Bronchitis

Not to be confused with bronchiolitis.
Bronchitis

Figure A shows the location of the lungs and bronchial tubes. Figure B is an enlarged view of a normal bronchial tube. Figure C is an enlarged view of a bronchial tube with bronchitis.
Classification and external resources
Pronunciation bron-kye-tis
Specialty Infectious disease, pulmonology
ICD-10 J20-J21, J42
ICD-9-CM 466, 491, 490
DiseasesDB 29135
MedlinePlus 001087
eMedicine article/807035 article/297108
MeSH D001991

Bronchitis is inflammation of the bronchi (large and medium-sized airways) in the lungs.[1] Symptoms include coughing up mucus, wheezing, shortness of breath, and chest discomfort.[1] Bronchitis is divided into two types: acute and chronic.[1] Acute bronchitis is also known as a chest cold.[1]

Acute bronchitis usually has a cough that lasts around three weeks.[2] In more than 90% of cases the cause is a viral infection.[2] These viruses may be spread through the air when people cough or by direct contact. Risk factors include exposure to tobacco smoke, dust, and other air pollution.[1] A small number of cases are due to high levels of air pollution or bacteria such as Mycoplasma pneumoniae or Bordetella pertussis.[2][3] Treatment of acute bronchitis typically involves rest, paracetamol (acetaminophen), and NSAIDs to help with the fever.[4][5]

Chronic bronchitis is defined as a productive cough that lasts for three months or more per year for at least two years.[6] Most people with chronic bronchitis have chronic obstructive pulmonary disease (COPD).[7] Tobacco smoking is the most common cause, with a number of other factors such as air pollution and genetics playing a smaller role.[8] Treatments include quitting smoking, vaccinations, rehabilitation, and often inhaled bronchodilators and steroids.[9] Some people may benefit from long-term oxygen therapy or lung transplantation.[9]

Acute bronchitis is one of the most common diseases.[4][10] About 5% of adults are affected and about 6% of children have at least one episode a year.[11][12] In 2010, COPD affects 329 million people or nearly 5% of the global population.[13] In 2013, it resulted in 2.9 million deaths, up from 2.4 million deaths in 1990.[14]

Acute bronchitis

Main article: Acute bronchitis
Bronchitis

Acute bronchitis, also known as a chest cold, is short term inflammation of the bronchi of the lungs.[1][2] The most common symptom is a cough.[2] Other symptoms include coughing up mucus, wheezing, shortness of breath, fever, and chest discomfort. The infection may last from a few to ten days.[1] The cough may persist for several weeks afterwards with the total duration of symptoms usually around three weeks.[1][2] Some have symptoms for up to six weeks.[4]

In more than 90% of cases the cause is a viral infection.[2] These viruses may be spread through the air when people cough or by direct contact. Risk factors include exposure to tobacco smoke, dust, and other air pollution.[1] A small number of cases are due to high levels of air pollution or bacteria such as Mycoplasma pneumoniae or Bordetella pertussis.[2][3] Diagnosis is typically based on a person's signs and symptoms.[15] The color of the sputum does not indicate if the infection is viral or bacterial. Determining the underlying organism is typically not needed.[2] Other causes of similar symptoms include asthma, pneumonia, bronchiolitis, bronchiectasis, and COPD.[2][11] A chest X-ray may be useful to detect pneumonia.[2]

Prevention is by not smoking and avoiding other lung irritants. Frequent hand washing may also be protective.[16] Treatment of acute bronchitis typically involves rest, paracetamol (acetaminophen), and NSAIDs to help with the fever.[4][5] Cough medicine has little support for its use and is not recommended in children less than six years of age.[2][17] There is tentative evidence that salbutamol may be useful in those with wheezing; however, it may result in nervousness.[2][18] Antibiotics should generally not be used.[19] An exception is when acute bronchitis is due to pertussis. Tentative evidence supports honey and pelargonium to help with symptoms.[2]

Acute bronchitis is one of the most common diseases.[4][10] About 5% of adults are affected and about 6% of children have at least one episode a year.[11][12] It occurs more often in the winter.[11] More than 10 million people in the United States visit a doctor each year for this condition with about 70% receiving antibiotics which are mostly not needed.[4] There are efforts to decrease the use of antibiotics in acute bronchitis.[10]

