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==Overview==
==Overview==
'''Bronchitis''' is an [[inflammation]] of the [[bronchus|bronchi]] (medium-size airways) in the [[lung]]s.<ref name=CDCBronchitis> Bronchitis (Chest Cold) - Get Smart: Know When Antibiotics Work. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/getsmart/community/for-patients/common-illnesses/bronchitis.html Accessed on July 28, 2016 </ref> ''Acute bronchitis'' is usually caused by [[virus]]es or [[bacteria]] and may last several days or weeks. ''Chronic bronchitis'' is not necessarily caused by infection and is generally part of a syndrome called [[chronic obstructive pulmonary disease]] (COPD); it is defined clinically as a persistent [[cough]] that produces [[sputum]] (phlegm), for at least three months in two consecutive years. The remainder of this article deals with ''acute'' bronchitis only. This is caused by a viral infection, such as a cold, or a bacterial infection. It also can result from breathing irritating fumes, such as those of tobacco smoke or polluted air. Constant coughing is the main symptom. Either type(chronic or acute) may lead to asthma or pneumonia.
Bronchitis is an [[inflammation]] of the [[bronchus|bronchi]] (medium and large size airways).<ref name=CDCBronchitis> Bronchitis (Chest Cold) - Get Smart: Know When Antibiotics Work. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/getsmart/community/for-patients/common-illnesses/bronchitis.html Accessed on July 28, 2016 </ref> [[Acute bronchitis]] is a self-limiting disease caused by [[virus]]es or [[bacteria]]. [[Chronic bronchitis]] is a disease by definition and is part of [[chronic obstructive pulmonary disease]] (COPD) which is defined as productive cough for at least three months in two consecutive years. Inflammatory response of the bronchial epithelium to infections or [[irritants]] that involve the medium and large size airways results in thickening of the bronchial and tracheal [[mucosa]]. Hallmark features of chronic bronchitis pathophysiology include: [[hyperplasia]] and [[hypertrophy]] of the [[Goblet cell|goblet cells]] of the airway, resulting in an increase in secretion of mucus which contributes to the airway obstruction. 
[[Microscope|Microscopically]] there is [[Infiltration (medical)|infiltration]] of the airway walls with [[Inflammation|inflammatory]] cells, particularly [[neutrophils]]. Inflammation is followed by scarring and remodeling that thickens the walls resulting in narrowing of the small airway. Further progression leads to [[metaplasia]] and [[fibrosis]] of the lower airway. The consequence of these changes is a limitation of airflow.<ref name="pmid19494220">{{cite journal |vauthors=Cosio MG, Saetta M, Agusti A |title=Immunologic aspects of chronic obstructive pulmonary disease |journal=N. Engl. J. Med. |volume=360 |issue=23 |pages=2445–54 |year=2009 |pmid=19494220 |doi=10.1056/NEJMra0804752 |url=}}</ref><ref name=kc>Kumar P, Clark M (2005). ''Clinical Medicine'', 6ed. Elsevier Saunders. pp 900-901. ISBN 0702027634.</ref><ref name="pmid22029978">{{cite journal |vauthors=McDonough JE, Yuan R, Suzuki M, Seyednejad N, Elliott WM, Sanchez PG, Wright AC, Gefter WB, Litzky L, Coxson HO, Paré PD, Sin DD, Pierce RA, Woods JC, McWilliams AM, Mayo JR, Lam SC, Cooper JD, Hogg JC |title=Small-airway obstruction and emphysema in chronic obstructive pulmonary disease |journal=N. Engl. J. Med. |volume=365 |issue=17 |pages=1567–75 |year=2011 |pmid=22029978 |pmc=3238466 |doi=10.1056/NEJMoa1106955 |url=}}</ref>
Acute bronchitis affects young children and old people. Its overall incidence is approximately 5% in the U.S. There is no racial or gender predilection for this disease.<ref name="pmid11209098">{{cite journal |vauthors=Macfarlane J, Holmes W, Gard P, Macfarlane R, Rose D, Weston V, Leinonen M, Saikku P, Myint S |title=Prospective study of the incidence, aetiology and outcome of adult lower respiratory tract illness in the community |journal=Thorax |volume=56 |issue=2 |pages=109–14 |year=2001 |pmid=11209098 |pmc=1746009 |doi= |url=}}</ref><ref name="pmid17108344">{{cite journal |vauthors=Wenzel RP, Fowler AA |title=Clinical practice. Acute bronchitis |journal=N. Engl. J. Med. |volume=355 |issue=20 |pages=2125–30 |year=2006 |pmid=17108344 |doi=10.1056/NEJMcp061493 |url=}}</ref><ref name=book1>Ferri FF. Ferri's Clinical Advisor 2016, 5 Books in 1. Elsevier Health Sciences; 2015.</ref>Although, Chronic bronchitis is common among geriatric patients. It occurs more commonly among Caucasian individuals compared to other races, but equally between males and females.<ref>[http://www.wrongdiagnosis.com/c/copd/prevalence.htm wrongdiagnosis.com > Prevalence and Incidence of COPD] Retrieved on Mars 14, 2010</ref>
Age, season of the year and the immunization status are the main determining risk factors for acquiring acute bronchitis.<ref name="pmid11119400">{{cite journal |vauthors=Gonzales R, Sande MA |title=Uncomplicated acute bronchitis |journal=Ann. Intern. Med. |volume=133 |issue=12 |pages=981–91 |year=2000 |pmid=11119400 |doi= |url=}}</ref><ref name="pmid17108344">{{cite journal |vauthors=Wenzel RP, Fowler AA |title=Clinical practice. Acute bronchitis |journal=N. Engl. J. Med. |volume=355 |issue=20 |pages=2125–30 |year=2006 |pmid=17108344 |doi=10.1056/NEJMcp061493 |url=}}</ref><ref name="pmid21121518">{{cite journal |vauthors=Albert RH |title=Diagnosis and treatment of acute bronchitis |journal=Am Fam Physician |volume=82 |issue=11 |pages=1345–50 |year=2010 |pmid=21121518 |doi= |url=}}</ref> The most potent risk factor in the development of [[chronic bronchitis]] is cigarette smoking.<ref name="medcauses">[http://www.medicinenet.com/chronic_obstructive_pulmonary_disease_copd/page3.htm7whatcauses MedicineNet.com - COPD causes]</ref> Other risk factors are occupational pollutants, such as cadmium, silica, and air pollutants, and genetic factors, such as [[alpha 1 antitrypsin deficiency]]<ref>[http://www.nlm.nih.gov/medlineplus/ency/article/000091.htm MedlinePlus Medical Encyclopedia]</ref>
Acute bronchitis is a self limiting lower respiratory tract infection that usually presents with cough that lasts for up to 3 weeks.<ref name="pmid11119400">{{cite journal |vauthors=Gonzales R, Sande MA |title=Uncomplicated acute bronchitis |journal=Ann. Intern. Med. |volume=133 |issue=12 |pages=981–91 |year=2000 |pmid=11119400 |doi= |url=}}</ref><ref name="pmid16798599">{{cite journal |vauthors=Landau LI |title=Acute and chronic cough |journal=Paediatr Respir Rev |volume=7 Suppl 1 |issue= |pages=S64–7 |year=2006 |pmid=16798599 |doi=10.1016/j.prrv.2006.04.172 |url=}}</ref> Chronic bronchitis usually gradually worsens over time and can result in death. The rate of deterioration varies between individuals and depends on the level of airflow obstruction. Prognosis is dependent on early recognition and smoking cessation, which improves the outcome significantly. Cigarette cessation, hand hygiene, vaccination and reduction in occupational exposure are the mainstays to decrease the severity and the risk of bronchitis.<ref name="pmid21121518">{{cite journal |vauthors=Albert RH |title=Diagnosis and treatment of acute bronchitis |journal=Am Fam Physician |volume=82 |issue=11 |pages=1345–50 |year=2010 |pmid=21121518 |doi= |url=}}</ref><ref name="pmid16428698">{{cite journal |vauthors=Braman SS |title=Chronic cough due to acute bronchitis: ACCP evidence-based clinical practice guidelines |journal=Chest |volume=129 |issue=1 Suppl |pages=95S–103S |year=2006 |pmid=16428698 |doi=10.1378/chest.129.1_suppl.95S |url=}}</ref>


