Acute bronchitis

What is Acute bronchitis?

Acute bronchitis is an inflammation of the mucous membranes lining the air passages of the lungs (bronchi). Both large and small airways can be involved with swelling and fluid leakage. The condition is acute and limited in duration.The most common precipitating factor for acute bronchitis is an upper respiratory viral infection such as the common cold (nasopharyngitis) or a sinus infection (sinusitis). Environmental factors may also contribute to the incidence of this conditions particularly in those who report frequent attacks of acute bronchitis. Gases, fumes, chemicals, dusts and smoke are just a few of the airway irritants that can be found in the work environment. These irritants may cause or prolong an episode of acute bronchitis.

Acute bronchitis occurs in persons of all ages and occupations. However, the chances of contracting acute bronchitis are increased in smokers, the aged, the chronically ill, those with decreased immunity, and those who are occupationally exposed to respiratory irritants and do not wear respiratory protection.

How is Acute bronchitis diagnosed?

• History is marked by a frequent cough, with or without production of sputum. The sputum might be reported as yellow or green. A mild fever might be reported. The individual may also complain of fever, loss of appetite, difficulty breathing, wheezing, malaise, and difficulty sleeping due to fits of coughing; coughing spasms can be severe enough to cause vomiting and/or incontinence of urine. There is usually a recent history of head cold, sinus infection or heavy exposure to an allergen or irritant.
• Physical exam of the chest usually reveals course breath sounds. Wheezing might also be present.
• Tests: The chest x-ray will be normal and often is not ordered. If shortness of breath or wheezing are reported, additional tests to measure airway obstruction (spirometry) and measurement of blood oxygen content (pulse oximetry) may be done. Sputum gram stain may be ordered in individuals with chronic lung disease (COPD). Sputum culture is not usually done unless the bronchitis is prolonged and unresponsive to usual antibiotic therapy.

How is Acute bronchitis treated?

Treatment is to relieve symptoms with a cough suppressant. An expectorant to help liquefy secretions may be added to the cough suppressant. If a viral infection is suspected, antibiotics are not indicated. But if the cough has lasted over one week, if there is a sudden worsening of a cough, or the cough is accompanied by fever, a bacterial infection becomes more likely and antibiotic therapy may be necessary. If the individual is producing yellow or green sputum, or has decreased immunity, antibiotics may also be indicated. If the acute bronchitis is environmentally induced, the individual must first be removed from that environment, and the causative agent needs to be identified. The agent is either removed from the environment or the individual is provided respiratory protection from the agent.Individuals with bronchitis and wheezing will benefit from an inhaled bronchodilator. If a person has a high fever or chills, antipyretics are helpful. It is important that the person with acute bronchitis be well-hydrated in order to prevent complications and speed recovery. Both oral fluids and a cool mist vaporizer help keep sputum thin and easily coughed up. Rest is an essential part of treatment.

Medications

• For minor discomfort, you may use:
  • Acetaminophen to reduce fever.
  • Non-prescription cough suppressants. Use only if your cough is non-productive (without sputum). It may be dangerous to stop a cough entirely as this traps excess mucus and irritants in bronchial tubes, leading to pneumonia and poor oxygen exchange in the lungs.
• Other drugs that may be prescribed:
  • Antibiotics to fight bacterial infections.
  • Expectorants to thin mucus so it can be coughed up more easily.
  • Cough suppressants.

Information	Brand	Generic	Label	Rating
	Zithromax	Azithromycin
	Amoxil	Amoxicillin
	Bactrim	Co-trimoxazole
	Cipro	Ciprofloxacin
	Principen	Ampicillin
	Augmentin	Amoxicillin/Clavulanate
Biaxin (Clarithromycin), Ilosone (Erythromycin), Doryx (Doxycycline)
Bronchospasm prophylaxis
	Singulair	Montelukast
Proventil (Albuterol), Decadron (Dexamethasone), Atrovent (Ipratropium bromide)

What might complicate it?

Bronchitis can progress to pneumonia and respiratory failure in the elderly in those with chronic lung disease and/or other medical conditions, and those with decreased immunity. Dehydration can lead to extremely thick bronchial secretions that can block airways, causing pneumonia, lung collapse, or respiratory failure.

Side effects of medications to treat acute bronchitis may occur. Bronchodilators may cause a rapid heart rate. Narcotic cough suppressants can decrease the individual's mental alertness. This can also occur with those who are unable to get adequate sleep due to their cough.

Predicted outcome

The prognosis for the individual with uncomplicated acute bronchitis is excellent. The course of the disease is generally three to five days of acute symptoms with a gradual recovery over the next seven days. If a bacterial infection is present, recovery time may be longer. It is not unusual for the cough to remain as much as one week after other symptoms have subsided and the individual has returned to work. Environmentally induced acute bronchitis is often cured as soon as the person is removed from the offending toxin or allergen. A person can be in severe bronchitic distress and fully recover before he reaches the doctor. In these cases, it is important to do some in-depth detective work to discover what exposure may have caused the attack and work to prevent future episodes.

Alternatives

Other common diagnoses that may present in a manner similar to acute bronchitis are pneumonia, chronic bronchitis, and asthma. Some less common diagnoses with similar symptoms are tuberculosis, a lung or chest tumor, AIDS-related complex, aspiration of liquids or food into the lungs, and lung diseases such as pneumoconiosis or silicosis.

Appropriate specialists

Internist, allergist, and lung specialist.

Last updated 15 December 2015