Chronic bronchitis

Chronic bronchitis is defined as a productive cough that lasts for three months or more per year for at least two years.[6] Most people with chronic bronchitis have chronic obstructive pulmonary disease (COPD).[7] Protracted bacterial bronchitis is defined as a chronic productive cough with a positive bronchoalveolar lavage that resolves with antibiotics.[20][21] Symptoms of chronic bronchitis may include wheezing and shortness of breath, especially upon exertion and low oxygen saturations.[22] The cough is often worse soon after awakening and the sputum produced may have a yellow or green color and may be streaked with specks of blood.[23]

Most cases of chronic bronchitis are caused by smoking cigarettes or other forms of tobacco.[22][24][25] Additionally, chronic inhalation of air pollution or irritating fumes or dust from hazardous exposures in occupations such as coal mining, grain handling, textile manufacturing, livestock farming,[26] and metal moulding may also be a risk factor for the development of chronic bronchitis.[27][28][29] Protracted bacterial bronchitis is usually caused by Streptococcus pneumoniae, Non-typable Haemophilus influenzae, or Moraxella catarrhalis.[20][21]

Individuals with an obstructive pulmonary disorder such as bronchitis may present with a decreased FEV1 and FEV1/FVC ratio on pulmonary function tests.[30][31][32] Unlike other common obstructive disorders such as asthma or emphysema, bronchitis rarely causes a high residual volume (the volume of air remaining in the lungs after a maximal exhalation effort).[33]

Evidence suggests that the decline in lung function observed in chronic bronchitis may be slowed with smoking cessation.[34] Chronic bronchitis is treated symptomatically and may be treated in a nonpharmacologic manner or with pharmacologic therapeutic agents. Typical nonpharmacologic approaches to the management of COPD including bronchitis may include: pulmonary rehabilitation, lung volume reduction surgery, and lung transplantation.[34] Inflammation and edema of the respiratory epithelium may be reduced with inhaled corticosteroids.[35] Wheezing and shortness of breath can be treated by reducing bronchospasm (reversible narrowing of smaller bronchi due to constriction of the smooth muscle) with bronchodilators such as inhaled long acting β2-adrenergic receptor agonists (e.g., salmeterol) and inhaled anticholinergics such as ipratropium bromide or tiotropium bromide.[36] Mucolytics may have a small therapeutic effect on acute exacerbations of chronic bronchitis.[37] Supplemental oxygen is used to treat hypoxemia (too little oxygen in the blood) and has been shown to reduce mortality in chronic bronchitis patients.[23][34] Oxygen supplementation can result in decreased respiratory drive, leading to increased blood levels of carbon dioxide (hypercapnea) and subsequent respiratory acidosis.[38]