'''Acute bronchitis''' is characterized by [[cough]] and [[sputum]] (phlegm) production and symptoms related to the obstruction of the airways by the inflamed airways and the phlegm, such as shortness of breath and wheezing. Diagnosis is by clinical examination and sometimes [[microbiology|microbiological]] examination of the phlegm. Treatment may be with [[antibiotic]]s (if a bacterial infection is suspected), [[bronchodilator]]s (to relieve breathlessness) and other treatments.
==Classification==
==Historical Perspective==
Bronchitis is classified in to two major categorize based on symptom chronicity.
*[[Acute bronchitis]]
*[[Chronic bronchitis]]
==Differential diagnosis==


In 1985, University of Newcastle, Australia Professor Robert Clancy developed an oral vaccine for acute bronchitis. This vaccine was commercialised four years later as Broncostat.[http://www.biotechnology-innovation.com.au/innovations/pharmaceuticals/broncostat.html]
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
 
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Organ System}}
==Pathophysiology==
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Disease}}
* '''[[Acute bronchitis]]:'''
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Symptoms}}
:Inflammatory response of the bronchial epithelium to infections or irritants that involve the medium and large size airways results in thickening of the bronchial and tracheal mucosa.
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Signs}}
:Bronchitis caused by [[influenza virus]] shows an epithelial-cell desquamation in association with the presence of a lymphocytic cellular infiltrate<ref name="pmid13782910">{{cite journal |vauthors=WALSH JJ, DIETLEIN LF, LOW FN, BURCH GE, MOGABGAB WJ |title=Bronchotracheal response in human influenza. Type A, Asian strain, as studied by light and electron microscopic examination of bronchoscopic biopsies |journal=Arch. Intern. Med. |volume=108 |issue= |pages=376–88 |year=1961 |pmid=13782910 |doi= |url=}}</ref>.
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Laboratory findings}}
*'''Chronic bronchitis:'''
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Diagnostic modality}}
:Halmark features include:[[hyperplasia]] (increased number) and [[hypertrophy]] (increased size) of the goblet cells ([[mucous gland]]) of the airway, resulting in an increase in secretion of mucus which contributes to the airway obstruction. 
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Management}}
:[[Microscope|Microscopically]] there is [[Infiltration (medical)|infiltration]] of the airway walls with [[Inflammation|inflammatory]] cells, particularly [[neutrophils]]. Inflammation is followed by scarring and remodeling that thickens the walls resulting in narrowing of the small airway. Further progression leads to [[metaplasia]] (abnormal change in the tissue) and [[fibrosis]] (further thickening and scarring) of the lower airway. The consequence of these changes is a limitation of airflow<ref name="pmid19494220">{{cite journal |vauthors=Cosio MG, Saetta M, Agusti A |title=Immunologic aspects of chronic obstructive pulmonary disease |journal=N. Engl. J. Med. |volume=360 |issue=23 |pages=2445–54 |year=2009 |pmid=19494220 |doi=10.1056/NEJMra0804752 |url=}}</ref><ref name=kc>Kumar P, Clark M (2005). ''Clinical Medicine'', 6ed. Elsevier Saunders. pp 900-901. ISBN 0702027634.</ref><ref name="pmid22029978">{{cite journal |vauthors=McDonough JE, Yuan R, Suzuki M, Seyednejad N, Elliott WM, Sanchez PG, Wright AC, Gefter WB, Litzky L, Coxson HO, Paré PD, Sin DD, Pierce RA, Woods JC, McWilliams AM, Mayo JR, Lam SC, Cooper JD, Hogg JC |title=Small-airway obstruction and emphysema in chronic obstructive pulmonary disease |journal=N. Engl. J. Med. |volume=365 |issue=17 |pages=1567–75 |year=2011 |pmid=22029978 |pmc=3238466 |doi=10.1056/NEJMoa1106955 |url=}}</ref>.
|-
 
