Bronchitis

Bronchitis is the inflammation of the airways of the lungs. It is caused by infection, cigarette smoking, and inhalation of environmental pollutants.

The most common symptoms of bronchitis are coughing and wheezing. Treatment primarily involves the relief of symptoms and, in cases of long-term bronchitis, minimising damage to the airways.

What is bronchitis?

Bronchitis is one of the most common conditions for which people seek medical advice. It can be a short-term disease (acute bronchitis) or a long term disease (chronic bronchitis). It occurs mostly in winter, especially during outbreaks of the flu.

Infection or irritation of the airways triggers them to inflame, narrow, and secrete thick mucus (phlegm) which clogs the small airways. That cause causes the characteristic cough of bronchitis, wheezing, and shortness of breath. The cough may produce sputum, which is phlegm coughed up from the lungs. This is known as a ‘productive cough’ and is an attempt by the body to clear mucus that is clogging the airways.

With chronic bronchitis, long term inflammation can result in permanent damage to, and narrowing of, the airways which obstructs the flow of air in and out of the lungs. For this reason, chronic bronchitis is considered to be a type of chronic obstructive pulmonary disease (COPD) that results in the gradual worsening of lung function. It is estimated that at least 15% of New Zealanders over 45 years of age have COPD, with most cases linked to smoking.

People with bronchitis are more susceptible to developing pneumonia, which is a serious infection of the lungs.

Causes

The most common cause of acute bronchitis is viral infection (90% of cases), but bacterial infection and environmental irritants are also causes. Acute bronchitis usually occurs after having had a cold or flu. It also often occurs with or after childhood infections, such as measles, whooping cough (pertussis), and diphtheria. Exposure to second-hand cigarette smoke during pregnancy and in the household is strongly linked to recurrent bronchitis in infants and children.

Chronic bronchitis may result from a series of acute bronchitis episodes. In other people it may evolve gradually due to heavy cigarette smoking or breathing air contaminated with other environmental pollutants, including work-place (occupational) exposures. In addition to cigarette smoking, the list of causative substances includes coal dust, oil mist, cement dust, welding fumes, organic dusts, engine exhausts, fire smoke, and second-hand cigarette smoke. Most people diagnosed with chronic bronchitis are aged 45 years or older.

A person’s chronic bronchitis will likely get worse is they contract an infection of the airways, like a cold or flu.

Signs and symptoms

The most obvious symptom of acute bronchitis is a short-term dry hacking cough, which can become a productive cough that produces white or yellow sputum. Wheezing and shortness of breath may also be present. As with any infection, there may also be fever, sore throat, chills, aches and pains, and a general feeling of tiredness and being unwell.

Children under five years old rarely have a productive cough. Instead, sputum is usually seen in vomit, and parents will often hear a rattling sound in the chest.

The most common symptoms of chronic bronchitis are a recurrent or persistent productive cough, wheezing, and gradually worsening shortness of breath. Other symptoms include fatigue, sore throat, nasal congestion, and headaches. Severe coughing may cause chest pain and cyanosis, which is a blue/grey colouration of the skin. Recurrent infection of the airways is also a sign of chronic bronchitis.

Because many symptoms of chronic bronchitis are similar to those of other lung conditions it is important that a doctor is consulted for a proper diagnosis.

Diagnosis

In acute bronchitis, coughing usually lasts between 10 to 20 days. There are no specific tests for acute bronchitis, although a chest x-ray may be requested if pneumonia is also suspected. Tests may be required if there is recurrent or persistent cough that suggests asthma or chronic bronchitis. Coughing for a period of greater than four weeks may be due to whooping cough (pertussis).

Chronic bronchitis is defined as productive cough for at least three months a year for two years in a row. A doctor will discuss a person’s medical history (including cigarette smoking and inhalation of toxic substances) and do a physical examination. Testing may include a chest x-ray, sputum tests, and a spirometry test to measure lung function. An important part of the diagnosis is to distinguish chronic bronchitis from other lung conditions, such as chronic asthma and bronchiectasis.

