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==Overview==
==Overview==
'''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]].<br>[[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.
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.   
==Historical Perspective==
[[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>
The beginnings of the clinical understanding of bronchitis are credited to physician Dr. Charles Badham. He was the first to differentiate bronchitis from [[pleurisy]] and [[pneumonia]] through the essays he wrote in 1808 and 1814.<ref> Charles Balham. Wikipedia (2016). https://en.wikipedia.org/wiki/Charles_Badham_(physician) Accessed on August 26, 2016</ref> Badham used the word [[catarrh]] to distinguish chronic [[cough]] and [[mucus hypersecretion]] as cardinal symptoms.<ref name="pmid18046898">{{cite journal |vauthors=Petty TL |title=The history of COPD |journal=Int J Chron Obstruct Pulmon Dis |volume=1 |issue=1 |pages=3–14 |year=2006 |pmid=18046898 |pmc=2706597 |doi= |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>
==Pathophysiology==
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]]:'''
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>
: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]].
: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>
*'''Chronic bronchitis:'''
:Hallmark features 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>


==Causes==
==Classification==
*<font size="3.3">'''[[Acute Bronchitis]]:'''</font>  may be caused by either virus, bacteria or environmental factors.
Bronchitis is classified in to two major categorize based on symptom chronicity.
::'''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>
*[[Acute bronchitis]]
::'''Bacteria:''' [[Mycoplasma pneumoniae]], [[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>
*[[Chronic bronchitis]]
::'''Environmental factors:''' Toxic fume inhalation, tobacco, dust and aerosol<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>
==Differential diagnosis==
*<font size="3.3">'''[[Chronic Bronchitis]]:'''</font> may be caused by smoking, air pollutants, occupational exposures, and genetic factors.
==Differentiating Bronchitis from other Diseases==
Bronchitis must be differentiated from other diseases that cause cough such as [[asthma]], [[pneumonia]], [[bronchiectasis]] and [[CHF]].
==Epidemiology and demography==
'''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><br>'''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>
==Risk Factors==
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>
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>.
==Natural History, Complications and Prognosis==
'''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==


===History and Symptoms===
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
'''Acute bronchitis''' presents with recent onset cough and fever usually accompanied with constitutional symptoms<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="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Organ System}}
'''Chronic bronchitis''', by definition is a chronic condition with productive cough and dyspnea lasting more than three months for two consecutive year<ref>[http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_SignsAndSymptoms.html U.S. National Heart Lung and Blood Institute - Signs and Symptoms]</ref>.
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Disease}}
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Symptoms}}
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Signs}}
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Laboratory findings}}
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Diagnostic modality}}
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Management}}
|-
| colspan="1" rowspan="5" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Cardiac}}
| style="padding: 5px 5px; background: #F5F5F5;" | HFpEF
| style="padding: 5px 5px; background: #F5F5F5;" |Exertional [[dyspnea]], reduced exercise tolerance, [[orthopnea]], [[paroxysmal nocturnal dyspnea]], edema
| style="padding: 5px 5px; background: #F5F5F5;" |Elevated [[Jugular venous pressure|JVP]], fine [[Rales|crackles]], [[edema]]
| style="padding: 5px 5px; background: #F5F5F5;" |Increased [[Brain natriuretic peptide|BNP]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Echocardiography]] (normal EF)
| style="padding: 5px 5px; background: #F5F5F5;" |Control of volume overload and [[hypertension]],
treatment of underlying condition ([[obesity]], [[Atrial fibrillation|AF]], [[coronary artery disease]], [[anemia]])
|-
| style="padding: 5px 5px; background: #F5F5F5;" |HFrEF
| style="padding: 5px 5px; background: #F5F5F5;" |Exertional [[dyspnea]], reduced exercise tolerance, [[orthopnea]], [[paroxysmal nocturnal dyspnea]], edema
| style="padding: 5px 5px; background: #F5F5F5;" |Elevated [[Jugular venous pressure|JVP]], fine [[Rales|crackles]], [[edema]]
| style="padding: 5px 5px; background: #F5F5F5;" |Increased [[Brain natriuretic peptide|BNP]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Echocardiography]] (reduced EF)
| style="padding: 5px 5px; background: #F5F5F5;" |[[Diuretics]], [[ACE inhibitor|ACE inhibitors]], [[Angiotensin II receptor antagonist|ARBs]], [[beta blockers]], [[nitrates]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Pericardial disease
| style="padding: 5px 5px; background: #F5F5F5;" |Exercise intolerance, [[dyspnea]], [[fatigue]]
| 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>
| style="padding: 5px 5px; background: #F5F5F5;" |Echocardiography, ECG
| style="padding: 5px 5px; background: #F5F5F5;" |Diuretics, [[pericardiectomy]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[Hypertrophic cardiomyopathy]]
| style="padding: 5px 5px; background: #F5F5F5;" |Dyspnea, [[chest pain]], [[palpitation]], [[lightheadedness]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Systolic murmurs|Systolic murmur]]
| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" |Echocardiography, ECG
| style="padding: 5px 5px; background: #F5F5F5;" |[[Beta blockers]], [[verapamil]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Valvular disease ([[Mitral regurgitation|MR]], [[Tricuspid regurgitation|TR]])
| style="padding: 5px 5px; background: #F5F5F5;" |Edema, [[fatigue]], exercise intolerance, dyspnea, [[lightheadedness]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Cardiac murmur]]
| 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]]
|}


===Physical Examination===
Physical examination often reveal signs of airflow narrowing and irritation which consist of: cough with or without sputum, wheezing and prolonged expiratory phase. Abnormal breathing sounds such as: rhonchi and rales are common findings in 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="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="pmid8430714">{{cite journal |vauthors=Badgett RG, Tanaka DJ, Hunt DK, Jelley MJ, Feinberg LE, Steiner JF, Petty TL |title=Can moderate chronic obstructive pulmonary disease be diagnosed by historical and physical findings alone? |journal=Am. J. Med. |volume=94 |issue=2 |pages=188–96 |year=1993 |pmid=8430714 |doi= |url=}}</ref>.
===Laboratory Findings===
Diagnostic tests are rarely needed to confirm the diagnosis of [[acute bronchitis]]. In very specific condition serologic tests, viral cultures or sputum analyses may be applied. Generally the inflammatory markers such as ''[[CRP]]'' raises during the course of acute bronchitis.<br>Chronic bronchitis is a diagnosis by definition although there are some laboratory findings as the disease advances and causes consequences<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>.
==Treatment==
===Medical Therapy===
====Acute bronchitis====
The treatment of bronchitis is primarily symptomatic and includes [[analgesics]], expectorants, and cough suppressants. The administration of antibiotics should be limited to cases in which a definitive pathogen is identified.
====Chronic bronchitis====
It includes a combination of inhaled [[corticosteroids]], [[bronchodilators]] ( e.g. [[Salbutamol]]), and inhaled [[anticholinergics]] (e.g. [[Ipratropium bromide]])<ref name="pmid23265995">{{cite journal| author=Little P, Stuart B, Moore M, Coenen S, Butler CC, Godycki-Cwirko M et al.| title=Amoxicillin for acute lower-respiratory-tract infection in primary care when pneumonia is not suspected: a 12-country, randomised, placebo-controlled trial. | journal=Lancet Infect Dis | year= 2012 | volume=  | issue=  | pages=  | pmid=23265995 | doi=10.1016/S1473-3099(12)70300-6 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23265995  }} </ref>
==Primary prevention==
Cigarette cessation,hand hygiene,vaccination and decrease 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>..
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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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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