| colspan="1" rowspan="5" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Cardiac}}
==Causes==
| style="padding: 5px 5px; background: #F5F5F5;" | HFpEF
*<font size="3.3">'''[[Acute Bronchitis]]:'''</font>  may be caused by either viral, bacterial or environmental causes.
| style="padding: 5px 5px; background: #F5F5F5;" |Exertional [[dyspnea]], reduced exercise tolerance, [[orthopnea]], [[paroxysmal nocturnal dyspnea]], edema
::'''Viruses:''' Influenza Virus,parainfluenza virus,respiratory syncytial virus, coronavirus, adenovirus, enterovirus, rhinovirus, coxsackievirus, and human metapneumovirus<ref name="pmid9323784">{{cite journal |vauthors=Jonsson JS, Sigurdsson JA, Kristinsson KG, Guthnadóttir M, Magnusson S |title=Acute bronchitis in adults. How close do we come to its aetiology in general practice? |journal=Scand J Prim Health Care |volume=15 |issue=3 |pages=156–60 |year=1997 |pmid=9323784 |doi= |url=}}</ref><ref name="pmid12402203">{{cite journal |vauthors=Boivin G, Abed Y, Pelletier G, Ruel L, Moisan D, Côté S, Peret TC, Erdman DD, Anderson LJ |title=Virological features and clinical manifestations associated with human metapneumovirus: a new paramyxovirus responsible for acute respiratory-tract infections in all age groups |journal=J. Infect. Dis. |volume=186 |issue=9 |pages=1330–4 |year=2002 |pmid=12402203 |doi=10.1086/344319 |url=}}</ref><ref name="pmid16107980">{{cite journal |vauthors=Louie JK, Hacker JK, Gonzales R, Mark J, Maselli JH, Yagi S, Drew WL |title=Characterization of viral agents causing acute respiratory infection in a San Francisco University Medical Center Clinic during the influenza season |journal=Clin. Infect. Dis. |volume=41 |issue=6 |pages=822–8 |year=2005 |pmid=16107980 |doi=10.1086/432800 |url=}}</ref>.
| style="padding: 5px 5px; background: #F5F5F5;" |Elevated [[Jugular venous pressure|JVP]], fine [[Rales|crackles]], [[edema]]
::'''Bacteries:''' Mycoplasma pneumoniae and,Chlamydophila pneumoniae and Bordetella pertussis<ref name="pmid17108344">{{cite journal |vauthors=Wenzel RP, Fowler AA |title=Clinical practice. Acute bronchitis |journal=N. Engl. J. Med. |volume=355 |issue=20 |pages=2125–30 |year=2006 |pmid=17108344 |doi=10.1056/NEJMcp061493 |url=}}</ref>.
| style="padding: 5px 5px; background: #F5F5F5;" |Increased [[Brain natriuretic peptide|BNP]]
::'''Environmental causes:''' Toxic fume inhalation, tobacco, dust and aerosol may result in acute bronchitis<ref name="pmid11106722">{{cite journal |vauthors=Irwin RS, Madison JM |title=The diagnosis and treatment of cough |journal=N. Engl. J. Med. |volume=343 |issue=23 |pages=1715–21 |year=2000 |pmid=11106722 |doi=10.1056/NEJM200012073432308 |url=}}</ref>.
| style="padding: 5px 5px; background: #F5F5F5;" |[[Echocardiography]] (normal EF)
*<font size="3.3">'''[[Chronic Bronchitis]]:'''</font> caused by ''smoking'',''Air Pollutants'',''Occupational Exposures'' and ''Genetic factors''
| style="padding: 5px 5px; background: #F5F5F5;" |Control of volume overload and [[hypertension]],
==Differentiating Bronchitis from other Diseases==
treatment of underlying condition ([[obesity]], [[Atrial fibrillation|AF]], [[coronary artery disease]], [[anemia]])
Bronchitis must be differentiated from other diseases that cause cough such as [[asthma]],[[pneumonia]],[[bronchectasis]] and [[CHF]].
|-
==Epidemiology and demography==
| style="padding: 5px 5px; background: #F5F5F5;" |HFrEF
