Bronchitis – Causes, Symptoms, Treatments

What is Bronchitis?

Bronchitis is an inflammation of the bronchial tubes, the airways that carry air to and from the lungs. These tubes become inflamed and irritated, producing mucus (phlegm) that can clog the airways and make breathing difficult. 

There are two main types of bronchitis:

• Acute bronchitis: This is a short-term illness that usually lasts for a few days or weeks. It is most commonly caused by a viral infection, such as the common cold or the flu.
• Chronic bronchitis: This is a long-term condition that causes inflammation of the bronchial tubes for at least three months in a year for two or more years. It is often caused by smoking.

What Causes Bronchitis?

The root causes of the inflammation that causes Bronchitis can be broadly categorized into two main culprits, those being infectious agents and irritants.

Viruses are the most common cause of acute bronchitis, accounting for up to 90% of cases. The viruses responsible are often the same ones that cause the common cold or flu, such as rhinovirus, respiratory syncytial virus (RSV), adenovirus, and influenza virus. These viruses infect the lining of the bronchial tubes, triggering inflammation and mucus production.

While less frequent than viruses, bacterial infections can also cause bronchitis, particularly in people with weakened immune systems or chronic health conditions. Common bacterial culprits include Bordetella pertussis (whooping cough), Mycoplasma pneumoniae, and Chlamydia pneumoniae.

Smoking is the leading cause of chronic bronchitis. The smoke irritates and damages the lining of the bronchial tubes, leading to inflammation and mucus production. Over time, this damage can become permanent, causing chronic bronchitis. Exposure to secondhand smoke from others who smoke can also irritate the bronchial tubes and contribute to bronchitis.

Breathing in air pollutants like smog, dust, and fumes can irritate the airways and trigger bronchitis, especially in individuals with sensitive lungs. People who work in environments with dust, fumes, or chemicals are at higher risk of developing bronchitis due to constant irritation of the airways.

Rarely, a genetic condition called alpha-1 antitrypsin deficiency can increase susceptibility to chronic bronchitis. This condition leads to a lack of a protein that protects the lungs from damage, making them more vulnerable to irritation from inhaled substances.

Other Risk Factors

Frequent Colds or Respiratory Infections: Having frequent colds or other respiratory infections makes you more susceptible to bronchitis because the viruses responsible can irritate the bronchial tubes and trigger inflammation.

People with chronic health conditions like asthma, cystic fibrosis, or heart disease might have a weakened immune system or compromised lung function, making them more prone to developing bronchitis from various causes. Older adults are more likely to develop chronic bronchitis, possibly due to weakened immune systems and cumulative exposure to irritants over time.

Symptoms of Bronchitis 

Cough:

• Nature of the cough: This can be dry and hacking at first, especially with acute bronchitis. As the illness progresses, the cough often becomes productive, meaning it brings up mucus (phlegm).
• Mucus characteristics: The mucus can vary in color from clear to yellow, green, or even blood-tinged. Green or yellow mucus might indicate bacterial involvement, but not always.
• Frequency and severity: The cough can be constant or occur in fits, and its intensity can range from mild to debilitating, disrupting sleep and daily activities.

Chest Tightness:

• Description: This feels like a squeezing or pressure sensation in the chest. It’s caused by inflamed bronchial tubes that restrict airflow.
• Severity: The tightness can be mild and annoying or severe and make breathing difficult.

Shortness of Breath (Dyspnea):

• Experience: This feels like not being able to get enough air into your lungs. It can occur at rest or worsen with activity.
• Cause: Shortness of breath arises from blocked airways due to mucus or inflamed bronchial tubes restricting airflow.

Wheezing:

• Sound: This is a whistling or high-pitched squeaking sound produced when narrowed airways force air through.
• When it happens: Wheezing typically occurs during exhalation (breathing out) but can sometimes be present during inhalation (breathing in) in severe cases.

Fever:

• Temperature: Acute bronchitis often presents with a low-grade fever, usually below 100.4°F (38°C). High fevers are less common.

Fatigue:

• Reason: The body’s immune system works hard to fight off the infection, leading to tiredness and a general feeling of being run down.

Additional Symptoms:

• Runny or stuffy nose: This is common with acute bronchitis caused by viruses like the common cold.
• Headache and muscle aches: These can be associated with the body’s inflammatory response.
• Sore throat: Inflammation from the upper respiratory tract can irritate the throat.

Variations in Symptoms:

• Acute vs. Chronic Bronchitis: While the core symptoms are similar, acute bronchitis usually comes on suddenly and resolves within a few weeks. Chronic bronchitis has persistent symptoms (cough with or without mucus production) for at least three months a year for two or more years.
• Age: Infants and young children might not be able to verbalize symptoms effectively. They may present with wheezing, rapid breathing, or difficulty feeding.
• Underlying conditions: People with asthma or COPD might experience worsening of their symptoms during a bronchitis episode.

