Bronchitis
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Bronchitis Main page |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]
Synonyms and keywords: Inflammation of bronchus
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 |
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
- ↑ 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.
- ↑ 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.
- ↑ 6.0 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.
- ↑ 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
- ↑ 9.0 9.1 Gonzales R, Sande MA (2000). "Uncomplicated acute bronchitis". Ann. Intern. Med. 133 (12): 981–91. PMID 11119400.
- ↑ 10.0 10.1 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.
- ↑ 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.