Introduction

Background

Acute bronchitis is a clinical syndrome produced by inflammation of the trachea, bronchi, and
bronchioles. In children, acute bronchitis usually occurs in association with viral respiratory tract
infection. Acute bronchitis is rarely a primary bacterial infection in otherwise healthy children.
Symptoms of acute bronchitis usually include cough that produces phlegm and may be
associated with retrosternal pain during deep breathing or coughing. Generally, the clinical
course of acute bronchitis is self-limited, with complete healing and full return to function
typically seen within 10-14 days following symptom onset.

Chronic bronchitis is recurring inflammation and degeneration of the bronchial tubes that may be
associated with active infection. Chronic bronchitis is often part of an underlying disease
process, such as asthma, cystic fibrosis, dyskinetic cilia syndrome, foreign body aspiration, or
exposure to an airway irritant. Recurrent tracheobronchitis may also be seen in patients with
tracheostomy or with certain forms of immunodeficiency. In all of these patient groups, chronic
bronchitis should not be the primary diagnosis because it does not describe the pathology of the
underlying disorder. Patients with chronic bronchitis have more mucus than normal because of
either increased production or decreased clearance. Coughing is the mechanism by which excess
secretion is cleared.

Defining chronic bronchitis and its prevalence in childhood has been complicated by the
significant clinical overlap with asthma and reactive airway disease states. In adults, chronic
bronchitis is defined as daily production of sputum for at least 3 months in 2 consecutive years.
Some have applied this definition to childhood chronic bronchitis. Others limit the definition to a
productive cough that lasts more than 2 weeks despite medical therapy. Chronic bronchitis has
also been defined as a complex of symptoms that includes cough that lasts more than 1 month or
recurrent productive cough that may be associated with wheezing or crackles on auscultation.
Elements of these descriptors are present in the working definitions of asthma, as well.1

Examples of normal airway color and architecture and an airway in a patient with chronic
bronchitis are shown below.
Normal airway color and architecture (in a child with mild tracheomalacia).
[ CLOSE WINDOW ]

Normal airway color and architecture (in a child with mild tracheomalacia).

Airway of a child with chronic bronchitis shows erythema, loss of normal architecture, and
swelling.
[ CLOSE WINDOW ]
Airway of a child with chronic bronchitis shows erythema, loss of normal architecture, and
swelling.

Pathophysiology

Acute bronchitis leads to the hacking cough and phlegm production that often follows upper
respiratory tract infection. This occurs because of the inflammatory response of the mucous
membranes within the lungs' bronchial passages. Viruses, acting alone or together, account for
most of these infections.2,3 If the patient is in otherwise good health, the mucous membrane
returns to normal, heralding recovery from the initial active infection. Symptoms typically
resolve within 10-14 days.

In adults, chronic bronchitis results from hypersecretion of mucus in the bronchi due to
hypertrophy of submucosal mucus-producing glands and increased numbers of goblet cells
within the epithelium. In most patients, this results from exposure to cigarette smoke.
Mucociliary clearance is delayed because of excess mucus production and loss of ciliated cells,
leading to a productive cough.

In children, chronic bronchitis follows either an endogenous response (eg, excessive

inflammation) to acute airway injury or continuous exposure to certain noxious environmental
agents (eg, allergens or irritants). An airway that undergoes such an insult responds quickly with
bronchospasm and cough, followed by inflammation, edema, and mucus production. This helps
explain the fact that chronic bronchitis in children is often actually asthma.
Mucociliary clearance is an important primary innate defense mechanism that protects the lungs
from the harmful effects of inhaled pollutants, allergens, and pathogens.4 Mucociliary
dysfunction is a common feature of chronic airway disease states in humans. The mucociliary
apparatus consists of 3 functional compartments: the cilia, a protective mucus layer, and an
airway surface liquid (ASL) layer, which work together to remove inhaled particles from the
lung. Animal study data have identified a critical role for ASL dehydration in the pathogenesis of
mucociliary dysfunction and chronic airway disease.5 ASL depletion resulted in reduced mucus
clearance and histologic signs of chronic airway disease, including mucus obstruction, goblet cell
hyperplasia, and chronic inflammatory cell infiltration. Study animals experienced reduced
bacterial clearance and high pulmonary mortality as a result.

The role of irritant exposure, particularly cigarette smoke and airborne particulates, in recurrent
(wheezy) bronchitis and asthma is becoming clearer. Kreindler et al demonstrated that the ion
transport phenotype of normal human bronchial epithelial cells exposed to cigarette smoke
extract is similar to that of cystic fibrosis epithelia, in which sodium is absorbed out of
proportion to chloride secretion in the setting of increased mucus production.6 These findings
suggest that the negative effects of cigarette smoke on mucociliary clearance may be mediated
through alterations in ion transport. McConnell et al noted that organic carbon and nitrogen
dioxide airborne particulates were associated with the chronic symptoms of bronchitis among
children with asthma in southern California.7

A chronic or recurrent insult to the airway epithelium, such as recurrent aspiration or repeated
viral infection, may contribute to chronic bronchitis in childhood. Following damage to the
airway lining, chronic infection by commonly isolated airway organisms may occur. The most
common bacterial pathogen that causes lower respiratory tract infections in children of all age
groups is Streptococcus pneumoniae. Nontypeable Haemophilus influenzae and Moraxella
catarrhalis may be significant pathogens in preschoolers (aged <5 y), whereas Mycoplasma
pneumoniae may be significant in school-aged children (aged >5-18 y).

Children with tracheostomies are often colonized with an array of flora, including alpha-
hemolytic streptococci and gamma-hemolytic streptococci. With acute exacerbations of
tracheobronchitis in these patients, pathogenic flora may include Pseudomonas aeruginosa and
Staphylococcus aureus (including methicillin-resistant strains), among other pathogens. Children
predisposed to oropharyngeal aspiration, particularly those with compromised protective airway
mechanisms, may become infected with oral anaerobic strains of streptococci.

Frequency

United States

Data collected from the National Ambulatory Care Survey 1991 Summary showed that
2,774,000 office visits by children younger than 15 years resulted in a diagnosis of bronchitis.8
Although the report did not separate diagnoses into acute or chronic bronchitis, the frequency of
visits made bronchitis just slightly less common than otitis media and slightly more common
than asthma. However, in children, asthma is often underdiagnosed and is frequently
misdiagnosed as chronic or recurrent bronchitis. Since 1996, 9-14 million Americans have been
diagnosed with chronic bronchitis annually.
International

Bronchitis, both acute and chronic, is prevalent throughout the world and is one of the top 5
reasons for childhood physician visits in countries that track such data. The incidence of
bronchitis in British schoolchildren is reported to be 20.7%. Weigl et al noted an overall increase
in hospitalization for lower respiratory tract infection (laryngotracheobronchitis, bronchitis,
wheezing bronchitis, bronchiolitis, bronchopneumonia, pneumonia) among German children;
this is consistent with observations among children from the United States, United Kingdom, and
Sweden.9 The incidence rate of bronchitis in children in this German cohort was 28%.

