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Bronchitis 

Bronchitis is an inflammation of the lining of the bronchial tubes, the airways that connect the trachea (windpipe) to the lungs. Bronchitis is more specifically when the lining of the bronchial tubes becomes inflamed or infected. People with bronchitis breathe less air and oxygen into their lungs; they also have heavy mucus or phlegm forming in their airways. 

Bronchitis can be acute or chronic. An acute medical condition occurs quickly and can cause severe symptoms, but it lasts only a short time (no longer than a few weeks). Acute bronchitis is most often caused by viruses that can infect the respiratory tract and attack the bronchial tubes. Infection by certain bacteria can also cause acute bronchitis. Most people have acute bronchitis at some point in their lives. Chronic bronchitis can be mild to severe and is longer lasting from several months to years. With chronic bronchitis, the bronchial tubes continue to be inflamed (red and swollen), irritated, and produce excessive mucus over time. The most common cause of chronic bronchitis is smoking. 

AcuteBronchitis 

Acute bronchitis is swelling and inflammation of the main air passages to the lungs. This swelling narrows the airways, making it harder to breath and causing other symptoms, such as a cough. 

Causes 

Acute bronchitis almost always follows a cold or flu-like infection. The infection is caused by viruses (influenza, parainfluenza, respiratory syncitial virus, rhinovirus and adenovirus). At first, it affects nose, sinuses, and throat. Then it spreads to the airways leading to lungs. Sometimes, bacteria (Mycoplasma, Streptococcus, Bordetella, Moraxella, Haemophilus and Chlamydia pneumoniae) also infect the airways. This is called a secondary infection. In addition, other agents such as tobacco smoke, chemicals and environmental air pollution may irritate the bronchi and cause acute bronchitis.

Symptoms 

The symptoms of acute bronchitis may include: 

• Chest discomfort. 

•Cough that produces mucus; it may be clear or yellow green. 

•Fatigue.
•Fever, usually low grade.
•Shortness of breath that gets worse with activity.
•Wheezing, in people with asthma.
•Even after acute bronchitis has cleared, a dry and nagging cough may remains for 1 to 4 weeks. 

Diagnosis 

In acute bronchitis, coughing usually lasts between 10 to 20 days. There are no specific tests for acute bronchitis. Certain tests may be required if there is recurrent or persistent cough that may suggest asthma or chronic bronchitis. Coughing for period of greater than four weeks may be due to whooping cough (pertussis).
Sputum tests: Sputum can be tested to see whooping cough (pertussis) or other illnesses that could be helped by antibiotics. Sputum can also be tested for signs of allergies.

• Chest X-ray
  • Spirometry
  • Pulse oximetry 

Treatment 

Treatment of acute bronchitis involves: 

•Getting adequate rest and fluid intake. 
•Use of analgesic and antipyretic medications to relieve muscle aches, pains, headaches, and to reduce fever. 
•Use of cough suppressants for a dry cough, but not for a productive cough. 
•Use of expectorants for productive cough, to help clear the airways of mucus. 
•Stopping smoking and avoidance of other airborne irritants. 

Chronic Bronchitis 

Chronic bronchitis is a long-term, often irreversible respiratory illness. It is a chronic inflammatory condition in the lungs that causes the respiratory passages to be swollen and irritation increases the mucus production and damages the lungs.

Causes 

Bronchitis is considered “chronic” if symptoms continue for three months or longer. Bronchitis caused by allergies can also be classified as chronic bronchitis. There are many causes of chronic bronchitis, but the main cause is cigarette smoke. Many other inhaled irritants (for example, smog, industrial pollutants, toxic gases in the environment or workplace and solvents) can also result in chronic bronchitis. Viral and bacterial infections that result in acute bronchitis may lead to chronic bronchitis if people have repeated attack with infectious agents. 

Pathophysiology 

The disease is caused by an interaction between noxious inhaled agents and host factors, such as genetic predisposition or respiratory infections which cause injury or irritation to the respiratory epithelium of the walls and lumen of the bronchi and bronchioles. 

Symptoms 

•Bluish skin due to lack of oxygen (cyanosis).
•Breathing difficulty including wheezing and shortness of breath.
•Cough and sputum production are the most common symptoms; they usually last for at least 3 months and occur daily. The intensity of coughing and the amount and frequency of sputum production vary from patient to patient. Sputum may be clear, yellowish, greenish, or occasionally, blood-tinged.
•Fatigue.
•Fever may indicate a secondary viral or bacterial lung infection.
•Muscles around the ribs sink in as the child tries to breathe in (called intercostal retractions).
•Infant’s nostrils get wide when breathing
•Rapid breathing (tachypnea).

Treatment

Medications used for treatment bronchitis are: 

Bronchodilator: Salmeterol, Albuterol, Metaproterenol and Formoterol 

Anticholinergic: Ipratropium bromide and Tiotropium 

Steroids: Presnisone, Dexamethasone PDE4 inhibitors: Roflumilast 

Antibiotics: Macrolides, Azithromycin sulfonamides, Tetracyclines, Trimetho-prim and Fluoroquinolones 

Vaccines: Patients with chronic bronchitis should receive a flu shot annually and pneumonia shot every five to seven years to prevent infections. 

Oxygen Therapy: As a patient’s disease progresses, they may find it increasingly difficult to breathe on their own and may require supplemental oxygen. 

Surgery: Lung volume reduction surgery, during which small wedges of damaged lung tissue are removed, may be recommended for some patients with chronic bronchitis. 

Cough suppressants: Cough suppressants such as dextromethorphan may be helpful in reducing cough symptoms. 

Prevention 

The majority of instances of chronic bronchitis can be prevented by quit smoking and avoiding second-hand smoke. Flu and pneumococcal vaccines can help to prevent repeated infections that may lead to the disease. Certain industries (for example, chemical, textile, thermal etc.) and farm workers are often associated with air-borne chemicals and dust; avoiding air-borne chemicals and dust with appropriate masks may prevent or reduce the individual’s chance of developing chronic bronchitis.