Acute Bronchitis

Acute bronchitis is a common, acute inflammation of the bronchi, with fever and a productive cough.

The disease is related to the following processes:  infectious and has an incidence of about  40,000 / 100.000.

Presentation

Cardiovascular

There may be chest tightness involved depending on the severity. Although acute bronchitis is usually self-limiting with frequent bouts can lead to chronic bronchitis and possibly COPD and heart failure.

Musculoskeletal

The main symptom in this category would be muscle aches due to the chills and fever, and chest discomfort from the coughing.

Respiratory

Production of sputum that is usually white and clear, but can also be yellowish-grey or green in color, occurs. Occasionally, but rarely, it can be streaked with blood. There may also be shortness of breath due to the inflammation of the bronchial tubes and not being able to get enough air flow to the lungs. Tachypnea may be present. Productive cough of more than 5 days duration may already be suggestive of bronchitis [5].

Systemic

Sometimes there can be a slight fever and chills, as in flu like symptoms. If the acute bronchitis is from a bacterial infection, it possibly, but rarely can get into the blood stream and cause bacteremia.

Workup

  • The first thing that the healthcare provider will be to ask questions regarding health history, such as smoking, second hand smoke or working in noxious inhalants.
  • The healthcare provider will then listen to the lungs for air exchange and wheezing. They will listen for the presence of rhonchi, prolonged expiration and wheezing.
  • The sputum can be tested for the presence of bacteria.
  • Oxygen saturation percentage will be measured with a pulse oximeter.
  • Chest x-ray may be done to rule out the presence of pneumonia.
  • Blood tests may be performed.
  • If necessary, pulmonary function tests and spirometry may be done, but these are performed when other diseases are suspected, such as COPD.

Treatment

The recommended treatment for acute bronchitis leans more towards palliative care, such as ibuprofen or acetaminophen for chills and fever, plenty of fluids and antitussives. Acute bronchitis is self-limiting and resolves on its own, although the cough may continue for a few more weeks. Antibiotics usually are not recommended as typically it is caused by a viral infection [6].

Antibiotic therapy may be given to high risk patients like those with asthma, smokers and Chronic Obstructive Pulmonary Disease (COPD), coupling it with bronchodilators significantly reduces hospital stay [7]. Studies further supports that using antibiotics in bronchitis cases can reduce hospital re-visits of patients from 76.8% to 27% in a 3 year period [8].

Occasionally a short-term dose of steroids may help with the inflammation of the bronchial tubes. Oral anti-inflammatory agents has been used to control the inflammation in acute bronchitis [9].

Prognosis

Acute bronchitis is almost always self limiting and clears up usually in 2 to 3 weeks without antibiotics. Some people, including infants, the elderly and those with pre-existing lung or cardiovascular diseases may be at higher risk of complications.

Although the main course of the acute bronchitis will subside quickly, the cough may continue for weeks after. If it lasts longer than a month, the physician may refer the patient to an otorhinolaryngologist, to see if something other than the bronchitis is causing the irritation to the lungs.

Complications

About one out of 20 people who experience acute bronchitis may develop a secondary infection which can become pneumonia.

Those that may be at risk for pneumonia are:

  • Infants, babies and the elderly where there is diminished immunity and are more susceptible to a secondary infection.
  • Patients with lung or heart conditions, these can include patients with COPD, heart failure patients and those with asthma.
  • Diabetics may complicate to Acute Respiratory Distress Syndrome if bronchitis episodes remains too long [4].
  • Smokers are more susceptible to develop chest infections, which can lead to a bacterial infection after having bronchitis.

Etiology

Acute bronchitis most often caused by a viral infection. The most common viruses are Rhinovirus, Influenza A virus, Influenza B virus, Parainfluenza virus, Corona virus and Respiratory Syncytial Virus [1]. The acute form of bronchitis can also be the result of inhaling things that can irritate the bronchial tubes such as smoke and toxic fumes, including ammonia. Smoking is one of the major causes of acute bronchitis.

Sometimes acute bronchitis can be caused by bacteria, such as Streptococcus. This can happen after a viral infection, such as a cold or the flu, which does not get better. Acute bronchitis can last 3 to 10 days, but the cough can last several weeks after the infection is gone.

Epidemiology

In the general population almost 5% will develop acute bronchitis in the US, the most occurrences happen during the fall and winter months. One of the top 5 reasons for children to see their Pediatrician is for lower respiratory infections, which include both acute and chronic bronchitis. Acute bronchitis is seen in males and females equally.