'''Acute bronchitis''' affects young children and old people. Its overall incidence is about 5% in the U.S. There is no racial or gender predilection for this disease<ref name="pmid11209098">{{cite journal |vauthors=Macfarlane J, Holmes W, Gard P, Macfarlane R, Rose D, Weston V, Leinonen M, Saikku P, Myint S |title=Prospective study of the incidence, aetiology and outcome of adult lower respiratory tract illness in the community |journal=Thorax |volume=56 |issue=2 |pages=109–14 |year=2001 |pmid=11209098 |pmc=1746009 |doi= |url=}}</ref><ref name="pmid17108344">{{cite journal |vauthors=Wenzel RP, Fowler AA |title=Clinical practice. Acute bronchitis |journal=N. Engl. J. Med. |volume=355 |issue=20 |pages=2125–30 |year=2006 |pmid=17108344 |doi=10.1056/NEJMcp061493 |url=}}</ref><ref name=book1>Ferri FF. Ferri's Clinical Advisor 2016, 5 Books in 1. Elsevier Health Sciences; 2015.</ref>..<br>'''Chronic bronchitis''' is common in old ages affects white people more than others but is equal between males and females<ref>[http://www.wrongdiagnosis.com/c/copd/prevalence.htm wrongdiagnosis.com > Prevalence and Incidence of COPD] Retrieved on Mars 14, 2010</ref>.
| style="padding: 5px 5px; background: #F5F5F5;" |Exertional [[dyspnea]], reduced exercise tolerance, [[orthopnea]], [[paroxysmal nocturnal dyspnea]], edema
==Risk Factors==
| style="padding: 5px 5px; background: #F5F5F5;" |Elevated [[Jugular venous pressure|JVP]], fine [[Rales|crackles]], [[edema]]
Age, season of the year and the immunization status are the main determining risk factors for acquiring acute bronchitis<ref name="pmid11119400">{{cite journal |vauthors=Gonzales R, Sande MA |title=Uncomplicated acute bronchitis |journal=Ann. Intern. Med. |volume=133 |issue=12 |pages=981–91 |year=2000 |pmid=11119400 |doi= |url=}}</ref><ref name="pmid17108344">{{cite journal |vauthors=Wenzel RP, Fowler AA |title=Clinical practice. Acute bronchitis |journal=N. Engl. J. Med. |volume=355 |issue=20 |pages=2125–30 |year=2006 |pmid=17108344 |doi=10.1056/NEJMcp061493 |url=}}</ref><ref name="pmid21121518">{{cite journal |vauthors=Albert RH |title=Diagnosis and treatment of acute bronchitis |journal=Am Fam Physician |volume=82 |issue=11 |pages=1345–50 |year=2010 |pmid=21121518 |doi= |url=}}</ref>.<br>
| style="padding: 5px 5px; background: #F5F5F5;" |Increased [[Brain natriuretic peptide|BNP]]
The most potent risk factor in the development of [[chronic bronchitis]] is ''cigarette Smoking''<ref name="medcauses">[http://www.medicinenet.com/chronic_obstructive_pulmonary_disease_copd/page3.htm7whatcauses MedicineNet.com - COPD causes]</ref>. The others are occupational pollutants such as;cadmium and silica,air pollutants and genetic factors such as;[[alpha 1 antitrypsin deficiency]]<ref>[http://www.nlm.nih.gov/medlineplus/ency/article/000091.htm MedlinePlus Medical Encyclopedia]</ref>.
| style="padding: 5px 5px; background: #F5F5F5;" |[[Echocardiography]] (reduced EF)
==Natural History, Complications and Prognosis==
| style="padding: 5px 5px; background: #F5F5F5;" |[[Diuretics]], [[ACE inhibitor|ACE inhibitors]], [[Angiotensin II receptor antagonist|ARBs]], [[beta blockers]], [[nitrates]]
'''Acute bronchitis''' is a self limiting lower respiratory tract infection usually presents with cough that lasts for up to 3 weeks<ref name="pmid11119400">{{cite journal |vauthors=Gonzales R, Sande MA |title=Uncomplicated acute bronchitis |journal=Ann. Intern. Med. |volume=133 |issue=12 |pages=981–91 |year=2000 |pmid=11119400 |doi= |url=}}</ref><ref name="pmid16798599">{{cite journal |vauthors=Landau LI |title=Acute and chronic cough |journal=Paediatr Respir Rev |volume=7 Suppl 1 |issue= |pages=S64–7 |year=2006 |pmid=16798599 |doi=10.1016/j.prrv.2006.04.172 |url=}}</ref>.<br>'''Chronic bronchitis''' usually gradually gets worse over time and can lead to death. The rate at which it gets worse varies between individuals and depends on the level of airflow obstruction. '''Acute bronchitis''' has very excellent prognosis<ref name="pmid17108344">{{cite journal |vauthors=Wenzel RP, Fowler AA |title=Clinical practice. Acute bronchitis |journal=N. Engl. J. Med. |volume=355 |issue=20 |pages=2125–30 |year=2006 |pmid=17108344 |doi=10.1056/NEJMcp061493 |url=}}</ref>. '''Chronic bronchitis''' however is dependent on early recognition and smoking cessation which improves the outcome significantly.
|-
==Diagnosis==
| style="padding: 5px 5px; background: #F5F5F5;" |Pericardial disease
 