Mortality/Morbidity

Acute bronchitis is almost always a self-limited process in the otherwise healthy child. However,
it frequently results in absenteeism from school and work. Chronic bronchitis is manageable with
proper treatment and avoidance of known triggers (eg, tobacco smoke). Proper management of
any underlying disease process, such as asthma, cystic fibrosis, immunodeficiency, congestive
heart failure, bronchiectasis, or tuberculosis, is also key.

Race

Differences in population prevalences have been identified in patients with chronic

bronchitis. For example, because of the association of chronic bronchitis with asthma and the
concentration of asthma risk factors among inner-city populations, this population group is at
higher risk.

Sex

The incidence of acute bronchitis is equal in males and females. The incidence of chronic
bronchitis is difficult to state precisely because of the lack of definitive diagnostic criteria and the
considerable overlap with asthma. However, in recent years, the prevalence rate of chronic
bronchitis has been reported to be consistently higher in females than in males.

Age

Acute (typically wheezy) bronchitis occurs most commonly in children younger than 2 years,
with another peak seen in children aged 9-15 years. Chronic bronchitis affects people of all ages
but is more prevalent in persons older than 45 years.

Clinical
History

Acute bronchitis begins as a respiratory tract infection that manifests as the common cold.
Symptoms often include coryza, malaise, chills, slight fever, sore throat, and back and muscle
pain. The cough in these children is usually accompanied by an initial watery nasal discharge.
After several days, the nasal discharge becomes thicker and colored or opaque. It then becomes
clear again and has a mucoid watery consistency before it spontaneously resolves within 7-10
days. Purulent nasal discharge is common with viral respiratory pathogens and, by itself, does
not imply a bacterial etiology to the infection.

Initially, the cough is dry and may be harsh or raspy sounding. The cough then loosens and
becomes productive. Children younger than 5 years rarely expectorate. In this age group, sputum
is usually seen in vomitus (ie, posttussive emesis). Parents frequently note a rattling sound in the
chest. Hemoptysis, a burning discomfort in the chest, and dyspnea may be present.

Brunton et al notes that adult patients with chronic bronchitis have a history of persistent cough
that produces yellow, white, or greenish sputum on most days for at least 3 months of the year
and for more than 2 consecutive years.10 Wheezing and reports of breathlessness are also
common. Pulmonary function testing in these adult patients reveals irreversible reduction in
maximal airflow velocity.

Recurrent episodes of acute or chronic bronchitis are unusual in children and should alert the
clinician to the likelihood of asthma. Bronchitis is often repeatedly diagnosed in children in
whom asthma has remained undiagnosed for many years. Similarly, a family history of asthma in
parents or siblings may be masked within a history of recurrent bronchitis. The diagnosis of
"asthmatic bronchitis" or "wheezy bronchitis" is simply asthma. For more detail on taking the
history of pediatric patients with recurrent cough, wheezing, and shortness of breath, see
Asthma.

Recurrent episodes of acute or chronic bronchitis may be associated with immunodeficiency.

Stiehm identifies the 4 most common immunodeficiencies in pediatric patients: transient
hypogammaglobulinemia of infancy (THI), immunoglobulin G (IgG) subclass deficiency,
impaired polysaccharide responsiveness (partial antibody deficiency), and selective IgA
deficiency (IgAD).11 A summary of immunodeficiency registries in 4 countries listed IgAD in
27.5% of the patients, IgG subclass deficiency in 4.8%, and THI in 2.3%. Patients typically have
normal cellular immune systems, phagocyte function, and complement levels. All 4
immunodeficiency states are characterized by recurrent bacterial respiratory infections, such as
purulent rhinitis, sinusitis, otitis, and bronchitis. Only a few cases require the use of intravenous
IgG (IVIG) and the long-term prognosis is generally excellent.

Ozkan studied immunoglobulin A (IgA) and IgG deficiency in children who presented with
recurrent sinopulmonary infection.12 The overall frequency of antibody defects was found to be
19.1%. IgA deficiency was observed in 9.3%, IgG subclass deficiency was observed in 8.4%,
and both IgA and IgG subclass deficiencies were observed in 1.4%. The prevalence of IgA and/or
IgG subclass deficiency was 25% in patients with recurrent upper respiratory tract infections,
22% in patients with recurrent pulmonary infections, and 12.3% in patients with recurrent
bronchiolitis.

Common variable immunodeficiency is the most frequent of the primary

hypogammaglobulinemias. Kainulainen et al conducted a nationwide survey of all patients with
common variable immunodeficiency who were receiving immunoglobulin replacement therapy
in Finland.13 Sinopulmonary infections were the most common clinical presentation; 66% had
recurrent pneumonia, 60% had recurrent maxillary sinusitis, and 45% had recurrent bronchitis.
The mean interval from the time of onset of symptoms to diagnosis was 8 years. Evidence of
chronic lung damage was noted in 17% of patients at the time of diagnosis, highlighting the
importance of early recognition in the prevention of chronic pulmonary sequelae.

To improve the recognition of common variable immunodeficiency, the authors suggest

consideration of this condition in patients with recurrent sinopulmonary infection. In addition to
a low serum IgG concentration, measurement of specific antibody production is recommended to
establish the diagnosis.

Physical

Lungs may sound normal. Crackles, rhonchi, or large airway wheezing, if any, tends to be
scattered and bilateral. The pharynx may be injected.

Causes

Acute bronchitis is generally caused by respiratory infections; approximately 90% are viral in
origin, and 10% are bacterial. Chronic bronchitis may be caused by repeated attacks of acute
bronchitis, which can weaken and irritate bronchial airways over time, eventually resulting in
chronic bronchitis. Industrial pollution is also a common cause; however, the chief culprit is
heavy long-term cigarette smoke exposure.

