Bronchitis overview

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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) in the lungs.[1] Acute bronchitis is usually caused by viruses 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.

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:
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.
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 (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[5][6][7].

Causes

  • Acute Bronchitis: may be caused by either viral, bacterial or environmental causes.
Viruses: Influenza Virus,parainfluenza virus,respiratory syncytial virus, coronavirus, adenovirus, enterovirus, rhinovirus, coxsackievirus, and human metapneumovirus[8][9][10].
Bacteries: Mycoplasma pneumoniae and,Chlamydophila pneumoniae and Bordetella pertussis[11].
Environmental causes: Toxic fume inhalation, tobacco, dust and aerosol may result in acute bronchitis[12].
  • Chronic Bronchitis: 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,bronchectasis and CHF.

Epidemiology and demography

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[13][11][14]..
Chronic bronchitis is common in old ages affects white people more than others but is equal 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

The majority of cases of bronchitis are caused by viruses and are self-limited. The treatment of bronchitis is primarily symptomatic and includes analgesics, decongestants, expectorants, and cough suppressants. The administration of antibiotics should be limited to cases in which a definitive pathogen is identified. Pharmacologic therapy for chronic bronchitis includes a combination of inhaled corticosteroids, bronchodilators ( e.g. Salbutamol), and inhaled anticholinergics (e.g. Ipratropium bromide)[23] About 15% had chronic obstructive lung disease and their results were not reported separately.[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

  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. ↑ Charles Balham. Wikipedia (2016). https://en.wikipedia.org/wiki/Charles_Badham_(physician) Accessed on August 26, 2016
  3. ↑ Petty TL (2006). "The history of COPD". Int J Chron Obstruct Pulmon Dis. 1 (1): 3–14. PMC 2706597. PMID 18046898.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ Kumar P, Clark M (2005). Clinical Medicine, 6ed. Elsevier Saunders. pp 900-901. ISBN 0702027634.
  7. ↑ 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.
  8. ↑ 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.
  9. ↑ 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.
  10. ↑ 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. ↑ 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.
  12. ↑ 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.
  13. ↑ 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.
  14. ↑ Ferri FF. Ferri's Clinical Advisor 2016, 5 Books in 1. Elsevier Health Sciences; 2015.
  15. ↑ wrongdiagnosis.com > Prevalence and Incidence of COPD Retrieved on Mars 14, 2010
  16. ↑ 16.0 16.1 Gonzales R, Sande MA (2000). "Uncomplicated acute bronchitis". Ann. Intern. Med. 133 (12): 981–91. PMID 11119400.
  17. ↑ 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.
  18. ↑ MedicineNet.com - COPD causes
  19. ↑ MedlinePlus Medical Encyclopedia
  20. ↑ 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.
  21. ↑ U.S. National Heart Lung and Blood Institute - Signs and Symptoms
  22. ↑ 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.
  23. ↑ 23.0 23.1 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.
  24. ↑ 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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