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Bronchitis is inflammation of the bronchi (large and medium-sized airways) in the lungs.[1] Symptoms include coughing up mucus, wheezing, shortness of breath, and chest discomfort.[1] Bronchitis is divided into two types: acute and chronic.[1] Acute bronchitis is also known as a chest cold.[1]

Bronchitis
Bronchitis.jpg
Figure A shows the location of the lungs and bronchial tubes. Figure B is an enlarged view of a normal bronchial tube. Figure C is an enlarged view of a bronchial tube with bronchitis.
Pronunciation
  • bron-kye-tis
Specialty Infectious disease, pulmonology
Symptoms Coughing up mucus, wheezing, shortness of breath, chest discomfort[1]
Types Acute, chronic[1]
Frequency Acute: ~5% of people a year[2][3]
Chronic: ~5% of people[3]

Acute bronchitis usually has a cough that lasts around three weeks.[4] In more than 90% of cases the cause is a viral infection.[4] These viruses may be spread through the air when people cough or by direct contact.[1] Risk factors include exposure to tobacco smoke, dust, and other air pollution.[1] A small number of cases are due to high levels of air pollution or bacteria such as Mycoplasma pneumoniae or Bordetella pertussis.[4][5] Treatment of acute bronchitis typically involves rest, paracetamol (acetaminophen), and NSAIDs to help with the fever.[6][7]

Chronic bronchitis is defined as a productive cough that lasts for three months or more per year for at least two years.[8] Most people with chronic bronchitis have chronic obstructive pulmonary disease (COPD).[9] Tobacco smoking is the most common cause, with a number of other factors such as air pollution and genetics playing a smaller role.[10] Treatments include quitting smoking, vaccinations, rehabilitation, and often inhaled bronchodilators and steroids.[11] Some people may benefit from long-term oxygen therapy or lung transplantation.[11]

Acute bronchitis is one of the most common diseases.[6][12] About 5% of adults are affected and about 6% of children have at least one episode a year.[2][13] In 2010, COPD affects 329 million people or nearly 5% of the global population.[3] In 2013, it resulted in 2.9 million deaths, a change from 2.4 million deaths in 1990.[14]

Contents

Acute bronchitisEdit

 
Bronchitis

Acute bronchitis, also known as a chest cold, is short term inflammation of the bronchi of the lungs.[1][4] The most common symptom is a cough.[4] Other symptoms include coughing up mucus, wheezing, shortness of breath, fever, and chest discomfort. The infection may last from a few to ten days.[1] The cough may persist for several weeks afterwards with the total duration of symptoms usually around three weeks.[1][4] Some have symptoms for up to six weeks.[6]

CauseEdit

In more than 90% of cases the cause is a viral infection.[4] These viruses may be spread through the air when people cough or by direct contact. Risk factors include exposure to tobacco smoke, dust, and other air pollution.[1] A small number of cases are due to high levels of air pollution or bacteria such as Mycoplasma pneumoniae or Bordetella pertussis.[4][5]

DiagnosisEdit

Diagnosis is typically based on a person's signs and symptoms.[15] The color of the sputum does not indicate if the infection is viral or bacterial. Determining the underlying organism is typically not needed.[4] Other causes of similar symptoms include asthma, pneumonia, bronchiolitis, bronchiectasis, and COPD.[4][2] A chest X-ray may be useful to detect pneumonia.[4]

Another common sign of bronchitis is a cough which lasts ten days to three weeks. If the cough lasts a month or a year it may be chronic bronchitis. In addition to having a cough a fever may be present. Acute bronchitis is normally caused by a viral infection. Typically these infections are rhinovirus, para influenza, or influenza. No specific testing is normally needed to diagnose acute bronchitis.[16]

TreatmentEdit

Prevention is by not smoking and avoiding other lung irritants. Frequent hand washing may also be protective.[17] Treatment of acute bronchitis typically involves rest, paracetamol (acetaminophen), and NSAIDs to help with the fever.[6][7] Cough medicine has little support for its use and is not recommended in children less than six years of age.[4][18] There is tentative evidence that salbutamol may be useful in those with wheezing; however, it may result in nervousness and tremors.[4][19] Antibiotics should generally not be used.[20] An exception is when acute bronchitis is due to pertussis. Tentative evidence supports honey and pelargonium to help with symptoms.[4] Getting plenty of rest and fluids is also often recommended.[21]