The most common causes of both acute and chronic bronchitis in the pediatric population are as
follows:

Viral infection
o
Adenovirus
o
Influenza
o
Parainfluenza
o
Respiratory syncytial virus
o
Rhinovirus
o
Human bocavirus14,15,16
o
Coxsackievirus
o
Herpes simplex virus

Secondary bacterial infection as part of an acute upper respiratory infection (extremely rare in
nonsmokers without cystic fibrosis)
o
S pneumoniae
o
M catarrhalis
 o
H influenzae (nontypeable)
o
Chlamydia pneumoniae (Taiwan acute respiratory [TWAR] agent)
o
Mycoplasma species

Air pollutants, such as occur with smoking and from second-hand smoke (also causes incident
bronchiolitis17 ): Tsai et al demonstrated that in utero and postnatal household cigarette smoke
exposure is strongly linked to asthma and recurrent bronchitis in children. 18

Allergies

Chronic aspiration or gastroesophageal reflux

Fungal infection

Plastic bronchitis
o
Plastic bronchitis is an unusual but potentially devastating form of obstructive bronchial
disease. The disease is characterized by the development of arborizing, thick, tenacious
casts of the tracheobronchial tree that produce airway obstruction.
o
Patients with congenital heart disease who have undergone a Fontan operation are a
group at high risk for development of this problem for presently unknown reasons. In
some cases, it appears many years after the Fontan procedure is performed. 19 Zahorec et
al describe patients in whom plastic bronchitis occurred in the immediate postoperative
period following a Fontan procedure. These patients were successfully managed with
short periods of high-frequency jet ventilation and vigorous pulmonary toilet. 20
o
Therapies include endoscopic debridement of the airway, vigorous pulmonary toilet and
aerosolized tissue plasminogen activator. Shah et al performed thoracic duct ligation,
resulting in complete resolution of the formation of casts in two patients with plastic
bronchitis refractory to medical management. 21 These results suggest that high
intrathoracic lymphatic pressures are related to the development of the recurrent
bronchial casts seen in this disorder.
Introduction
Background

Bronchitis is one of the top conditions for which patients seek medical care. Bronchitis is
characterized by inflammation of the bronchial tubes (or bronchi), which are the air passages that
extend from the trachea into the small airways and alveoli. Triggers may be infectious agents,
such as viruses or bacteria, or noninfectious agents, such as smoking or inhalation of chemical
pollutants or dust.

Acute bronchitis is manifested by cough and, occasionally, sputum production that last for no
more than 3 weeks. Although bronchitis should not be treated with antimicrobials, it is frequently
difficult to refrain from prescribing them. Accurate testing and decision-making protocols
regarding who might benefit from antimicrobial therapy would be useful but are not currently
available.

Chronic bronchitis is defined clinically as cough with sputum expectoration for at least 3 months
during a period of 2 consecutive years. Chronic bronchitis is associated with hypertrophy of the
mucus-producing glands found in the mucosa of large cartilaginous airways. As the disease
advances, progressive airflow limitation occurs, usually in association with pathologic changes
of emphysema. This condition is called chronic obstructive pulmonary disease (COPD). When a
stable patient experiences sudden clinical deterioration with increased sputum volume, sputum
purulence, and/or worsening of shortness of breath, this is referred to as an acute exacerbation of
chronic bronchitis as long as conditions other than acute tracheobronchitis are ruled out.

Generally, bronchitis is a diagnosis made by exclusion of other conditions such as sinusitis,

pharyngitis, tonsillitis, and pneumonia.

Pathophysiology

Respiratory viruses are the most common causes of acute bronchitis. The most common viruses
include influenza A and B, parainfluenza, respiratory syncytial virus, and coronavirus, although
an etiologic agent is identified only in a minority of cases.1

During an episode of acute bronchitis, the cells of the bronchial-lining tissue are irritated and the
mucous membrane becomes hyperemic and edematous, diminishing bronchial mucociliary
function. Consequently, the air passages become clogged by debris and irritation increases. In
response, copious secretion of mucus develops, which causes the characteristic cough of
bronchitis. For instance, with mycoplasmal pneumonia, bronchial irritation results from the
attachment of the organism (Mycoplasma pneumoniae) to the respiratory mucosa, with eventual
sloughing of affected cells. Acute bronchitis usually lasts approximately 10 days. If the
inflammation extends downward to the ends of the bronchial tree, into the small bronchi
(bronchioles), and then into the air sacs, bronchopneumonia results.

Chronic bronchitis is a condition associated with excessive tracheobronchial mucus production

sufficient to cause cough with expectoration for at least 3 months for more than 2 consecutive
years. The alveolar epithelium is both the target and the initiator of inflammation in chronic
bronchitis.

A predominance of neutrophils and the peribronchial distribution of fibrotic changes result from
the action of interleukin 8, colony-stimulating factors, and other chemotactic and
proinflammatory cytokines. Airway epithelial cells release these inflammatory mediators in
response to toxic, infectious, and inflammatory stimuli, in addition to decreased release of
regulatory products such as ACE or neutral endopeptidase.

Chronic bronchitis can be categorized as simple chronic bronchitis, chronic mucopurulent

bronchitis, or chronic bronchitis with obstruction. Mucoid sputum production characterizes
simple chronic bronchitis. Persistent or recurrent purulent sputum production in the absence of
localized suppurative disease, such as bronchiectasis, characterizes chronic mucopurulent
bronchitis. Chronic bronchitis with obstruction must be distinguished from chronic infective
asthma. The differentiation is based mainly on the history of the clinical illness. Patients who
have chronic bronchitis with obstruction present with a long history of productive cough and a
late onset of wheezing, whereas patients who have asthma with chronic obstruction have a long
history of wheezing with a late onset of productive cough.

Chronic bronchitis may result from a series of attacks of acute bronchitis, or it may evolve
gradually because of heavy smoking or inhalation of air contaminated with other pollutants in the
environment. When so-called smoker's cough is continual rather than occasional, the mucus-
producing layer of the bronchial lining has probably thickened, narrowing the airways to the
point where breathing becomes increasingly difficult. With immobilization of the cilia that sweep
the air clean of foreign irritants, the bronchial passages become more vulnerable to further
infection and the spread of tissue damage.

Frequency

United States

In one study, acute bronchitis affected 44 of 1000 adults annually, and 82% of episodes occurred
in fall or winter.2 By way of comparison, 91 million cases of influenza, 66 million cases of the
common cold, and 31 million cases of other acute upper respiratory tract infections occurred
during that same year.

According to estimates from national interviews taken by the National Center for Health
Statistics in 2006, approximately 9.5 million people, or 4% of the population, were diagnosed
with chronic bronchitis. These statistics may underestimate the prevalence of COPD by as much
as 50% because many patients underreport their symptoms and their conditions remain
undiagnosed. However, an overdiagnosis of chronic bronchitis by patients and clinicians has also
been suggested. The term bronchitis is often used as a common descriptor for a nonspecific and
self-limited cough, thereby falsely increasing its incidence even though the patient does not meet
the criteria for diagnosis.

