: Bronchitis, Bronchiectasis, and Cystic Fibrosis"
2. ^ Hueston WJ (March 1997). "Antibiotics: neither cost effective nor 'cough' effective". The Journal of Family Practice 44 (3): 261–5. PMID 9071245. 
3. ^ "CDC Definition of Chronic Bronchitis from NIOSH HAZARD REVIEW, Health Effects of Occupational Exposure to Respirable Crystalline Silica"
4. ^ "Ross and Wilson: Anatomy and Physiology (tenth edition)"

External links

• Bronchitis—Acute Bronchitis, WebMD
• Bronchitis, MayoClinic.com

Look up bronchitis in Wiktionary, the free dictionary.

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v • d • e Inflammation Acute Plasma derived mediators Bradykinin · complement (C3, C5a, MAC) · coagulation (Factor XII, Plasmin, Thrombin) Cell derived mediators preformed: Lysosome granules · vasoactive amines (Histamine, Serotonin) synthesized on demand: cytokines (IFN-γ, IL-8, TNF-α, IL-1) · eicosanoids (Leukotriene B4, Prostaglandins) · Nitric oxide · Kinins Chronic Macrophage · Epithelioid cell · Giant cell · Granuloma Processes Traditional: Rubor · Calor · Tumor · Dolor (pain) · Functio laesa Modern: Acute-phase reaction/Fever · Vasodilation · Increased vascular permeability · Exudate · Leukocyte extravasation · Chemotaxis Specific types Nervous CNS (Encephalitis, Myelitis) · Meningitis (Arachnoiditis) · PNS (Neuritis) · eye (Dacryoadenitis, Scleritis, Keratitis, Choroiditis, Retinitis, Chorioretinitis, Blepharitis, Conjunctivitis, Iritis, Uveitis) · ear (Otitis, Labyrinthitis, Mastoiditis) Cardiovascular Carditis (Endocarditis, Myocarditis, Pericarditis) · Vasculitis (Arteritis, Phlebitis, Capillaritis) Respiratory upper (Sinusitis, Rhinitis, Pharyngitis, Laryngitis) · lower (Tracheitis, Bronchitis, Bronchiolitis, Pneumonitis, Pleuritis) · Mediastinitis Digestive mouth (Stomatitis, Gingivitis, Gingivostomatitis, Glossitis, Tonsillitis, Sialadenitis/Parotitis, Cheilitis, Pulpitis, Gnathitis) · tract (Esophagitis, Gastritis, Gastroenteritis, Enteritis, Colitis, Enterocolitis, Duodenitis, Ileitis, Caecitis, Appendicitis, Proctitis) · accessory (Hepatitis, Cholangitis, Cholecystitis, Pancreatitis) · Peritonitis Integumentary Dermatitis (Folliculitis) · Cellulitis · Hidradenitis Musculoskeletal Arthritis · Dermatomyositis · soft tissue (Myositis, Synovitis/Tenosynovitis, Bursitis, Enthesitis, Fasciitis, Capsulitis, Epicondylitis, Tendinitis, Panniculitis) Osteochondritis: Osteitis (Spondylitis, Periostitis) · Chondritis Urinary Nephritis (Glomerulonephritis, Pyelonephritis) · Ureteritis · Cystitis · Urethritis Reproductive female: Oophoritis · Salpingitis · Endometritis · Parametritis · Cervicitis · Vaginitis · Vulvitis · Mastitis male: Orchitis · Epididymitis · Prostatitis · Balanitis · Balanoposthitis pregnancy/newborn: Chorioamnionitis · Omphalitis Endocrine Insulitis · Hypophysitis · Thyroiditis · Parathyroiditis · Adrenalitis Lymphatic Lymphangitis · Lymphadenitis

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Dansk (Danish)
n. - bronkitis

Nederlands (Dutch)
bronchitis

Français (French)
n. - bronchite

Deutsch (German)
n. - Bronchitis

Ελληνική (Greek)
n. - (παθολ.) βρογχίτιδα

Italiano (Italian)
bronchite

Português (Portuguese)
n. - bronquite (f) (Med.)

Русский (Russian)
бронхит

Español (Spanish)
n. - bronquitis

Svenska (Swedish)
n. - bronkit

中文（简体）(Chinese (Simplified))
支气管炎

中文（繁體）(Chinese (Traditional))
n. - 支氣管炎

한국어 (Korean)
n. - 기관지염

日本語 (Japanese)
n. - 気管支炎

العربيه (Arabic)
‏(الاسم) التهاب القصبات‏

עברית (Hebrew)
n. - ‮דלקת הסימפונות, ברונכיטיס‬

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