EpidemiologyEdit

Acute bronchitis is one of the most common diseases.[6][12] About 5% of adults are affected and about 6% of children have at least one episode a year.[2][13] It occurs more often in the winter.[2] More than 10 million people in the United States visit a doctor each year for this condition with about 70% receiving antibiotics which are mostly not needed.[6] There are efforts to decrease the use of antibiotics in acute bronchitis.[12]

Chronic bronchitisEdit

Chronic bronchitis is defined as a productive cough that lasts for three months or more per year for at least two years.[8] Most people with chronic bronchitis have chronic obstructive pulmonary disease (COPD).[9] Protracted bacterial bronchitis is defined as a chronic productive cough with a positive bronchoalveolar lavage that resolves with antibiotics.[22][23] Symptoms of chronic bronchitis may include wheezing and shortness of breath, especially upon exertion and low oxygen saturations.[24] The cough is often worse soon after awakening and the sputum produced may have a yellow or green color and may be streaked with specks of blood.[25]

CauseEdit

Most cases of chronic bronchitis are caused by smoking cigarettes or other forms of tobacco.[24][26][27] Additionally, chronic inhalation of air pollution or irritating fumes or dust from hazardous exposures in occupations such as coal mining, grain handling, textile manufacturing, livestock farming,[28] and metal moulding may also be a risk factor for the development of chronic bronchitis.[29][30][31] Protracted bacterial bronchitis is usually caused by Streptococcus pneumoniae, Non-typable Haemophilus influenzae, or Moraxella catarrhalis.[22][23]

DiagnosisEdit

Individuals with an obstructive pulmonary disorder such as bronchitis may present with a decreased FEV1 and FEV1/FVC ratio on pulmonary function tests.[32][33][34] Unlike other common obstructive disorders such as asthma or emphysema, bronchitis rarely causes a high residual volume (the volume of air remaining in the lungs after a maximal exhalation effort).[35]

TreatmentEdit

Evidence suggests that the decline in lung function observed in chronic bronchitis may be slowed with smoking cessation.[36] Chronic bronchitis is treated symptomatically and may be treated in a nonpharmacologic manner or with pharmacologic therapeutic agents. Typical nonpharmacologic approaches to the management of COPD including bronchitis may include: pulmonary rehabilitation, lung volume reduction surgery, and lung transplantation.[36] Inflammation and edema of the respiratory epithelium may be reduced with inhaled corticosteroids.[37] 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 long acting β2-adrenergic receptor agonists (e.g., salmeterol) and inhaled anticholinergics such as ipratropium bromide or tiotropium bromide.[38] Mucolytics may have a small therapeutic effect on acute exacerbations of chronic bronchitis.[39] Supplemental oxygen is used to treat hypoxemia (too little oxygen in the blood) and has been shown to reduce mortality in chronic bronchitis patients.[25][36] Oxygen supplementation can result in decreased respiratory drive, leading to increased blood levels of carbon dioxide (hypercapnia) and subsequent respiratory acidosis.[40]

EpidemiologyEdit

Chronic bronchitis has a 3.4% to 22% prevalence rate among the general population. Individuals over the age of 45, smokers, those that live in areas with high air pollution and those have asthma have a higher risk of developing chronic bronchitis.[41] This wide range is due to the different definitions of chronic bronchitis which can be defined based on signs and symptoms or the clinical diagnosis of the disorder. Chronic bronchitis tends to affect men more often than women. While the primary risk factor for chronic bronchitis is smoking, there is still a 4%-22% chance that people with chronic bronchitis were never smokers. This might suggest other risk factors such as the inhalation of fuels, dusts, and fumes.[42] Obesity has also been linked to an increased risk in the onset of chronic bronchitis. In the United States in the year 2014 per 100,000 population the death rate of chronic bronchitis was 0.2%[43].

ReferencesEdit

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