International

Acute bronchitis is common throughout the world and is one of the top 5 reasons for seeking
medical care in countries that collect such data.

Mortality/Morbidity

Bronchitis is almost always self-limited in individuals who are otherwise healthy, although it
may result in absenteeism from work and school. Severe cases occasionally produce
deterioration in patients with significant underlying cardiopulmonary disease or other
comorbidities.

Race

No difference in racial distribution is reported; however, bronchitis occurs more frequently in

populations with a low socioeconomic status and in people who live in urban and highly
industrialized areas.

Sex

Bronchitis affects males more than females.

Age

Although found in all age groups, acute bronchitis is most frequently diagnosed in children
younger than 5 years, whereas chronic bronchitis is more prevalent in people older than 50 years.
In the United States, up to two thirds of men and one fourth of women have emphysema at death.

Clinical
History

Obtain a complete history, including information on exposure to toxic substances and smoking.
Patients with chronic bronchitis are often overweight and cyanotic. Initially, cough is present in
the winter months. Over the years, the cough progresses from hibernal to perennial, and
mucopurulent relapses increase in frequency, the duration and severity of which increase to the
point of exertional dyspnea.

Symptoms of acute bronchitis include the following:

Cough and sputum production

Cough is the most commonly observed symptom. It begins early in the course of many
acute respiratory infections and becomes more prominent as the disease progresses.

Cough begins within 2 days of infection in the majority of patients. In patients with acute
bronchitis, cough generally lasts from 10-20 days.

Sputum production is reported in approximately half the patients in whom cough

occurred. Sputum may be clear, yellow, green, or even blood-tinged.

Purulent sputum is reported in 50% of persons with acute bronchitis. Changes in sputum
color are due to peroxidase released by leukocytes in sputum; therefore, color alone
cannot be considered indicative of bacterial infection.

Sore throat

Runny or stuffy nose

Headache

Muscle aches

Extreme fatigue

Fever: This is a relatively unusual sign and, when accompanied by cough, suggests either
influenza or pneumonia.

Nausea, vomiting, and diarrhea: These are rare. Severe cases may cause general malaise and
chest pain. With severe tracheal involvement, burning, substernal chest pain associated with
respiration, and coughing may occur.

Dyspnea and cyanosis: These are not observed in adults unless the patient has underlying COPD
or another condition that impairs lung function.

Physical

The physical examination findings in acute bronchitis can vary from normal-to-pharyngeal
erythema, localized lymphadenopathy, and rhinorrhea to coarse rhonchi and wheezes that change
in location and intensity after a deep and productive cough. Diffuse wheezes, high-pitched
continuous sounds, and the use of accessory muscles can be observed in severe cases.
Occasionally, diffuse diminution of air intake or inspiratory stridor occurs; these findings
indicate obstruction of a major bronchi or the trachea, which requires sequentially vigorous
coughing, suctioning, and, possibly, intubation or even tracheostomy.
 Sustained heave along the left sternal border indicates right ventricular hypertrophy secondary
to chronic bronchitis.
Clubbing on the digits and peripheral cyanosis indicate cystic fibrosis.

Bullous myringitis may suggest mycoplasmal pneumonia.

Conjunctivitis, adenopathy, and rhinorrhea suggest adenovirus infection.

Causes

Acute bronchitis is usually caused by infections, such as those caused by Mycoplasma species,
Chlamydia pneumoniae, Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus
influenzae, and by viruses, such as influenza, parainfluenza, adenovirus, rhinovirus, and
respiratory syncytial virus. Exposure to irritants, such as pollution, chemicals, and tobacco
smoke, may also cause acute bronchial irritation.

Cigarette smoking is indisputably the predominant cause of chronic bronchitis. Estimates suggest
that cigarette smoking accounts for 85-90% of chronic bronchitis and COPD. Studies indicate that
smoking pipes, cigars, and marijuana causes similar damage.
o Smoking impairs ciliary movement, inhibits the function of alveolar macrophages, and
leads to hypertrophy and hyperplasia of mucus-secreting glands.

o Smoking can also increase airway resistance via vagally mediated smooth muscle
constriction.

o Unless some other factor can be isolated as the irritant that produces the symptoms, the
first step in dealing with chronic bronchitis is for the patient to stop smoking.

Air pollution levels have been associated with increased respiratory health problems among
people living in affected areas. The Air Pollution and Respiratory Health Branch of the National
Center for Environmental Health directs the fight of the US Centers for Disease Control and
Prevention (CDC) against respiratory illness associated with air pollution.

o According to the Healthy People 2000 report, each year in the United States, the
following occur:

"The health costs of human exposure to outdoor air pollutants range from $40
to $50 billion."

"An estimated 50,000 to 120,000 premature deaths are associated with

exposure to air pollutants."

"People with asthma experience more than 100 million days of restricted
activity, costs for asthma exceed $4 billion, and about 4,000 people die of
asthma."

A growing body of literature has demonstrated that specific occupational exposures are
associated with the symptoms of chronic bronchitis. The list of agents includes coal,
manufactured vitreous fibers, oil mist, cement, silica, silicates, osmium, vanadium, welding
fumes, organic dusts, engine exhausts, fire smoke, and secondhand cigarette smoke.
lternative Names

Bronchitis - acute

Prevention

Good handwashing is one of the best ways to avoid exposure to viruses and other respiratory
infections.

Since flu viruses have been shown to be a significant cause of bronchitis, getting a flu shot may
also help prevent acute bronchitis.

Minimize exposure to cold, damp environments which, combined with air pollution or tobacco
smoke, may make people more susceptible to bronchitis.

References

Knutson D. Diagnosis and Management of Acute Bronchitis. Am Fam Physician. May 2002;
65(10): 2039-44.
Aagaard E. Management of Acute Bronchitis in Healthy Adults. Infect Dis Clin North Am. Dec
2004; 18(4): 919-37.

American Academy of Pediatrics. Cough Illness/Bronchitis. In: Pickering LK, ed. Red Book:
2003 Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, IL: American
Academy of Pediatrics; 2003:696.

Pathophysiology of Acute Bronchitis

Posted by admin | Posted in bronchitis | Posted on 18-02-2009

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Today, it is important that you should maintain a healthy body in order for it to fight off any
diseases that it may come in contact with. In order to function properly in society and always be
a productive member of society, you should always be healthy. However, there are some cases
where people suffer from differing kinds of diseases that can significantly affect their daily life.

One such disease that is considered to be common among many people is called bronchitis.
Bronchitis is an illness where the bronchial tubes get inflamed. Because of this, people with this
kind of illness can have difficulty in breathing and suffer from mild fever. There are mainly two
types of bronchitis that affects people. One is called acute or short-term bronchitis, and the other
is chronic or long-term bronchitis. Acute bronchitis is easy to treat with the proper diagnosis and
management.