References

  1. 1 2 3 4 5 6 7 8 9 "What Is Bronchitis?". August 4, 2011. Retrieved 1 April 2015.
  2. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Albert, RH (1 December 2010). "Diagnosis and treatment of acute bronchitis.". American family physician. 82 (11): 1345–50. PMID 21121518.
  3. 1 2 "What Causes Bronchitis?". August 4, 2011. Retrieved 1 April 2015.
  4. 1 2 3 4 5 6 Tackett, KL; Atkins, A (December 2012). "Evidence-based acute bronchitis therapy.". Journal of pharmacy practice. 25 (6): 586–90. doi:10.1177/0897190012460826. PMID 23076965.
  5. 1 2 "How Is Bronchitis Treated?". August 4, 2011. Retrieved 1 April 2015.
  6. 1 2 Vestbo, Jørgen (2013). "Diagnosis and Assessment" (PDF). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Global Initiative for Chronic Obstructive Lung Disease. pp. 9–17.
  7. 1 2 Reilly, John J.; Silverman, Edwin K.; Shapiro, Steven D. (2011). "Chronic Obstructive Pulmonary Disease". In Longo, Dan; Fauci, Anthony; Kasper, Dennis; Hauser, Stephen; Jameson, J.; Loscalzo, Joseph. Harrison's Principles of Internal Medicine (18th ed.). McGraw Hill. pp. 2151–9. ISBN 978-0-07-174889-6.
  8. ↑ Decramer M, Janssens W, Miravitlles M (April 2012). "Chronic obstructive pulmonary disease". Lancet. 379 (9823): 1341–51. doi:10.1016/S0140-6736(11)60968-9. PMID 22314182.
  9. 1 2 Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, Zielinski J (September 2007). "Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary". Am. J. Respir. Crit. Care Med. 176 (6): 532–55. doi:10.1164/rccm.200703-456SO. PMID 17507545.
  10. 1 2 3 Braman, SS (January 2006). "Chronic cough due to acute bronchitis: ACCP evidence-based clinical practice guidelines.". Chest. 129 (1 Suppl): 95S–103S. doi:10.1378/chest.129.1_suppl.95S. PMID 16428698.
  11. 1 2 3 4 Wenzel, RP; Fowler AA, 3rd (16 November 2006). "Clinical practice. Acute bronchitis.". The New England Journal of Medicine. 355 (20): 2125–30. doi:10.1056/nejmcp061493. PMID 17108344.
  12. 1 2 Fleming, DM; Elliot, AJ (March 2007). "The management of acute bronchitis in children.". Expert opinion on pharmacotherapy. 8 (4): 415–26. doi:10.1517/14656566.8.4.415. PMID 17309336.
  13. ↑ Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, et al. (December 2012). "Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010". Lancet. 380 (9859): 2163–96. doi:10.1016/S0140-6736(12)61729-2. PMID 23245607.
  14. ↑ GBD 2013 Mortality and Causes of Death, Collaborators (17 December 2014). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.". Lancet. 385: 117–71. doi:10.1016/S0140-6736(14)61682-2. PMC 4340604Freely accessible. PMID 25530442.
  15. ↑ "How Is Bronchitis Diagnosed?". August 4, 2011. Retrieved 1 April 2015.
  16. ↑ "How Can Bronchitis Be Prevented?". August 4, 2011. Retrieved 1 April 2015.
  17. ↑ Smith, SM; Schroeder, K; Fahey, T (24 November 2014). "Over-the-counter (OTC) medications for acute cough in children and adults in community settings.". The Cochrane database of systematic reviews. 11: CD001831. doi:10.1002/14651858.CD001831.pub5. PMID 25420096.
  18. ↑ Becker, LA; Hom, J; Villasis-Keever, M; van der Wouden, JC (6 July 2011). "Beta2-agonists for acute bronchitis.". The Cochrane database of systematic reviews (7): CD001726. doi:10.1002/14651858.CD001726.pub4. PMID 21735384.
  19. ↑ Smith, SM; Fahey, T; Smucny, J; Becker, LA (1 March 2014). "Antibiotics for acute bronchitis.". The Cochrane database of systematic reviews. 3: CD000245. doi:10.1002/14651858.CD000245.pub3. PMID 24585130.
  20. 1 2 Goldsobel, AB; Chipps, BE (March 2010). "Cough in the pediatric population". The Journal of Pediatrics. 156 (3): 352–358.e1. doi:10.1016/j.jpeds.2009.12.004. PMID 20176183.
  21. 1 2 Craven, V; Everard, ML (January 2013). "Protracted bacterial bronchitis: reinventing an old disease". Archives of Disease in Childhood. 98 (1): 72–76. doi:10.1136/archdischild-2012-302760. PMID 23175647.