It is also seen in children under two years of age and then again between the ages of 9 and 15. Younger children exposed to second hand smoking and polycyclic aromatic hydrocarbons are more susceptible to develop bronchitis [2]. Elder patients are more prone to bronchitis because of their relatively low Forced Expiratory Volume (FEV), thus tend to accumulate more air and bacteria compared to the younger population [3].

Sex distribution
Age distribution

Pathophysiology

Usually a viral infection, such as a cold or the flu, can turn into acute bronchitis, producing excess mucous and a cough lasting for several weeks in 50% of those affected, and 25% have the cough for a month or more.

An airway that is exposed to certain environmental agents, such as irritants or allergens, responds quickly to a cough and bronchospasm, followed by mucous production, edema and inflammation. This fact may explain why chronic bronchitis in children is actually asthma. The mucociliary clearance is a primary defense mechanism that helps protect the lungs from the damage caused by the inhalation of pollutants, pathogens and allergens.

Prevention

There is no way to prevent acute bronchitis from occurring but steps can be taken to reduce the risks. Smoking or being in a smoking environment can be a big trigger for those who have had episodes if bronchitis or whose pulmonary status is already compromised.

Receiving an annual flu shot is also recommended. Children receiving pneumonia and flu vaccines controls protracted bacterial bronchitis and prevents recurrent coughing [10]. Avoiding the inhalation of noxious irritants, especially in enclosed areas.

Summary

Viruses, bacteria, and other agents can cause inflammation of the inner lining of the bronchial tubes, a condition which is referred to as acute bronchitis. Production of mucus causes one of the main symptoms - cough. Often acute bronchitis follows an upper respiratory infection.

Patient Information

Acute bronchitis is an inflammation of the bronchial tubes, the major airways into the lungs, which may be usually caused by bacteria and viruses.

Common signs and symptoms are:

  • Cough
  • Shortness of breath
  • Wheezing
  • Chest pain
  • Fever
  • Malaise

Most cases of bronchitis are caused by a viral infection and resolve themselves within a few days to weeks.

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References

  1. Albert RH. Diagnosis and treatment of acute bronchitis. Am Fam. Physician. 2010; 82(11):1345-50 (ISSN: 1532-0650)
  2. Ghosh R; Topinka J; Joad JP; Dostal M; Sram RJ; Hertz-Picciotto I. Air pollutants, genes and early childhood acute bronchitis. Mutat Res. 2013; 749(1-2):80-6 (ISSN: 0027-5107)
  3. Jivcu C, Gotfried M. Gemifloxacin use in the treatment of acute bacterial exacerbation of chronic bronchitis.Int J Chron Obstruct Pulmon Dis. 2009;4:291-300.
  4. Homsi S; Milojkovic N; Alawad B; Homsi Y. Prolonged period of acute bronchitis with late progression to acute respiratory distress syndrome as possible result of influenza A (H1N1) virus infection. J Ark Med Soc. 2012; 109(4):62-4 (ISSN: 0004-1858)
  5. Wenzel RP, Fowler AA 3rd. Clinical practice. Acute bronchitis. N Engl J Med. Nov 16 2006;355(20):2125-30.
  6. Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA. Sep 17 1997;278(11):901-4.
  7. Kroening-Roche JC; Soroudi A; Castillo EM; Vilke GM. Antibiotic and bronchodilator prescribing for acute bronchitis in the emergency department.J Emerg Med. 2012; 43(2):221-7 (ISSN: 0736-4679)
  8. Roth S; Gonzales R; Harding-Anderer T; Bloom FJ; Graf T; Stahl MS; Maselli JH; 
  9. Metlay JP. Unintended consequences of a quality measure for acute bronchitis. Am J Manag Care. 2012; 18(6):e217-24 (ISSN: 1936-2692)
  10. Llor C; Moragas A; Bayona C; Morros R; Pera H; Cots JM; Fernández Y; Miravitlles M; Boada A. Effectiveness of anti-inflammatory treatment versus antibiotic therapy and placebo for patients with non-complicated acute bronchitis with purulent sputum. The BAAP Study protocol.BMC Pulm Med. 2011; 11:38 (ISSN: 1471-2466)
  11. Priftis KN; Litt D; Manglani S; Anthracopoulos MB; Thickett K; Tzanakaki G; Fenton P; Syrogiannopoulos GA; Vogiatzi A; Douros K; Slack M; Everard ML. Bacterial bronchitis caused by Streptococcus pneumoniae and nontypable Haemophilus influenzae in children: the impact of vaccination.Chest. 2013; 143(1):152-7 (ISSN: 1931-3543)

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