First of all, acute bronchitis offers several signs and symptoms that you should be aware of in
order to detect the disease and stop it on its tracks. The symptoms for acute bronchitis will
include hacking cough with mucus, headaches, squeezing sensation around the eyes, chest
tightness, mild fever, and difficulty in breathing. As you can see, the signs and symptoms of
acute bronchitis is very similar to the common cold.

People mainly affected by this illness are infants, children, the elderly, tobacco smokers, and
people who have weak respiratory systems. People who live in highly polluted areas are also
commonly affected by acute bronchitis. You have to consider that you should get this illness
treated in order for it to not develop into chronic bronchitis. Bronchitis can happen anytime of
the year but it will usually happen during the winter months.

Treatment will include getting a lot of rest, humidifying the home with humidifiers, inhaling
steam, taking a long shower, and drinking a lot of non-caffeinated and non-alcoholic beverages.
However, if the bronchitis is caused by bacteria or by fungus, it is important that you should
consult your doctor about it where they can prescribe some anti-bacterial or anti-fungal
medications.

Here is a closer look of acute bronchitis to better understand its pathophysiology or how it
works.

Usually bronchitis occurs after the person was infected with cold or infection. The virus that
causes the common cold can also be the virus that can cause bronchitis. Acute bronchitis can also
happen by inhaling irritants that can damage and inflame the bronchial tubes. Cigarette smoke
and other chemical fumes inhaled can significantly damage your bronchial tubes. The
inflammation causes the airway to constrict and therefore, causes you to have difficulty in
breathing. If left untreated or if you continue inhaling irritants such as cigarette smoke, the acute
bronchitis will eventually develop into its chronic form where it can permanently damage your
bronchial tubes and tissues surrounding it.

This is the prognosis is of acute bronchitis.

If you are suffering from acute bronchitis, it is recommended that you should stop smoking or at
least lessen your cigarette or tobacco consumption. If it is possible, you should avoid dusty areas.
You can also consider installing air filters in your home if you live in an area where there is
heavy percentage of air pollution.

Acute bronchitis is the last up to 10 to 12 day. However, acute bronchitis is usually followed by
flu or call. You have to consider the bronchitis is contagious and can be transmitted by air
through coughing. This is why it is important for you to carry a damp handkerchief or towel for
you to cover your mouth if you need to cough.
If the coughing persists for more than a month, there may be other illnesses that are inside your
body, such as pneumonia. It is also important that you should observe the mucus secretion. If
there is blood present, you should immediately consult your physician for further diagnosis.

These are the things you should know about acute bronchitis. With the proper management and
care, you will be able to stop it on its tracks and prevent it from developing into its chronic form.
If you experience symptoms associated with bronchitis, you should consult your doctor
immediately. They will perform some tests to determine what is causing the bronchitis whether it
is viral or bacterial infection.

Inflammation of the airways (bronchi). Acute bronchitis is a serious disease in infants, usually caused by
viruses such as influenza which produce intense inflammation of the respiratory tract that may lead to
asphyxia. Chronic bronchitis affects adults who smoke cigarettes. Excessive bronchial mucous secretion
follows, inducing a chronic cough productive of sputum.

Portions of the summary below have been contributed by Wikipedia.

For information about the bronchial condition called asthma see Allergic asthma

Bronchitis
Classifications and external resources

ICD-10 J20-J21

ICD-9 490-491

Bronchitis is an obstructive pulmonary disorder characterized by inflammation of the bronchi of

the lungs. Like many disorders, bronchitis can be acute (short-term), or chronic (long-lasting).
Chronic bronchitis is defined clinically as a persistent cough that produces sputum matter that is
coughed up from the respiratory tract, for at least three months in two consecutive years.

Chronic bronchitis is predominantly caused by smoking, and has also been linked to
pneumoconiosis, excessive alcohol consumption and exposure to cold and draught.

Symptoms
An expectorating cough (the colour of the mucus does not signify whether the infection is viral or
bacterial) Dyspnea (Shortness of breath) Fatigue and/or malaise Mild fever Mild chest pains Vibration in
chest when breathing coldness

Diagnosis

A physical examination will often reveal decreased intensity of breath sounds (rhonchi) and
extended expiration.

A variety of lab test results may suggest chronic bronchitis, namely:

a chest x-ray that reveals hyperinflation and increased bronchovascular markings a pulmonary function
test that shows an increase in the lung's residual volume and a decreased vital capacity arterial blood
gases that show a decreased level of oxygen in the blood and an increased level of carbon dioxide a
sputum culture that has pathogenic microorganisms and/or neutrophils in it

Some of these findings may also be seen in acute bronchitis.

Pathophysiology

Acute bronchitis often follows a cold or infection.

Chronic bronchitis, however, is most likely due to environmental irritation of the bronchial tubes
and is often caused by smoking. The initiating event in developing chronic bronchitis is chronic
irritation due to inhalation of certain substances (especially cigarette smoke). As bronchitis
persists to become chronic bronchitis, a substantial increase in the number of goblet cells in the
small airways is seen. A Reid index larger than 0.4 is indicative of chronic bronchitis.

The role of infection in the pathogenesis of chronic bronchitis is secondary.

Treatment

In most cases, acute bronchitis is caused by viruses, not bacteria and it will go away on its own
after a few days without antibiotics.

To treat acute bronchitis that appears to be caused by a bacterial infection, or as a precaution,

antibiotics may be given.
To help the bronchial tree heal faster and not make bronchitis worse, smokers should cut down
on the number of cigarettes they smoke (or quit altogether if possible), or at least try not to
smoke in their house.

Prognosis

Acute bronchitis usually lasts approximately 10 or 11 days.

Should the cough last longer than a month, some doctors may issue a referral to an ENT Doctor
to see if a cause other than bronchitis is causing the irritation.

The prognosis for patients with severe chronic bronchitis varies, but recovery is harder for those
patients with additional severe illnesses (lung diseases or heart conditions). Pulmonary
hypertension, cor pulmonale, and chronic respiratory failure are possible complications from
chronic bronchitis.

Prevention

The best way to avoid acute bronchitis is to wash your hands frequently and thoroughly, to get
lots of rest, and to drink lots of fluids. Acute bronchitis is most commonly caused by viruses or
bacteria, which spread via coughing droplets in the air and/or from touching contaminated
surfaces.

Chronic bronchitis is often preventable. Smokers in the early stages of chronic bronchitis
can change and improve the course of the disease by quitting smoking.

