Definition and Overview

Bronchitis is a disease that is characterized by inflammation of the bronchial mucosa or the lining of the respiratory passages. The inflammation causes irritation of the membrane, resulting in the narrowing of the airway and production of thickened mucus and secretions. Patients thus experience frequent coughing spells and difficulty of breathing.

There are two kinds of bronchitis, based on the length of time the symptoms occur: acute bronchitis, which lasts for up to three weeks; and chronic bronchitis, which lasts for a minimum of three months in a year, occurring for two consecutive years. Chronic bronchitis is a type of chronic obstructive pulmonary disease or COPD.

Acute bronchitis is common in children, while chronic bronchitis is common in the older age group, specifically in patients who are more than 65 years old. Previously, bronchitis was noted to be more common in men than in women. However, in recent years, there has been an increasing trend in the number of women diagnosed with the disease.

An estimated 10 million people are diagnosed with chronic bronchitis. It is one of the top causes of mortality in the United States.

Causes of Condition

Acute bronchitis is typically caused by an infection with a virus or bacteria. Viruses, such as the influenza virus, cause the majority of cases of acute bronchitis. It usually develops during a bout of upper respiratory tract infection. Most of the cases of acute bronchitis occur during wintertime or fall.

On the other hand, chronic bronchitis is usually caused by smoking or exposure to second-hand smoke. Cigarettes are usually the ones to blame, but other forms of tobacco may also cause this condition. Cigarette smoking leads to the significant decrease in the amount of air exhaled by the patient, which plays an important role in the patient’s pulmonary function. Babies who are exposed to smoking mothers have also been shown to have decreased pulmonary function, which contributes to the development of this condition.

People who are exposed to air pollution may also be at risk of developing chronic bronchitis. Studies have shown higher rates of chronic bronchitis in urban areas compared to rural communities, which has been attributed to more air pollution in cities. Long-term exposure to dust, fumes and other industrial chemicals may also result in this condition. This is usually seen in patients who work at coal and mining sites as well as in metal molding, textile, and livestock industries.

Key Symptoms

The most common symptom of bronchitis, whether acute or chronic, is cough that is associated with mucus production. The phlegm may be clear, yellow, or green, and rarely, may be blood-streaked. Patients also have breathing difficulties and occasionally, with chest discomfort.

Since acute bronchitis is usually associated with an infection, patients may present with fever and chills. Sometimes, even when the respiratory infection has already been treated, the cough may persist for a few weeks afterwards. The symptoms eventually resolve on their own.

Chronic bronchitis, meanwhile, presents with episodes of recurrent bronchospasm. There is actually no period where the patient is free of symptoms; instead, patients typically have chronic cough that comes with phlegm, with episodes of wheezing and acute attacks of difficulty in breathing. Patients experience an increased response to different stimuli, resulting in hyper-responsiveness of the airway. Air trapping occurs and there is inefficient gas exchange, resulting in shortness of breath and bronchoconstriction. Patients with chronic bronchitis are prone to respiratory infection, with symptoms usually lasting longer.

Who to See and Types of Treatments Available

If you have a cough that lasts for more than two weeks, it is best to see your doctor. You should also consult a health professional if you experience difficulty in breathing and have cough associated with high fever and bloody phlegm. Your doctor will more likely to request for a chest x-ray and sputum studies. Further examinations may include pulmonary function tests, which determine the amount of air that you can get into your lungs and how fast you can get it out.

Since viruses usually cause acute bronchitis, treatment is supportive and is directed towards the symptoms. This condition generally resolves on its own. Increased fluid intake and bed rest are advised. If your doctor suspects a bacterial infection, you may also be given antibiotics. If you are in good health, your airway will return to normal once acute bronchitis resolves.

If you are diagnosed with chronic bronchitis, your primary physician may refer you to a pulmonary specialist. The most important aspect of the management of chronic bronchitis is smoking cessation. Scientific evidence shows that modifying the individual's environment, specifically by avoiding smoking and exposure to secondhand smoke, can slow down the decline of the patient's pulmonary function. More benefit is seen when patients quit earlier, before the onset of permanent lung damage and a significant decrease in pulmonary function. Aside from smoking cessation, you will also be advised to avoid other lung irritants and wear a mask when going out.

Oxygen support is the only treatment that has been shown to reduce the mortality in patients who have chronic bronchitis. Patients are encouraged to use oxygen support for at least 12 hours every day.

Patients with chronic bronchitis may also be given medications in order to improve their symptoms. Specifically, bronchodilators, such as beta-agonists and anticholinergic, may be given to help open up the airways. Inhaled steroids may also be used to decrease the inflammation in the area.

Patients are likewise advised to undergo pulmonary rehabilitation, which includes conditioning of the cardiovascular system combined with patient education. You will be taught specific breathing exercises, which can help improve your symptoms and maximize your lung's capacity. Pulmonary rehabilitation has been shown to improve the patient’s capacity for exercise and quality of life. Pulmonary rehabilitation is also associated with decreased hospitalization rates in patients.

Resources:

  • Understanding Chronic Bronchitis. https://lung.org./
  • What is Bronchitis? National Institutes of Health
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