Bronchitis

If you get a lingering cough with or without sputum after a common cold or upper respiratory infection, you might be suffering from bronchitis. Bronchitis is the inflammation of the inner lining of the bronchial tubes, which are the air passages extending from the trachea (windpipe) into the lungs. It is a very common condition in winters, especially after the common cold. Culprits may be infectious agents like viruses, bacteria, or non-infectious agents like smoke, dust, or chemicals. It presents as a cough with or without mucous that lasts for less than three weeks (acute bronchitis). If your cough persists for more than three weeks, it is now known as chronic bronchitis. Chronic bronchitis is defined as a cough with sputum that has occurred for three months a year for two consecutive years. Smoking is the most important risk factor for developing chronic bronchitis. 

Bronchitis can be of two types based on duration:

Acute bronchitis: when the duration of bronchitis is not more than three weeks, it is called acute bronchitis. It is caused by viruses, bacteria, pollutants, and chemicals.

Chronic bronchitis: when bronchitis persists for more than three weeks, it is known as chronic bronchitis. It is defined as a chronic cough with sputum production for a minimum of 3 months a year for two consecutive years. It is associated with the enlargement of mucous-producing glands of the inner lining of the bronchi. With the advancement of the disease, limitation to the airflow occurs and is now termed chronic obstructive pulmonary disease (COPD). COPD is a disease of smokers.

The causative factors irritate the lining and trigger an inflammatory reaction with increased mucous production and decreased mucous clearing by the affected cilia (hair-like structures in the lining to move the mucous up and down). Most commonly, it is caused by viruses, like; influenza A and B, adenovirus, respiratory syncytial virus, parainfluenza, rhinovirus,  and coronavirus. Some bacteria may also be responsible for cases of acute bronchitis like Haemophilus influenza, Streptococcus pneumonia, Mycoplasma species, Chlamydia, pneumoniae, Bordetella pertussis, and Moraxella catarrhalis. Sometimes it is caused by pollutants, chemicals, smoke, etc. Tobacco smoking is the single most important causative factor for chronic bronchitis.

Acute bronchitis is common worldwide.  It is one of the top five reasons for clinic visits. Acute bronchitis is more common in children less than 5 years, while chronic bronchitis is mostly found in people older than 50 years. In the U.S, 9.3 million people were diagnosed as having chronic bronchitis in 2018. it is found more in males than in females. It is more prevalent in low-socioeconomic and highly industrialized areas.

The following factors can increase your chances of having bronchitis.

• Infections like the common cold
• Tobacco smoking.
• Decreased immunity to other infections
• Exposure to chemicals at work
• Living in a highly polluted area
• Gastric acid reflux disease

You may have the following signs and symptoms if you suffer from bronchitis.

• Cough with or without sputum
• Mild fever
• Body aches
• Fatigue
• Difficulty breathing
• Chest discomfort

It is often challenging to differentiate bronchitis from other respiratory diseases. It is often called a cold chest. Your doctor will ask you questions regarding your symptoms and examine you with special emphasis on chest auscultation with a stethoscope. You may be advised of some tests like;

Blood tests; Complete blood picture, blood culture, procalcitonin levels to differentiate it from bacterial bronchitis and guide about using antibiotics.

Sputum tests: you may be asked to submit a sample of your sputum to be sent to a lab for further tests.

Imaging: Chest radiograph to check for pneumonia.

Bronchoscopy: a flexible thin tube with a camera is inserted in your windpipe to check for foreign body, tumor, condition of the lining, etc.

Spirometry: In this test, your breathing efficiency is assessed by asking you to breathe in an instrument called a spirometer.

Laryngoscopy: your larynx is viewed by a camera to exclude epiglottitis.

Some other disorders may present like bronchitis and must be excluded;

• Pharyngitis
• Tonsillitis
• Sinusitis
• Gastric acid reflux disease
• Retained foreign body
• Cystic fibrosis
• Asthma
• COPD
• Bronchiectasis

Once the diagnosis is made, the treatment is directed towards symptoms control. Since it is mostly caused by viruses, antibiotics are usually not prescribed. Bed rest is advised with special care of proper ventilation in the room to maintain oxygen levels. Medicines that open the bronchial tree for the expulsion of mucous are used along with avoiding irritants.

Medications include:

• Codeine and dextromethorphan to suppress cough if it is very irritating.
• Ipratropium bromide to dilate the bronchi and bronchioles
• NSAIDs for fever and body aches
• Mucolytics to thin down the mucous
• Oxygen can be given in cases of chronic bronchitis
• Antibiotics(amoxicillin plus clavulanate, azithromycin) can be given to very old or very young patients with other co-morbid diseases as they are susceptible to complications.

Bronchitis is a self-limited disease. It is completely curable and has a good prognosis in an otherwise healthy person. It can take a severe form in patients with other co-morbid disorders.

Following habits can help you stay away from bronchitis;

• Quit smoking
• Try to stay away from second-hand smoke and chemicals
• Take a healthy balanced diet
• Perform regular exercises
• Wear a face mask when going into a polluted area
• Get vaccinated for influenza and pneumonia vaccines