Acute Bronchitis
A patient information
WILLIAM J. HUESTON, M.D., handout on acute
Medical University of South Carolina, Charleston, bronchitis, written by the
South Carolina authors of this article, is
ARCH G. MAINOUS III, PH.D., provided on page 1281.
University of Kentucky College of Medicine, Lexington,
Kentucky

Acute bronchitis is a lower respiratory tract infection that causes reversible bronchial inflammation. In up
to 95 percent of cases, the cause is viral. While antibiotics are often prescribed for patients with acute
bronchitis, little evidence shows that these agents provide significant symptomatic relief or shorten the
course of the illness. In a few small studies, bronchodilators such as albuterol have been found to relieve
some symptoms of acute bronchitis. Increased attention is being given to the role of Chlamydia species in
acute bronchitis and adult-onset asthma. Studies in progress may help to clarify the importance of these
organisms in acute bronchitis and to determine whether early treatment can prevent or ameliorate
asthma.
Acute bronchitis is one of the most common diagnoses made by primary care physicians. 1-3
In
the United States alone, the evaluation and treatment of this illness is estimated to cost $200
million to $300 million per year.4 Even though the diagnosis of acute bronchitis is frequently
made, the definition of this illness lacks clarity and its pathophysiology is often misunderstood.
Furthermore, acute bronchitis has traditionally been treated with antibiotics, although little
evidence supports the effectiveness of antibiotic treatment in this illness.

This article examines the causes of acute bronchitis, as well as the physiologic responses to this
illness. The value of antibiotics and other agents in the treatment of bronchitic cough is also
appraised.

Definition and Epidemiology

One reason that acute bronchitis is such a common diagnosis in primary care practice is that
physicians often lump various conditions together under the diagnosis of bronchitis. In the
absence of clear diagnostic signs or laboratory tests, the diagnosis of acute bronchitis is purely
clinical.5 Consequently, cough from upper respiratory tract infections, sinusitis or allergic
syndromes (e.g., mild asthma or viral pneumonia) may be diagnosed as acute bronchitis.

True acute purulent bronchitis is characterized by infection of the bronchial tree with resultant
bronchial edema and mucus formation.6 Because of these changes, patients develop a productive
cough and signs of bronchial obstruction, such as wheezing or dyspnea on exertion. Unlike the
chronic inflammatory changes of asthma, the inflammation in acute bronchitis is transient and
usually resolves soon after the infection clears. In some patients, however, the inflammation can
last several months.7 In rare cases, a postbronchitis cough can persist for up to six months.

Bronchitis can have causes other than infection. Bronchial wall inflammation can occur in
asthma or can be secondary to mucosal injury in an acute event, such as smoke or chemical fume
inhalation. This inflammation can also result from chronic toxic exposure, such as cigarette
smoking. It is important to realize that when underlying inflammation is present, such as in
asthmatics or smokers, infective agents are likely to cause more severe cough and wheezing.

Viruses are the most common cause of bronchial inflammation in otherwise healthy adults with
acute bronchitis. Only a small portion of acute bronchitis infections are caused by nonviral
agents, with the most common organism being Mycoplasma pneumoniae.8-10 Study findings
suggest that Chlamydia pneumoniae may be another nonviral cause of acute bronchitis.11,12

The obstructive symptoms of acute bronchitis, as determined by spirometric studies, are very
similar to those of mild asthma.13 In one study,13 forced expiratory volume in one second (FEV1),
mean forced expiratory flow during the middle of forced vital capacity (FEF25-75%) and peak flow
values declined to less than 80 percent of the predicted values in almost 60 percent of patients
during episodes of acute bronchitis. In the five weeks following the infection, these values
returned to normal. Another study14 found that patients with acute bronchitis were 6.5 times more
likely to have been told they had asthma in the past and nine times more likely to be diagnosed
with asthma in the future.
The findings of these studies12,13 suggest that patients with acute bronchitis may have an
underlying predisposition to bronchial reactivity during times of viral infection and that this
reactivity may evolve into the more chronic bronchial inflammation which characterizes asthma.
Recent epidemiologic findings of serologic evidence of C. pneumoniae infection in adults with
new-onset asthma suggest that untreated chlamydial infections may have a role in the transition
from the acute inflammation of bronchitis to the chronic inflammatory changes of asthma.11,12

Diagnosis

Patients with acute bronchitis usually have a viral respiratory infection with transient
inflammatory changes that produce sputum and symptoms of airway obstruction. The cough in
acute bronchitis may produce either clear or purulent sputum. While this cough generally lasts
seven to 10 days, it can persist. Approximately 50 percent of patients with acute bronchitis have
a cough that lasts up to three weeks, and 25 percent of patients have a cough that persists for over
a month.12

The diagnosis of asthma should

be considered in patients with
repetitive episodes of acute
bronchitis.

The appearance of sputum is not

predictive of a bacterial infection .

Physical Examination
While a lung examination may be useful in patients with acute bronchitis, it is not diagnostic.
Wheezing, rhonchi, a prolonged expiratory phase or other obstructive signs may be present.
However, some patients may exhibit no signs of bronchospasm. Patients should be asked about
night coughing, and they should undergo forced expiration in the prone position to detect
wheezing. A night cough or wheezing may be the only signs that bronchial obstruction is present.

Diagnostic Studies
The appearance of sputum is not predictive of whether a bacterial infection is present. Purulent
sputum is most often caused by viral infections.5,15 Microscopic examination or culture of sputum
in the healthy adult with acute bronchitis generally is not helpful. Since most cases of acute
bronchitis are caused by viruses, cultures are usually negative or exhibit normal respiratory flora.

When M. pneumoniae infection is present, routine sputum cultures are still negative. Rapid tests
for the identification of Mycoplasma organisms have been developed. However, these tests are
not routinely available, and they are unlikely to be cost-effective studies in the acute care
setting.16
No available test can provide a definitive diagnosis of acute bronchitis. While decreases in
pulmonary function have been demonstrated in patients with acute bronchitis,
diagnostic pulmonary function testing should not be performed in previously healthy patients.
When underlying asthma is suspected, pulmonary function testing should be considered.

It must be kept in mind that acute bronchitis can cause transient pulmonary function
abnormalities. Therefore, to diagnose asthma, the physician must find changes that persist after
the acute phase of the illness. When pneumonia is suspected, chest radiographs and pulse
oximetry may be helpful in making the diagnosis.

Differential Diagnosis

Many conditions other than acute bronchitis present with cough (Table 1). Acute bronchitis or
pneumonia can present with fever, constitutional symptoms and a productive cough. While patients with
pneumonia often have rales, this finding is neither sensitive nor specific for this illness. When
pneumonia is suspected on the basis of the presence of a high fever, constitutional symptoms, severe
dyspnea and certain physical findings or risk factors, a chest radiograph should be obtained to confirm
the diagnosis.