  22. 1 2 U.S. National Library of Medicine (2011). "Chronic obstructive pulmonary disease". A.D.A.M. Medical Encyclopedia. Retrieved 28 December 2012.
  23. 1 2 Cohen, Jonathan; Powderly, William (2004). Infectious Diseases, 2nd ed. Mosby (Elsevier). Chapter 33: Bronchitis, Bronchiectasis, and Cystic Fibrosis. ISBN 0323025730.
  24. ↑ "Understanding Chronic Bronchitis". American Lung Association. 2012. Retrieved 30 December 2012.
  25. ↑ Forey, BA; Thornton, AJ; Lee, PN (June 2011). "Systematic review with meta-analysis of the epidemiological evidence relating smoking to COPD, chronic bronchitis and emphysema". BMC Pulmonary Medicine. 11 (36): 36. doi:10.1186/1471-2466-11-36. PMC 3128042Freely accessible. PMID 21672193.
  26. ↑ Szczyrek, M; Krawczyk, P; Milanowski, J; Jastrzebska, I; Zwolak, A; Daniluk, J (2011). "Chronic obstructive pulmonary disease in farmers and agricultural workers-an overview". Annals of Agricultural and Environmental Medicine. 18 (2): 310–313. PMID 22216804.
  27. ↑ Fischer, BM; Pavlisko, E; Voynow, JA (2011). "Pathogenic triad in COPD: oxidative stress, protease-antiprotease imbalance, and inflammation". International Journal of Chronic Obstructive Pulmonary Disease. 6: 413–421. doi:10.2147/COPD.S10770. PMC 3157944Freely accessible. PMID 21857781.
  28. ↑ National Heart Lung and Blood Institute (2009). "Who Is at Risk for Bronchitis?". National Institutes of Health. Retrieved 30 December 2012.
  29. ↑ National Institute of Occupational Safety and Health (2012). "Respiratory Diseases Input: Occupational Risks". NIOSH Program Portfolio. Centers for Disease Control and Prevention. Retrieved 30 December 2012.
  30. ↑ "National Health and Nutrition Examination Survey (NHANES) Respiratory Health Spirometry Procedures Manual" (PDF). Centers for Disease Control and Prevention. 2008. Retrieved 2 January 2013.
  31. ↑ Willemse, BW; Postma, DS; Timens, W; ten Hacken, NH (March 2004). "The impact of smoking cessation on respiratory symptoms, lung function, airway hyperresponsiveness and inflammation". The European Respiratory Journal. 23 (3): 464–476. doi:10.1183/09031936.04.00012704. PMID 15065840.
  32. ↑ Mohamed Hoesein, FA; Zanen, P; Lammers, JW (June 2011). "Lower limit of normal or FEV1/FVC<0.70 in diagnosing COPD: an evidence-based review". Respiratory medicine. 105 (6): 907–915. doi:10.1016/j.rmed.2011.01.008. PMID 21295958.
  33. ↑ Wanger, J; Clausen, JL; Coates, A; Pedersen, OF; Brusasco, V; Burgos, F; Casaburi, R; Crapo, R; et al. (September 2005). "Standardisation of the measurement of lung volumes". The European Respiratory Journal. 26 (3): 511–522. doi:10.1183/09031936.05.00035005. PMID 16135736.
  34. 1 2 3 Fauci, Anthony S.; Daniel L. Kasper; Dan L. Longo; Eugene Braunwald; Stephen L. Hauser; J. Larry Jameson (2008). Chapter 254. Chronic Obstructive Pulmonary Disease Harrison's Principles of Internal Medicine (17th ed.). New York: McGraw-Hill. ISBN 978-0-07-147691-1.
  35. ↑ Spencer, S; Karner, C; Cates, CJ; Evans, DJ (2011). "Inhaled corticosteroids versus long acting beta(2)-agonists for chronic obstructive pulmonary disease". Cochrane Database of Systematic Reviews. 12 (CD007033): CD007033. doi:10.1002/14651858.CD007033.pub3. PMID 22161409.
  36. ↑ Karner, C; Chong, J; Poole, P (21 July 2014). "Tiotropium versus placebo for chronic obstructive pulmonary disease". The Cochrane database of systematic reviews. 7 (7): CD009285. doi:10.1002/14651858.CD009285.pub3. PMID 25046211.
  37. ↑ Poole, P; Black, PN; Cates, CJ (2012). "Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease". Cochrane Database of Systematic Reviews. 8 (CD001287): CD001287. doi:10.1002/14651858.CD001287.pub4. PMID 22895919.
  38. ↑ Iscoe, S; Beasley, R; Fisher, JA (2011). "Supplementary oxygen for nonhypoxemic patients:O2 much of a good thing?". Critical Care. 15 (3): 305. doi:10.1186/cc10229. PMC 3218982Freely accessible. PMID 21722334.

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