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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> | '''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. | ||
==Historical Perspective== | ==Historical Perspective== | ||
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> | 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> | ||
==Pathophysiology== | ==Pathophysiology== | ||
* '''[[Acute bronchitis]]:''' | * '''[[Acute bronchitis]]:''' | ||
: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. | :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> | :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:''' | *'''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]] | :[[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== | ==Causes== | ||
*<font size="3.3">'''[[Acute Bronchitis]]:'''</font> may be caused by either | *<font size="3.3">'''[[Acute Bronchitis]]:'''</font> may be caused by either virus, bacteria or environmental factors. | ||
::'''Viruses:''' Influenza | ::'''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> | ||
::''' | ::'''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> | ||
::'''Environmental | ::'''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> | ||
*<font size="3.3">'''[[Chronic Bronchitis]]:'''</font> caused by | *<font size="3.3">'''[[Chronic Bronchitis]]:'''</font> may be caused by smoking, air pollutants, occupational exposures, and genetic factors. | ||
==Differentiating Bronchitis from other Diseases== | ==Differentiating Bronchitis from other Diseases== | ||
Bronchitis must be differentiated from other diseases that cause cough such as [[asthma]],[[pneumonia]],[[ | Bronchitis must be differentiated from other diseases that cause cough such as [[asthma]], [[pneumonia]], [[bronchiectasis]] and [[CHF]]. | ||
==Epidemiology and demography== | ==Epidemiology and demography== | ||
'''Acute bronchitis''' affects young children and old people. Its overall incidence is | '''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== | ==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> | 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>. | 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== | ==Natural History, Complications and Prognosis== | ||
Revision as of 14:49, 30 September 2016
|
Bronchitis Main page |
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.
Historical Perspective
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.[2] Badham used the word catarrh to distinguish chronic cough and mucus hypersecretion as cardinal symptoms.[3]
Pathophysiology
- 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.[4]
- Chronic bronchitis:
- Hallmark features 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.[5][6][7]
Causes
- Acute Bronchitis: may be caused by either virus, bacteria or environmental factors.
- Viruses: Influenza virus, parainfluenza virus, respiratory syncytial virus, coronavirus, adenovirus, enterovirus, rhinovirus, coxsackievirus, and human metapneumovirus[8][9][10]
- Bacteria: Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Bordetella pertussis[11]
- Environmental factors: Toxic fume inhalation, tobacco, dust and aerosol[12]
- Chronic Bronchitis: 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.[13][11][14]
Chronic bronchitis is common among geriatric patients. It occurs more commonly among Caucasian individuals compared to other races, but equally between males and females.[15]
Risk Factors
Age, season of the year and the immunization status are the main determining risk factors for acquiring acute bronchitis.[16][11][17]
The most potent risk factor in the development of chronic bronchitis is cigarette Smoking[18]. The others are occupational pollutants such as;cadmium and silica,air pollutants and genetic factors such as;alpha 1 antitrypsin deficiency[19].
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[16][20].
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[11]. Chronic bronchitis however is dependent on early recognition and smoking cessation which improves the outcome significantly.
Diagnosis
History and Symptoms
Acute bronchitis presents with recent onset cough and fever usually accompanied with constitutional symptoms[17].
Chronic bronchitis, by definition is a chronic condition with productive cough and dyspnea lasting more than three months for two consecutive year[21].
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[17][11][22].
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.
Chronic bronchitis is a diagnosis by definition although there are some laboratory findings as the disease advances and causes consequences[11].
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)[23]
Primary prevention
Cigarette cessation,hand hygiene,vaccination and decrease occupational exposure are the mainstays to decrease the severity and the risk of bronchitis[17][24]..
References
- ↑ 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
- ↑ Charles Balham. Wikipedia (2016). https://en.wikipedia.org/wiki/Charles_Badham_(physician) Accessed on August 26, 2016
- ↑ Petty TL (2006). "The history of COPD". Int J Chron Obstruct Pulmon Dis. 1 (1): 3–14. PMC 2706597. PMID 18046898.
- ↑ WALSH JJ, DIETLEIN LF, LOW FN, BURCH GE, MOGABGAB WJ (1961). "Bronchotracheal response in human influenza. Type A, Asian strain, as studied by light and electron microscopic examination of bronchoscopic biopsies". Arch. Intern. Med. 108: 376–88. PMID 13782910.
- ↑ 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.
- ↑ Kumar P, Clark M (2005). Clinical Medicine, 6ed. Elsevier Saunders. pp 900-901. ISBN 0702027634.
- ↑ 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.
- ↑ Jonsson JS, Sigurdsson JA, Kristinsson KG, Guthnadóttir M, Magnusson S (1997). "Acute bronchitis in adults. How close do we come to its aetiology in general practice?". Scand J Prim Health Care. 15 (3): 156–60. PMID 9323784.
- ↑ Boivin G, Abed Y, Pelletier G, Ruel L, Moisan D, Côté S, Peret TC, Erdman DD, Anderson LJ (2002). "Virological features and clinical manifestations associated with human metapneumovirus: a new paramyxovirus responsible for acute respiratory-tract infections in all age groups". J. Infect. Dis. 186 (9): 1330–4. doi:10.1086/344319. PMID 12402203.
- ↑ Louie JK, Hacker JK, Gonzales R, Mark J, Maselli JH, Yagi S, Drew WL (2005). "Characterization of viral agents causing acute respiratory infection in a San Francisco University Medical Center Clinic during the influenza season". Clin. Infect. Dis. 41 (6): 822–8. doi:10.1086/432800. PMID 16107980.
- ↑ 11.0 11.1 11.2 11.3 11.4 11.5 Wenzel RP, Fowler AA (2006). "Clinical practice. Acute bronchitis". N. Engl. J. Med. 355 (20): 2125–30. doi:10.1056/NEJMcp061493. PMID 17108344.
- ↑ Irwin RS, Madison JM (2000). "The diagnosis and treatment of cough". N. Engl. J. Med. 343 (23): 1715–21. doi:10.1056/NEJM200012073432308. PMID 11106722.
- ↑ 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.
- ↑ Ferri FF. Ferri's Clinical Advisor 2016, 5 Books in 1. Elsevier Health Sciences; 2015.
- ↑ wrongdiagnosis.com > Prevalence and Incidence of COPD Retrieved on Mars 14, 2010
- ↑ 16.0 16.1 Gonzales R, Sande MA (2000). "Uncomplicated acute bronchitis". Ann. Intern. Med. 133 (12): 981–91. PMID 11119400.
- ↑ 17.0 17.1 17.2 17.3 Albert RH (2010). "Diagnosis and treatment of acute bronchitis". Am Fam Physician. 82 (11): 1345–50. PMID 21121518.
- ↑ MedicineNet.com - COPD causes
- ↑ MedlinePlus Medical Encyclopedia
- ↑ 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.
- ↑ U.S. National Heart Lung and Blood Institute - Signs and Symptoms
- ↑ Badgett RG, Tanaka DJ, Hunt DK, Jelley MJ, Feinberg LE, Steiner JF, Petty TL (1993). "Can moderate chronic obstructive pulmonary disease be diagnosed by historical and physical findings alone?". Am. J. Med. 94 (2): 188–96. PMID 8430714.
- ↑ Little P, Stuart B, Moore M, Coenen S, Butler CC, Godycki-Cwirko M; et al. (2012). "Amoxicillin for acute lower-respiratory-tract infection in primary care when pneumonia is not suspected: a 12-country, randomised, placebo-controlled trial". Lancet Infect Dis. doi:10.1016/S1473-3099(12)70300-6. PMID 23265995.
- ↑ 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.