TABLE 1
Differential Diagnosis of Acute Bronchitis

Disease process Signs and symptoms

Reactive airway disease

Asthma
Allergic Evidence of reversible airway obstruction even when not infected
aspergillosis Transient pulmonary infiltrates
Eosinophilia in sputum and peripheral blood smear
Occupational Symptoms worse during the work week but tend to improve during
exposures weekends, holidays and vacations
Chronic Chronic cough with sputum production on a daily basis for a minimum
bronchitis of three months
Typically occurs in smokers
Respiratory infection
Sinusitis
Tenderness over the sinuses
Postnasal drainage
Common cold Upper airway inflammation and no evidence of bronchial wheezing
Pneumonia Evidence of infiltrate on the chest radiograph
Other causes
Congestive
heart failure Basilar rales
Orthopnea
Cardiomegaly
Evidence of increased interstitial or alveolar fluid on the chest
radiograph
S3 gallop
 Tachycardia
Reflux Intermittent symptoms worse when lying down
esophagitis Heartburn
Bronchogenic Constitutional signs often present
tumor Cough chronic, sometimes with hemoptysis
Other aspiration Usually related to a precipitating event, such as smoke inhalation
syndromes Vomiting
Decreased level of consciousness

Asthma and allergic bronchospastic disorders, such as allergic aspergillosis or bronchospasm due
to other environmental and occupational exposures, can mimic the productive cough of acute
bronchitis. When obstructive symptoms are not obvious, mild asthma may be diagnosed as acute
bronchitis. Furthermore, since respiratory infections can trigger bronchospasm in asthma,
patients with asthma that occurs only in the presence of respiratory infections resemble patients
with acute bronchitis.

Asthma should be considered in patients with repetitive episodes of acute bronchitis. Patients
who repeatedly present with cough and wheezing can be given full spirometric testing with
bronchodilation or provocative testing with a methacholine challenge test to help differentiate
asthma from recurrent bronchitis. Those with findings suggestive of the chronic inflammatory
changes that occur in asthma may benefit from chronic anti-inflammatory therapy.

Upper respiratory tract infection and sinusitis can also be confused with acute bronchitis. In all
three of these illnesses, patients may have a productive cough. However, the material produced
from the cough in an upper respiratory infection or sinusitis is from the deep pharynx and has
accumulated from postnasal drainage.

The differential diagnosis should also include nonpulmonary causes of cough and shortness of
breath. In older patients, congestive heart failure may cause cough, shortness of breath and
wheezing. Symptoms are often worse at night. Reflux esophagitis with chronic aspiration can
cause bronchial inflammation with cough and wheezing.17 Finally, bronchogenic tumors may
produce a cough and obstructive symptoms.4

Treatment

Antibiotics
Although many authorities have argued that antibiotics have no role in the treatment of acute
bronchitis, these agents remain the predominant therapy offered to patients. Primary care
physicians in the United States have treated acute bronchitis with a wide range of antibiotics,18,19
even though scant evidence exists that antibiotics offer any significant advantage over placebo
(Table 2).20 Placebo-controlled studies using doxycycline,7,15 erythromycin21,22 and trimethoprim-
sulfamethoxazole23 have failed to show consistent significant benefit for antibiotic therapy in
acute bronchitis. Even when patients with M. pneumoniae infection can be identified using a
rapid identification system, treatment with erythromycin has provided only limited benefit.24
 TABLE 2
Trials of Antibiotics in the Treatment of Acute Bronchitis

Sample
Study Antibiotic size Results

Stott and West Doxycycline 212 No benefit on any outcome

(1976)15
Williamson Doxycycline 74 No benefit on any outcome
(1984)7
Brickfield, et al. Erythromycin 52 No benefit on any outcome
(1986)21
Dunlay, et al. Erythromycin 63 Reduced use of cough medicines and
(1987)22 fewer abnormal lung examinations on
follow-up in treated patients
Franks and Trimethoprim with 67 Fewer days of coughing, fewer days off
Gleiner (1984)23 sulfamethoxazole work and reduced use of decongestants
in treated patients
King, et al.* Erythromycin 91 Earlier return to work in treated patients
(1996)24

*--The study population contained a disproportionate number of patients who were positive for
Mycoplasma infection.

Adapted with permission from Orr PH, Scherer K, Macdonald A, Moffatt ME. Randomized placebo-
controlled trials of antibiotics for acute bronchitis: a critical review of the literature. J Fam Pract
1993;36(5):507-12.

Frequently, antibiotics are prescribed primarily to meet patient expectations.25 While physicians
may understand that antibiotics are not effective for acute bronchitis, they prescribe them
anyway, fearing that failure to do so will leave patients less satisfied. However, one study26 found
that patient satisfaction with care did not depend on the receipt of an antibiotic prescription. As
long as physicians explained the rationale for treatment, patients who expected antibiotics and
did not get them were just as satisfied as those who were given antibiotics.

Another explanation for the frequent prescription of antibiotics is the lack of distinction between
acute and chronic bronchitis. Chronic bronchitis is characterized by persistent and irreversible
inflammatory changes in the bronchial tree, with these changes resulting in chronic cough, daily
sputum production and shortness of breath. Patients with underlying chronic bronchitis may
periodically become infected with a wide variety of organisms that produce changes in their
usual respiratory symptoms. In such cases, the evidence regarding the effectiveness of antibiotic
therapy is variable.

Although some studies show that antibiotic therapy is beneficial in patients with exacerbations of
chronic bronchitis,27,28 other studies are less convincing.29,30 Antibiotic effectiveness trials that do
not differentiate between acute bronchitis and exacerbations of chronic bronchitis add to the
confusion. Misconceptions about the role of bacteria in acute bronchitis and the widespread
practice of treating this illness with antibiotics may stem from studies that included patients with
chronic bronchitis who were mislabeled as having acute bronchitis.31

Bronchodilators

Evidence does not support the

use of antibiotics in patients with
acute bronchitis; bronchodilators
may provide relief in some
circumstances.

The pulmonary function findings in mild asthma and acute bronchitis are similar. Thus, it has
been hypothesized that bronchodilating agents may offer symptomatic relief to patients with
bronchitis.

