Bronchitis: A Comprehensive Guide

Overview

Bronchitis is an inflammation of the lining of your bronchial tubes, which carry air to and from your lungs. People who have bronchitis often cough up thickened mucus, which can be discolored. Bronchitis may be either acute or chronic.

• Acute bronchitis is very common. It often develops from a cold or other respiratory infection and typically improves within a week to 10 days without lasting effects, though the cough may linger for weeks.
• Chronic bronchitis, a more serious condition, is a constant irritation or inflammation of the lining of the bronchial tubes, often due to smoking. It's one of the conditions included in chronic obstructive pulmonary disease (COPD).

According to the Centers for Disease Control and Prevention (CDC), acute bronchitis is one of the most common diagnoses in outpatient settings, accounting for millions of visits annually. Chronic bronchitis affects about 8.6 million Americans, with a higher prevalence among those over 45 and smokers.

Symptoms

For either acute or chronic bronchitis, signs and symptoms may include:

• Cough – The primary symptom, which may produce mucus. The mucus may be clear, white, yellowish-gray, or green. In chronic bronchitis, the cough lasts at least three months and occurs for at least two consecutive years.
• Fatigue – Feeling tired or weak due to the body's effort to fight the infection or inflammation.
• Shortness of breath – Difficulty breathing or feeling breathless, especially during physical activity.
• Slight fever and chills – A low-grade fever may accompany acute bronchitis.
• Chest discomfort – Mild soreness or a tight feeling in the chest.
• Wheezing – A whistling or squeaky sound when you breathe, more common in chronic bronchitis.

If you have acute bronchitis, you might have cold symptoms, such as a mild headache or body aches. While these symptoms usually improve in about a week, you may have a lingering cough that lasts for several weeks.

Causes and Risk Factors

Causes

Acute bronchitis is usually caused by viruses, typically the same viruses that cause colds and flu. Occasionally, bacterial infections can also cause acute bronchitis.

Chronic bronchitis is caused by repeated irritation and damage to the lung and airway tissue. The most common cause is smoking, but it can also be caused by long-term exposure to air pollution, dust, or toxic gases in the environment or workplace.

Risk Factors

Factors that increase your risk of bronchitis include:

• Cigarette smoke – People who smoke or who live with smokers are at higher risk.
• Low resistance – This may result from another acute illness, such as a cold, or from a chronic condition that compromises your immune system.
• Exposure to irritants – Your risk is higher if you work around certain lung irritants, such as grains or textiles, or are exposed to chemical fumes.
• Gastroesophageal reflux disease (GERD) – Repeated bouts of severe heartburn can irritate your throat and make you more prone to developing bronchitis.
• Age – Infants, young children, and older adults have a greater vulnerability to infection.

Diagnosis

Your doctor will likely start by asking about your symptoms and medical history. They may also perform a physical exam, listening to your lungs with a stethoscope to check for abnormal sounds such as wheezing.

In some cases, your doctor may suggest the following tests:

• Chest X-ray – This can help determine if you have pneumonia or another condition that may explain your cough. This is especially common if your doctor suspects pneumonia.
• Sputum tests – Mucus (sputum) can be tested to see if you have illnesses that could be helped by antibiotics, or to rule out whooping cough (pertussis) and other conditions.
• Pulmonary function test – During this test, you blow into a device called a spirometer, which measures how much air your lungs can hold and how quickly you can get air out of your lungs. This test checks for signs of asthma or emphysema.

For chronic bronchitis, your doctor will look for a productive cough that lasts at least three months, with recurring bouts occurring for at least two consecutive years.

Treatment Options

Acute Bronchitis

In most cases, acute bronchitis will resolve on its own within a week to 10 days. Treatment focuses on relieving symptoms:

• Rest – Get plenty of sleep and take it easy.
• Fluids – Drink plenty of water, juice, and herbal tea to help loosen mucus.
• Over-the-counter (OTC) medications –
  • Pain relievers such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) to reduce fever and ease discomfort.
  • Cough suppressants to help you sleep, though coughing is important for clearing mucus.
  • Expectorants to help loosen and expel mucus.
• Humidifier – Warm, moist air helps relieve coughs and loosen mucus.

Antibiotics are generally not prescribed for acute bronchitis because it is usually caused by a virus. However, if your doctor suspects a bacterial infection, they may prescribe antibiotics.

Chronic Bronchitis

Chronic bronchitis requires ongoing medical management. Treatment may include:

• Bronchodilators – Inhaled medications that help open the airways and make breathing easier.
• Steroids – Inhaled corticosteroids can help reduce inflammation and mucus production.
• Oxygen therapy – If your blood oxygen levels are low, you may need supplemental oxygen.
• Pulmonary rehabilitation – A program that includes exercise, breathing techniques, and nutritional counseling to help you manage your symptoms and improve your quality of life.
• Lifestyle changes – Quitting smoking is the most important step. Avoiding secondhand smoke and other lung irritants is also crucial.

Living with Bronchitis

If you have chronic bronchitis, making certain lifestyle changes can help you manage your symptoms and improve your quality of life:

• Quit smoking – This is the most important step you can take. Talk to your doctor about programs and products that can help you quit.
• Avoid lung irritants – Stay away from secondhand smoke, dust, fumes, vapors, and air pollution as much as possible.
• Use a humidifier – Adding moisture to the air can help ease breathing and loosen mucus.
• Exercise regularly – Regular physical activity can strengthen the muscles that help you breathe. Consult your doctor before starting any exercise program.
• Eat a healthy diet – A balanced diet can help you maintain your strength and energy.
• Practice breathing exercises – Techniques such as pursed-lip breathing can help improve your breathing efficiency.

Prevention

To reduce your risk of bronchitis:

• Avoid cigarette smoke – Don't smoke, and avoid secondhand smoke.
• Get vaccinated –
  • Flu vaccine annually.
  • Pneumococcal vaccine, especially if you are over 65 or have a chronic health condition.
  • Pertussis (whooping cough) vaccine.
• Wash your hands – Frequent hand washing can limit your exposure to viruses and bacteria.
• Wear a mask – If you have COPD, consider wearing a face mask when you're exposed to dust or fumes, and when you're in crowds during flu season.
• Boost your immunity – Eat a healthy diet, get regular exercise, and ensure adequate sleep to keep your immune system strong.

Complications

Although a single episode of bronchitis usually isn't cause for concern, it can lead to pneumonia in some people. Repeated bouts of bronchitis, however, may indicate chronic bronchitis, which can lead to several complications, including:

• Frequent and severe infections – Chronic bronchitis makes you more susceptible to respiratory infections such as colds and the flu, which can further damage your bronchial tubes.
• Narrowed bronchial tubes – The bronchial tubes can become permanently narrowed, making it difficult to breathe.
• Respiratory failure – In severe cases, the damage to your lungs can affect the exchange of oxygen and carbon dioxide, leading to respiratory failure.
• Right-sided heart failure (cor pulmonale) – This serious condition occurs when the right ventricle of the heart fails due to chronic high blood pressure in the lungs (pulmonary hypertension), which can be caused by chronic bronchitis.
• Emphysema – Chronic bronchitis can increase your risk of developing emphysema, a condition in which the air sacs (alveoli) in your lungs are destroyed, reducing the surface area available for the exchange of oxygen and carbon dioxide.

When to Seek Emergency Care

Sources and Further Reading

• Mayo Clinic
• Centers for Disease Control and Prevention (CDC)
• National Heart, Lung, and Blood Institute (NHLBI)
• World Health Organization (WHO)
• Cleveland Clinic