Definition
[brongkī′tis]
acute
or chronic inflammation of the mucous membranes of the tracheobronchial
tree. Caused by the spread of upper respiratory viral or sometimes
bacterial infections to the bronchi, it is often observed with or after
childhood infections, such as measles, whooping cough, diphtheria, and
typhoid fever.
Etymology: Gk, bronchos, windpipe, itis, inflammation
Bronchitis
is an inflammation of the air passages between the nose and the lungs,
including the windpipe or trachea and the larger air tubes of the lung
that bring air in from the trachea (bronchi). Bronchitis can either be
of brief duration (acute) or have a long course (chronic). Acute
bronchitis is usually caused by a viral infection, but can also be
caused by a bacterial infection and can heal without complications.
Chronic bronchitis is a sign of serious lung disease that may be slowed
but cannot be cured.
Description
Although
acute and chronic bronchitis are both inflammations of the air
passages, their causes and treatments are different. Acute bronchitis is
most prevalent in winter. It usually follows a viral infection, such as
a cold or the flu, and can be accompanied by a secondary bacterial
infection. Acute bronchitis resolves within two weeks, although the cough
may persist longer. Acute bronchitis, like any upper airway
inflammatory process, can increase a person's likelihood of developing pneumonia.
Anyone
can get acute bronchitis, but infants, young children, and the elderly
are more likely to get the disease because people in these age groups
generally have weaker immune systems. Smokers and people with heart or
other lung diseases are also at higher risk of developing acute
bronchitis. Individuals exposed to chemical fumes or high levels of air
pollution also have a greater chance of developing acute bronchitis.
Chronic bronchitis is a major cause of disability and death
in the United States. The American Lung Association estimates that
about 14 million Americans suffer from the disease. Like acute
bronchitis, chronic bronchitis is an inflammation of airways accompanied
by coughing and spitting up of phlegm. In chronic bronchitis, these
symptoms are present for at least three months in each of two
consecutive years.
Chronic bronchitis is caused
by inhaling bronchial irritants, especially cigarette smoke. Until
recently, more men than women developed chronic bronchitis, but as the
number of women who smoke has increased, so has their rate of chronic
bronchitis. Because this disease progresses slowly, middle-aged and
older people are more likely to be diagnosed with chronic bronchitis.
Causes and symptoms
Acute bronchitis
Acute
bronchitis usually begins with the symptoms of a cold, such as a runny
nose, sneezing, and dry cough. However, the cough soon becomes deep and
painful. Coughing brings up a greenish yellow phlegm or sputum. These
symptoms may be accompanied by a fever of up to 102°F (38.8°C). Wheezing after coughing is common.
In
uncomplicated acute bronchitis, the fever and most other symptoms,
except the cough, disappear after three to five days. Coughing may
continue for several weeks. Acute bronchitis is often complicated by a
bacterial infection, in which case the fever and a general feeling of
illness persist. To be cured, the bacterial infection should be treated
with antibiotics.
Chronic bronchitis
Chronic
bronchitis is caused by inhaling respiratory tract irritants. The most
common irritant is cigarette smoke. The American Lung Association
estimates that 80-90% of COPD cases are caused by smoking. Other irritants include chemical fumes, air pollution, and environmental irritants, such as mold or dust.
Chronic
bronchitis develops slowly over time. The cells that line the
respiratory system contain fine, hair-like outgrowths from the cell
called cilia. Normally, the cilia of many cells beat rhythmically to
move mucus along the airways. When smoke or other irritants are inhaled,
the cilia become paralyzed or snap off. When this occurs, the cilia are
no longer able to move mucus, and the airways become inflamed,
narrowed, and clogged. This leads to difficulty breathing and can
progress to the life-threatening disease emphysema.
A
mild cough, sometimes called smokers' cough, is usually the first
visible sign of chronic bronchitis. Coughing brings up phlegm, although
the amount varies considerably from person to person. Wheezing and shortness of breath
may accompany the cough. Diagnostic tests show a decrease in lung
function. As the disease advances, breathing becomes difficult and
activity decreases. The body does not get enough oxygen, leading to
changes in the composition of the blood.
Diagnosis
Initial
diagnosis of bronchitis is based on observing the patient's symptoms
and health history. The physician will listen to the patient's chest
with a stethoscope for specific sounds that indicate lung inflammation,
such as moist rales and crackling, and wheezing, that indicates airway
narrowing. Moist rales is a bubbling sound heard with a stethoscope that
is caused by fluid secretion in the bronchial tubes.
A sputum culture
may be performed, particularly if the sputum is green or has blood in
it, to determine whether a bacterial infection is present and to
identify the disease-causing organism so that an appropriate antibiotic
can be selected. Normally, the patient will be asked to cough deeply,
then spit the material that comes up from the lungs (sputum) into a cup.
This sample is then grown in the laboratory to determine which
organisms are present. The results are available in two to three days,
except for tests for tuberculosis, which can take as long as two months.