Treatment for acute bronchitis

Acute bronchitis will usually resolve on its own within a couple of weeks, with complete healing of the airways and return to full function. Hence, the aim of treatment is to control symptoms. Antibiotics are not usually effective because most cases of acute bronchitis are caused by viruses. They should only be used if bacterial infection is strongly suspected or confirmed by testing.

Treatment of acute bronchitis involves:

• Adequate rest and fluid intake
• Using medications available at the pharmacy to relieve muscle aches and pains and headaches, and to reduce fever
• Using cough suppressants for a dry cough (i.e. a cough that does not produce sputum) but not a productive cough
• Using expectorants for productive cough, to help clear the airways of sputum
• Quiting smoking and avoidance of other airborne irritants
• Use of medications that open obstructed airways in people who have associated wheezing with their coughing or underlying asthma or COPD.

In children with acute bronchitis, the main target of treatment is the control of fever and aches and pains, which can be achieved with medications such as paracetamol or ibuprofen from a pharmacy.

People prone to bronchitis can try to avoid infections, such as colds and flus, through:

• Regular hand washing and drying
• Avoiding touching your eyes, nose, and mouth
• Avoiding contact with people who are unwell
• Reducing time spent in crowded places, especially during cold and flu season
• Getting an annual influenza vaccination and possibly vaccination that protects against some types of pneumonia.

Treatment for chronic bronchitis

The primary objective of treatment for chronic bronchitis is to control symptoms and to prevent further airway damage and narrowing. The most effective way of achieving this is to quit smoking and to avoid inhalation of environmental irritants and toxins.

Education and exercise can help to maintain lung function and quality of life. Physiotherapy is useful for learning how to control breathing to avoid breathlessness and to clear phlegm from the lungs.

Medications used in the treatment of chronic bronchitis include:

• Bronchodilators (relievers) to open obstructed airways to make breathing easier
• Oral corticosteroids to control acute exacerbations of chronic bronchitis
• Inhaled corticosteroids (preventers) to prevent acute exacerbations of chronic bronchitis
• Use of a combined bronchodilator and inhaled corticosteroid to control persistent cough
• Antibiotics to control short term infections that cause worsening bronchitis symptoms.

Support and information

For people with chronic bronchitis, the Asthma and Respiratory Foundation provides useful information on COPD and how to manage it, as well as links to COPD support groups around the country.

Asthma and Respiratory Foundation NZ

Phone: 04 499 4592
Email: [email protected]
Website: www.asthmafoundation.org.nz

References

Asthma and Respiratory Foundation NZ (2010). What is acute bronchitis? (PDF). Wellington: Asthma and Respiratory Foundation New Zealand (Inc.). https://s3-ap-southeast-2.amazonaws.com/assets.asthmafoundation.org.nz/documents/What-Is-Acute-Bronchitis-Fact-Sheet.pdf
Asthma and Respiratory Foundation NZ (2010). What is chronic bronchitis? (PDF). Wellington: Asthma and Respiratory Foundation New Zealand (Inc.). https://s3-ap-southeast-2.amazonaws.com/assets.asthmafoundation.org.nz/documents/What-Is-Choronic-Bronchitis-Fact-Sheet.pdf
Asthma and Respiratory Foundation NZ (Date not stated). Living with COPD (Web Page). Wellington: Asthma and Respiratory Foundation New Zealand (Inc.). https://www.asthmafoundation.org.nz/your-health/living-with-copd [Accessed: 28/10/20]Carolan, P.L. (2019). Paediatric bronchitis (Web page). Medscape Reference: Drugs and Diseases. New York, NY: WebMD LLC. https://emedicine.medscape.com/article/1001332-overview [Accessed:28/10/20]
Jazeela Fayyaz, D.O. (2020). Bronchitis (Web page). Medscape Reference: Drugs and Diseases. New York, NY: WebMD LLC. https://emedicine.medscape.com/article/297108-overview [Accessed: 28/10/20]
Ministry of Health (2008). A Portrait of health – Key results of the 2006/07 New Zealand Health Survey (Report PDF). Wellington: Ministry of Health. http://www.health.govt.nz/system/files/documents/publications/portrait-of-health-june08.pdf
O’Toole, M.T. (Ed.) (2017). Bronchitis. Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed.). St Louis, MI: Elsevier.

Last reviewed: October 2020

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