| style="padding: 5px 5px; background: #F5F5F5;" |Exercise intolerance, [[dyspnea]], [[fatigue]]
===History and Symptoms===
| style="padding: 5px 5px; background: #F5F5F5;" |Elevated [[Jugular venous pressure|JVP]], pericardial knock, [[kussmaul's sign]], [[pulsus paradoxus]]
 
| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>-</nowiki>
Bronchitis is usually a diagnosis of exclusion. Presence of [[cough]] without [[fever]] lasting more than 5 days and with normal vitals (no [[tachypnea]] or [[tachycardia]]) is suggestive of acute bronchitis. The presentation may vary according to the pathogen involved.
| style="padding: 5px 5px; background: #F5F5F5;" |Echocardiography, ECG
 
| style="padding: 5px 5px; background: #F5F5F5;" |Diuretics, [[pericardiectomy]]  
===Physical Examination===
|-
 
| style="padding: 5px 5px; background: #F5F5F5;" |[[Hypertrophic cardiomyopathy]]
A [[physical examination]] will often reveal decreased intensity of breath sounds, wheeze (rhonchi) and prolonged [[Exhalation|expiration]].  Most doctors rely on the presence of a persistent dry or wet cough as evidence of bronchitis.
| style="padding: 5px 5px; background: #F5F5F5;" |Dyspnea, [[chest pain]], [[palpitation]], [[lightheadedness]]
 
| style="padding: 5px 5px; background: #F5F5F5;" |[[Systolic murmurs|Systolic murmur]]
===Laboratory Findings===
| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>-</nowiki>
 
| style="padding: 5px 5px; background: #F5F5F5;" |Echocardiography, ECG
Acute bronchitis is usually a diagnosis of exclusion. A careful history and physical examination are very useful in doing a correct diagnosis. Other laboratory testings like [[antigen]] testing via multiplex PCR ([[polymerase chain reaction]]) and serological markers, can act as useful adjunct to the diagnosis. Nevertheless, these tests should be limited only for conditions when a pathogen is highly suspected, epidemic with a pathogen is present ([[influenza]]). These tests have limited availability and have not shown to be cost effective in outpatients department.
| style="padding: 5px 5px; background: #F5F5F5;" |[[Beta blockers]], [[verapamil]]
==Treatment==
|-
 