Occasionally, in diagnosing a chronic lung disorder, the sample of sputum is collected using a procedure called a bronchoscopy. In this procedure, the patient is given a local anesthetic, and a tube is passed into the airways to collect a sputum sample.
A pulmonary function test
is important in diagnosing chronic bronchitis and other variations of
COPD. This test uses an instrument called a spirometer to measure the
volume of air entering and leaving the lungs. The test is done in the
doctor's office and is painless. It involves breathing into the
spirometer mouthpiece either normally or forcefully. Volumes less than
80% of the normal values indicate an obstructive lung disease.
To better determine what type of obstructive lung disease a patient has, the doctor may do a chest x ray,
electrocardiogram (ECG), and blood tests. An electrocardiogram is an
instrument that is used to measure the electrical activity of the heart
and is useful in the diagnosis of heart conditions. Other tests may be
used to measure how effectively oxygen and carbon dioxide are exchanged
in the lungs.
Treatment
Acute bronchitis
When no secondary infection is present, acute bronchitis is treated in the same way as the common cold.
Home care includes drinking plenty of fluids, resting, not smoking,
increasing moisture in the air with a cool mist humidifier, and taking acetaminophen
(Datril, Tylenol, Panadol) for fever and pain. Aspirin should not be
given to children because of its association with the serious illness,
Reye's syndrome.
Expectorant cough medicines,
unlike cough suppressants, do not stop the cough. Instead they are used
to thin the mucus in the lungs, making it easier to cough up. This type
of cough medicine may be helpful to individuals suffering from
bronchitis. People who are unsure about what type of medications are in
over-the-counter cough syrups should ask their pharmacist for an
explanation.
If a secondary bacterial infection
is present, the infection is treated with an antibiotic. Patients need
to take the entire amount of antibiotic prescribed. Stopping the
antibiotic early can lead to a return of the infection. Tetracycline or
ampicillin are often used to treat adults. Other possibilities include
trimethoprim/sulfamethoxazole (Bactrim or Septra) and the newer
erythromycin-like drugs, such as azithromycin (Zithromax) and
clarithromycin (Biaxin). Children under age eight are usually given
amoxicillin (Amoxil, Pentamox, Sumox, Trimox), because tetracycline
discolors permanent teeth that have not yet come in.
Chronic bronchitis
The
treatment of chronic bronchitis is complex and depends on the stage of
chronic bronchitis and whether other health problems are present.
Lifestyle changes, such as quitting smoking and avoiding secondhand
smoke or polluted air, are an important first step. Controlled exercise performed on a regular basis is also important.
Drug therapy begins with bronchodilators.
These drugs relax the muscles of the bronchial tubes and allow
increased air flow. They can be taken by mouth or inhaled using a
nebulizer. A nebulizer is a device that delivers a regulated flow of
medication into the airways. Common bronchodilators include albuterol
(Ventolin, Proventil, Apo-Salvent) and metaproterenol (Alupent,
Orciprenaline, Metaprel, Dey-Dose).
Anti-inflammatory medications are added to reduce swelling of the airway tissue. Corticosteroids,
such as prednisone, can be taken orally or intravenously. Other
steroids are inhaled. Long-term steroid use can have serious side
effects. Other drugs, such as ipratropium (Atrovent), are given to
reduce the quantity of mucus produced.
As the
disease progresses, the patient may need supplemental oxygen.
Complications of COPD are many and often require hospitalization in the
latter stages of the disease.
Alternative treatment
Alternative practitioners focus on prevention by eating a healthy diet that strengthens the immune system and practicing stress
management. Bronchitis can become serious if it progresses to
pneumonia, therefore, antibiotics may be required. In addition, however,
there are a multitude of botanical and herbal medicines that can be
formulated to treat bronchitis. Some examples include inhaling
eucalyptus or other essential oils in warm steam. Herbalists recommend a
tea made of mullein (Verbascum thapsus), coltsfoot (Tussilago farfara), and anise seed (Pimpinella anisum). Homeopathic medicine and traditional Chinese medicine may also be very useful for bronchitis, and hydrotherapy can contribute to cleaning the chest and stimulating immune response.
Prognosis
When
treated, acute bronchitis normally resolves in one to two weeks without
complications, although a cough may continue for several more weeks.
The progression of chronic bronchitis, on the other hand, may be slowed,
and an initial improvement in symptoms may be achieved. Unfortunately,
however, there is no cure for chronic bronchitis, and the disease can
often lead to or coexist with emphysema. Taken together, all forms of
COPD are a leading cause of death.
Prevention
The
best way to prevent bronchitis is not to begin smoking or to stop
smoking. Smokers are ten times more likely to die of COPD than
non-smokers. Smokers who stop show improvement in lung function. Other
preventative steps include avoiding chemical and environmental
irritants, such as air pollution, and maintaining good overall health.
Immunizations against certain types of pneumonia (as well as influenza) are an important preventative measure for anyone with lung or immune system diseases.
Source.American Lung Association. 1740 Broadway, New York, NY 10019. (800) 586-4872. http://www.lungusa.org.
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