Three studies32-34 have evaluated the effectiveness of bronchodilators in the treatment of acute
bronchitis (Table 3). These studies all demonstrated significant relief of symptoms in patients
with bronchitis who received oral albuterol (4 mg four times daily),33 inhaled albuterol (two puffs
four times daily)34 or fenoterol (not available in the United States).32 Compared with patients who
received placebo, those who were treated with albuterol were more likely to have stopped
coughing within a week of the initiation of therapy.33,34 The patients who were treated with
inhaled albuterol also returned to work sooner.33 The effects of combining albuterol with an
antibiotic have also been assessed. In one of these studies,32 no benefit was shown from adding
erythromycin to the treatment regimen of patients who were already receiving albuterol.

TABLE 3
Studies of Bronchodilators for Acute Bronchitis or Cough

Main difference
Study Study Duration of noted with drug
Study population size Medication used therapy therapy

Melbye, et al. Adults with 73 Fenoterol aerosol Seven days Improvement in

(1991)32 bronchitis vs. placebo general symptom
score
Faster resolution of
abnormal lung findings

Improvement in the
forced expiratory
volume in one second
(FEV1)
Hueston Adults with 34 Oral albuterol vs. Seven days Reduction in the
 (1991)33 bronchitis erythromycin percentage of patients
who were coughing
after one week

Trend toward
improved well-being
Hueston Adults with 46 Albuterol aerosol Seven days Reduction in the
(1994)34 bronchitis vs. placebo (with percentage of patients
and without an who were coughing
antibiotic) after one week

More patients returned

to work by day 4 of
treatment
Littenberg, et Acute 104 Albuterol aerosol Seven days No benefits
al. (1996)35 nonspecific vs. placebo
cough

Another study35 in patients with undifferentiated cough found no beneficial effect from albuterol
therapy. The investigators who conducted this study did not attempt to select patients with
productive cough and/or obstructive symptoms. Because of the multiple causes of cough, the
study population most likely included patients with acute bronchitis as well as many other
conditions, including sinusitis, upper respiratory infection and asthma. The results of this study
demonstrate that bronchodilators are likely to be effective only when bronchial inflammatory
changes are present.

Until better clinical data are available, physicians must rely on an accurate history and the
clinical picture of productive cough and wheezing to guide them in the use of bronchodilator
therapy.

Possible Complication of Bronchitis: Adult-Onset Asthma

Serologic evidence of previous infection with C. pneumoniae has been found in some adults with
new-onset asthma.36 Consequently, considerable attention has been focused on whether adult-
onset asthma is frequently preceded by a chlamydial respiratory infection.11,12 Both Chlamydia
trachomatis37 and C. pneumoniae38 have been cultured from the sputum of children with asthma.
However, no prevalence studies have assessed the frequency with which patients who have
respiratory illnesses such as bronchitis are infected with Chlamydia species and the percentage of
these patients who progress to asthma.

The reversibility of bronchial inflammation when chlamydial infections are treated is uncertain.
In one small open-label study of patients in a single practice,39 bronchial obstruction was reversed
in about one half of the patients who received antibiotic therapy. The patients who responded to
antibiotics tended to have serologic evidence of acute infection or infection for a shorter period
of time compared with the patients who did not respond to antibiotic therapy. While this
evidence is still preliminary, it suggests that early treatment of persistent wheezing with agents
effective against Chlamydia species may prevent the development of asthmatic symptoms in
adults. Further studies that confirm the effectiveness of antichlamydial therapy would be useful
in guiding treatment decisions.

Pathophysiology of acute bronchitis

Nowadays, it is significant that you should keep a healthy body in order for it to fight off any
illness that it may come in contact with. In order to function properly in society and always be a
productive member of society, you should always be well. Though, there are some cases where
people bear from differing kinds of diseases that can significantly affect their every day life.

One such disease that is measured to be general among many people is called
bronchitis. Bronchitis is a sickness where the bronchial tubes get inflamed. Because of this,
people with this type of illness can have complexity in breathing and bear from mild fever. There
are mainly two types of bronchitis that affects people. One is called acute or short-term
bronchitis, and the other is chronic or long-term bronchitis. Acute bronchitis is easy to treat with
the suitable diagnosis and management.

Firstly, acute bronchitis offers numerous signs and symptoms that you should be aware of in
order to identify the disease and stop it on its tracks. The symptoms for acute bronchitis will
include hacking cough with mucus, headaches, squeezing sensation around the eyes, chest
tightness, mild fever, and intricacy in breathing. As you can see, the signs and symptoms of acute
bronchitis are much related to the common cold. People mainly affected by this illness are
infants, children, the elderly, tobacco smokers, and people who have weak respiratory systems.
People who live in much polluted areas are also commonly affected by acute bronchitis. You
have to consider that you should get this illness treated in order for it to not expand into chronic
bronchitis. Bronchitis can happen anytime of the year but it will generally happen during the
winter months.

Treatment will include getting a lot of rest, humidifying the home with humidifiers, inhaling
steam, taking a long shower, and drinking a lot of non-caffeinated and non-alcoholic beverages.
Yet, if the bronchitis is caused by bacteria or by fungus, it is significant that you should consult
your doctor about it where they can advise some anti-bacterial or anti-fungal medications. Here
is a closer look of acute bronchitis to better understand its pathophysiology or how it works.
Generally bronchitis occurs after the person was infected with cold or infection. The virus that
grounds the common cold can also be the virus that can cause bronchitis. Acute bronchitis can
also occur by inhaling irritants that can damage and inflame the bronchial tubes. Cigarette smoke
and other chemical fumes inhaled can significantly damage your bronchial tubes. The irritation
causes the airway to constrict and so, causes you to have difficulty in breathing. If left untreated
or if you continue inhaling irritants such as cigarette smoke, the acute bronchitis will ultimately
develop into its chronic form where it can lastingly damage your bronchial tubes and tissues
surrounding it. This is the prognosis is of acute bronchitis.

If you are distressing from acute bronchitis, it is suggested that you should stop smoking or at
least lessen your cigarette or tobacco consumption. If it is probable, you should evade dusty
areas. You can also consider installing air filters in your home if you live in an area where there
is heavy percentage of air pollution. Acute bronchitis is the last up to 10 to 12 day.

Conversely, acute bronchitis is usually followed by flu or call. You have to consider the
bronchitis is contagious and can be transmitted by air through coughing. This is why it is
significant for you to carry a damp handkerchief or towel for you to cover your mouth if you
require coughing.

If the coughing continues for more than a month, there may be other illnesses that are inside your
body, such as pneumonia. It is also significant that you should scrutinize the mucus secretion. If
there is blood present, you should directly consult your physician for further diagnosis. These are
the things you should know about acute bronchitis.

With the proper management and care, you will be able to prevent it on its tracks and stop it from
developing into its chronic form. If you experience symptoms connected with bronchitis, you
should consult your doctor immediately. They will carry out some tests to decide what is causing
the bronchitis whether it is viral or bacterial infection.