| style="padding: 5px 5px; background: #F5F5F5;" |Valvular disease ([[Mitral regurgitation|MR]], [[Tricuspid regurgitation|TR]])
===Medical Therapy===
| style="padding: 5px 5px; background: #F5F5F5;" |Edema, [[fatigue]], exercise intolerance, dyspnea, [[lightheadedness]]
 
| style="padding: 5px 5px; background: #F5F5F5;" |[[Cardiac murmur]]
Bronchitis is usually caused by a viral agent. The treatment of bronchitis is usually symptomatic with [[analgesics]], [[decongestants]], cough suppressant ([[codeine]] or hydrocodone-containing preparations or inhaled [[corticosteroids]]). Use of antibiotics should be limited to conditions when a diagnosis with a definitive pathogen is there. Oseltamivir for influenza (during influenza epidemics), and [[azithromycin]] for atypical bacterias like [[mycoplasma]],[[chlamydiae]] has been shown useful in clinical trials.
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" |Echocardiography, ECG
| style="padding: 5px 5px; background: #F5F5F5;" |Valve repair or replacement, diuretics, [[beta blockers]]
|-
| colspan="1" rowspan="5" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Pulmonary}}
| style="padding: 5px 5px; background: #F5F5F5;" |[[Chronic obstructive pulmonary disease|Chronic airway disease]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Cough]], dyspnea, chest pain, exercise intolerance
| style="padding: 5px 5px; background: #F5F5F5;" |Tachypnea, respiratory distress, [[cyanosis]], edema, [[rhonchi]] and [[crackles]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Hypoxemia]], hypercapnea, [[polycythemia]],
| style="padding: 5px 5px; background: #F5F5F5;" |[[PFTs|PFT]], chest imaging
| style="padding: 5px 5px; background: #F5F5F5;" |[[Bronchodilator|Bronchodilators]], [[Corticosteroid|corticosteroids]], [[Anticholinergic|anticholinergics]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[Interstitial lung disease|Interstitial lung diseaee]]
| style="padding: 5px 5px; background: #F5F5F5;" |Exercise intolerance, cough
| style="padding: 5px 5px; background: #F5F5F5;" |Crackles, [[clubbing]], cyanosis
| style="padding: 5px 5px; background: #F5F5F5;" |Hypoxemia
| style="padding: 5px 5px; background: #F5F5F5;" |PFT, Chest imaging, lung biopsy
| style="padding: 5px 5px; background: #F5F5F5;" |Corticosteroids, bronchodilators
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[Pulmonary hypertension]]
| style="padding: 5px 5px; background: #F5F5F5;" |Dyspnea, fatigue, chest pain, [[syncope]], [[palpitation]]
| style="padding: 5px 5px; background: #F5F5F5;" |Edema, clubbing, elevated [[Jugular venous pressure|JVP]], [[Tricuspid regurgitation|TR]] murmur
| style="padding: 5px 5px; background: #F5F5F5;" |Elevated BNP, elevated [[d-dimer]]
| style="padding: 5px 5px; background: #F5F5F5;" |Echocardiography, cardiac cathaterization
| style="padding: 5px 5px; background: #F5F5F5;" |Diuretics, [[Calcium channel blocker|calcium channel blockers]], [[endothelin receptor antagonist]], [[Sildenafil|phosphodiesterase 5 inhibitor]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[Sleep apnea]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Snoring]], [[somnolence]], headache, fatigue, irritability
| style="padding: 5px 5px; background: #F5F5F5;" |Tachypnea, hypertension, tachycardia
| style="padding: 5px 5px; background: #F5F5F5;" |Hypoxemia, polycythemia
| style="padding: 5px 5px; background: #F5F5F5;" |[[Polysomnography]]
| style="padding: 5px 5px; background: #F5F5F5;" |Weight reduction, [[CPAP]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[Asthma]]
| style="padding: 5px 5px; background: #F5F5F5;" |Dry [[cough]], [[dyspnea]], [[wheezing]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Wheezing]], [[tachypnea]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Hypoxemia]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[PFTs|PFT]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Bronchodilator|Bronchodilators]], [[Corticosteroid|corticosteroids]], [[Anticholinergic|anticholinergics]]
|-
| style="background: #4479BA; padding: 5px 5px;" rowspan=2 colspan=1 |{{fontcolor|#FFFFFF| |Others}}
| style="padding: 5px 5px; background: #F5F5F5;" |Liver disease
| style="padding: 5px 5px; background: #F5F5F5;" |Fatigue, edema, [[jaundice]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Ascites]], palmar erythema, [[gynecomastia]]
| style="padding: 5px 5px; background: #F5F5F5;" |Increased [[AST]] and [[ALT]], decreased [[albumin]], increased [[Bilirubin|Br]]
| style="padding: 5px 5px; background: #F5F5F5;" |Liver function test, Liver biopsy
| style="padding: 5px 5px; background: #F5F5F5;" |Diuretics, treatment of underlying disease
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[Chronic kidney disease]]
| style="padding: 5px 5px; background: #F5F5F5;" |Fatigue, anorexia, nausea, edema, decreased exercise tolerance
| style="padding: 5px 5px; background: #F5F5F5;" |Edema, hypertension, crackles
| style="padding: 5px 5px; background: #F5F5F5;" |Increased [[BUN]] and [[Cr]]
| style="padding: 5px 5px; background: #F5F5F5;" |BUN, Cr
| style="padding: 5px 5px; background: #F5F5F5;" |Control of blood pressure, anemia, [[dialysis]], [[Kidney transplantation|kidney transplant]]
|}


==References==
==References==
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[[Category:Pulmonology]]
[[Category:Pulmonology]]
[[Category:General practice]]
[[Category:General practice]]
[[Category:Infectious disease]]
[[Category:primary care]]
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Latest revision as of 20:44, 29 July 2020

Bronchitis Main page

Patient Information

Overview

Causes

Classification

Acute bronchitis
Chronic bronchitis

Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

Bronchitis is an inflammation of the bronchi (medium and large size airways).[1] Acute bronchitis is a self-limiting disease caused by viruses or bacteria. Chronic bronchitis is a disease by definition and is part of chronic obstructive pulmonary disease (COPD) which is defined as productive cough for at least three months in two consecutive years. Inflammatory response of the bronchial epithelium to infections or irritants that involve the medium and large size airways results in thickening of the bronchial and tracheal mucosa. Hallmark features of chronic bronchitis pathophysiology include: hyperplasia and hypertrophy of the goblet cells of the airway, resulting in an increase in secretion of mucus which contributes to the airway obstruction. Microscopically there is infiltration of the airway walls with inflammatory cells, particularly neutrophils. Inflammation is followed by scarring and remodeling that thickens the walls resulting in narrowing of the small airway. Further progression leads to metaplasia and fibrosis of the lower airway. The consequence of these changes is a limitation of airflow.[2][3][4] Acute bronchitis affects young children and old people. Its overall incidence is approximately 5% in the U.S. There is no racial or gender predilection for this disease.[5][6][7]Although, Chronic bronchitis is common among geriatric patients. It occurs more commonly among Caucasian individuals compared to other races, but equally between males and females.[8] Age, season of the year and the immunization status are the main determining risk factors for acquiring acute bronchitis.[9][6][10] The most potent risk factor in the development of chronic bronchitis is cigarette smoking.[11] Other risk factors are occupational pollutants, such as cadmium, silica, and air pollutants, and genetic factors, such as alpha 1 antitrypsin deficiency[12] Acute bronchitis is a self limiting lower respiratory tract infection that usually presents with cough that lasts for up to 3 weeks.[9][13] Chronic bronchitis usually gradually worsens over time and can result in death. The rate of deterioration varies between individuals and depends on the level of airflow obstruction. Prognosis is dependent on early recognition and smoking cessation, which improves the outcome significantly. Cigarette cessation, hand hygiene, vaccination and reduction in occupational exposure are the mainstays to decrease the severity and the risk of bronchitis.[10][14]

Classification

Bronchitis is classified in to two major categorize based on symptom chronicity.

Differential diagnosis

Organ System Disease Symptoms Signs Laboratory findings Diagnostic modality Management
Cardiac HFpEF Exertional dyspnea, reduced exercise tolerance, orthopnea, paroxysmal nocturnal dyspnea, edema Elevated JVP, fine crackles, edema Increased BNP Echocardiography (normal EF) Control of volume overload and hypertension,

treatment of underlying condition (obesity, AF, coronary artery disease, anemia)

HFrEF Exertional dyspnea, reduced exercise tolerance, orthopnea, paroxysmal nocturnal dyspnea, edema Elevated JVP, fine crackles, edema Increased BNP Echocardiography (reduced EF) Diuretics, ACE inhibitors, ARBs, beta blockers, nitrates
Pericardial disease Exercise intolerance, dyspnea, fatigue Elevated JVP, pericardial knock, kussmaul's sign, pulsus paradoxus - Echocardiography, ECG Diuretics, pericardiectomy
Hypertrophic cardiomyopathy Dyspnea, chest pain, palpitation, lightheadedness Systolic murmur - Echocardiography, ECG Beta blockers, verapamil
Valvular disease (MR, TR) Edema, fatigue, exercise intolerance, dyspnea, lightheadedness Cardiac murmur - Echocardiography, ECG Valve repair or replacement, diuretics, beta blockers
Pulmonary Chronic airway disease Cough, dyspnea, chest pain, exercise intolerance Tachypnea, respiratory distress, cyanosis, edema, rhonchi and crackles Hypoxemia, hypercapnea, polycythemia, PFT, chest imaging Bronchodilators, corticosteroids, anticholinergics
Interstitial lung diseaee Exercise intolerance, cough Crackles, clubbing, cyanosis Hypoxemia PFT, Chest imaging, lung biopsy Corticosteroids, bronchodilators
Pulmonary hypertension Dyspnea, fatigue, chest pain, syncope, palpitation Edema, clubbing, elevated JVP, TR murmur Elevated BNP, elevated d-dimer Echocardiography, cardiac cathaterization Diuretics, calcium channel blockers, endothelin receptor antagonist, phosphodiesterase 5 inhibitor
Sleep apnea Snoring, somnolence, headache, fatigue, irritability Tachypnea, hypertension, tachycardia Hypoxemia, polycythemia Polysomnography Weight reduction, CPAP
Asthma Dry cough, dyspnea, wheezing Wheezing, tachypnea Hypoxemia PFT Bronchodilators, corticosteroids, anticholinergics
Others Liver disease Fatigue, edema, jaundice Ascites, palmar erythema, gynecomastia Increased AST and ALT, decreased albumin, increased Br Liver function test, Liver biopsy Diuretics, treatment of underlying disease
Chronic kidney disease Fatigue, anorexia, nausea, edema, decreased exercise tolerance Edema, hypertension, crackles Increased BUN and Cr BUN, Cr Control of blood pressure, anemia, dialysis, kidney transplant

References

  1. ↑ Bronchitis (Chest Cold) - Get Smart: Know When Antibiotics Work. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/getsmart/community/for-patients/common-illnesses/bronchitis.html Accessed on July 28, 2016
  2. ↑ Cosio MG, Saetta M, Agusti A (2009). "Immunologic aspects of chronic obstructive pulmonary disease". N. Engl. J. Med. 360 (23): 2445–54. doi:10.1056/NEJMra0804752. PMID 19494220.
  3. ↑ Kumar P, Clark M (2005). Clinical Medicine, 6ed. Elsevier Saunders. pp 900-901. ISBN 0702027634.
  4. ↑ McDonough JE, Yuan R, Suzuki M, Seyednejad N, Elliott WM, Sanchez PG, Wright AC, Gefter WB, Litzky L, Coxson HO, Paré PD, Sin DD, Pierce RA, Woods JC, McWilliams AM, Mayo JR, Lam SC, Cooper JD, Hogg JC (2011). "Small-airway obstruction and emphysema in chronic obstructive pulmonary disease". N. Engl. J. Med. 365 (17): 1567–75. doi:10.1056/NEJMoa1106955. PMC 3238466. PMID 22029978.
  5. ↑ Macfarlane J, Holmes W, Gard P, Macfarlane R, Rose D, Weston V, Leinonen M, Saikku P, Myint S (2001). "Prospective study of the incidence, aetiology and outcome of adult lower respiratory tract illness in the community". Thorax. 56 (2): 109–14. PMC 1746009. PMID 11209098.
  6. ↑ 6.0 6.1 Wenzel RP, Fowler AA (2006). "Clinical practice. Acute bronchitis". N. Engl. J. Med. 355 (20): 2125–30. doi:10.1056/NEJMcp061493. PMID 17108344.
  7. ↑ Ferri FF. Ferri's Clinical Advisor 2016, 5 Books in 1. Elsevier Health Sciences; 2015.
  8. ↑ wrongdiagnosis.com > Prevalence and Incidence of COPD Retrieved on Mars 14, 2010
  9. ↑ 9.0 9.1 Gonzales R, Sande MA (2000). "Uncomplicated acute bronchitis". Ann. Intern. Med. 133 (12): 981–91. PMID 11119400.
  10. ↑ 10.0 10.1 Albert RH (2010). "Diagnosis and treatment of acute bronchitis". Am Fam Physician. 82 (11): 1345–50. PMID 21121518.
  11. ↑ MedicineNet.com - COPD causes
  12. ↑ MedlinePlus Medical Encyclopedia
  13. ↑ Landau LI (2006). "Acute and chronic cough". Paediatr Respir Rev. 7 Suppl 1: S64–7. doi:10.1016/j.prrv.2006.04.172. PMID 16798599.
  14. ↑ Braman SS (2006). "Chronic cough due to acute bronchitis: ACCP evidence-based clinical practice guidelines". Chest. 129 (1 Suppl): 95S–103S. doi:10.1378/chest.129.1_suppl.95S. PMID 16428698.
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