Both acute and chronic bronchitis involve inflammation of the bronchial tubes, the airways that carry air to and from the lungs. However, they differ significantly in their cause, duration, severity, and treatment approach. Let’s delve deeper:

Cause:

• Acute Bronchitis: Primarily caused by viruses (like those causing the common cold or flu) that infect the bronchial tubes. In rare cases, bacteria can be the culprit.
• Chronic Bronchitis: Most commonly caused by smoking, which irritates and damages the bronchial tubes over time. Exposure to air pollutants or irritants like secondhand smoke or dust can also contribute.

Duration:

• Acute Bronchitis: A short-term illness usually lasting 2-3 weeks. Symptoms typically worsen for the first few days before gradually improving.
• Chronic Bronchitis: A long-term condition with persistent symptoms for at least 3 months a year for two or more consecutive years. Symptoms may flare up (exacerbations) and subside, but the underlying inflammation never fully resolves.

Severity:

• Acute Bronchitis: Generally less severe than chronic bronchitis. Symptoms like cough and chest tightness might be disruptive but are usually manageable.
• Chronic Bronchitis: Can progressively worsen over time, leading to increasing shortness of breath and difficulty performing daily activities. It’s a major component of Chronic Obstructive Pulmonary Disease (COPD), a serious lung condition.

Symptoms:

• Similarities: Both can cause cough (dry or productive), chest tightness, shortness of breath, and fatigue.
• Differences: Fever is more common with acute bronchitis due to the viral infection. Chronic bronchitis might cause increased mucus production throughout the day, while acute bronchitis might have mucus only with coughing.

Complications of Bronchitis

While acute bronchitis is usually a self-limited illness that resolves on its own within a few weeks, there are some potential complications that can arise. 

Secondary Pneumonia is the most common complication of acute bronchitis, especially if left untreated or if certain risk factors are present. When the initial viral infection weakens the body’s defenses, it allows bacteria to take hold in the lungs, leading to a more serious lower respiratory tract infection (pneumonia). Symptoms of pneumonia can include worsening cough with increased mucus production, high fever, chills, shortness of breath, and sharp chest pain. Early diagnosis and treatment with antibiotics are crucial for preventing serious complications.

 In some cases, the cough associated with acute bronchitis can linger for several weeks (post-bronchitis cough) even after the infection has cleared. While bothersome, it’s usually not a cause for major concern and can often be managed with home remedies like cough suppressants or steam inhalation. However, if the cough is severe or persistent, lasting more than 4 weeks, consult a doctor to rule out other underlying conditions.

Acute bronchitis often starts with a viral upper respiratory infection that can involve the sinuses. Inflammation in the sinuses (sinusitis) can sometimes occur alongside bronchitis, causing additional symptoms like facial pain, pressure, and congestion.

Similar to sinus infections, the viral infection that triggers acute bronchitis can sometimes spread to the middle ear, causing an ear infection (otitis media). This is more common in young children but can occur in adults as well. Symptoms include earache, fever, and muffled hearing.

The cough and fever associated with acute bronchitis can lead to dehydration, especially in young children and older adults. It’s essential to maintain adequate fluid intake during illness to prevent dehydration and support recovery.

For individuals with pre-existing respiratory conditions like asthma or COPD, acute bronchitis can trigger flare-ups of their symptoms, leading to worsening shortness of breath, wheezing, and chest tightness.

How is Bronchitis Diagnosed?

In most cases, diagnosing acute bronchitis doesn’t require a lot of elaborate tests. Doctors can often make an accurate diagnosis based on your medical history and a physical examination. 

Your doctor will ask you about your symptoms, including the duration, severity, and nature of your cough, as well as any other symptoms like fever, chest tightness, shortness of breath, or fatigue. They’ll also inquire about your risk factors, such as smoking history, exposure to irritants, and any recent illnesses.

The doctor will listen to your chest with a stethoscope to check for abnormal breath sounds like wheezing or crackling, which can indicate airway narrowing or mucus accumulation. They might also examine your nose and throat for signs of infection.

In some cases, additional tests might be helpful, particularly if:

• Your symptoms are severe or unusual.
• Your cough persists for more than a few weeks.
• You have underlying health conditions that could be contributing to your symptoms.
• Your doctor suspects a different condition besides bronchitis.

Along with a physical examination a doctor might employ additional tools to ensure an accurate diagnosis.

While not routinely used for diagnosing acute bronchitis, a chest X-ray can be helpful to rule out other conditions like pneumonia, heart failure, or lung cancer. It can also show signs of inflammation or congestion in the lungs.

Pulse Oximetry is a simple test that measures the oxygen saturation in your blood using a painless clip placed on your finger. It can help assess if your bronchitis is causing low blood oxygen levels.

In rare cases, your doctor might collect a mucus sample (sputum) to identify the specific virus or bacteria causing your bronchitis, especially if they suspect a bacterial infection or if you’re at high risk for complications. However, this is not typically done for uncomplicated acute bronchitis.

How is Bronchitis Treated?

The treatment approach for bronchitis depends on whether it’s acute or chronic. 

Acute Bronchitis:

Since acute bronchitis is usually caused by a virus, antibiotics are not effective. The mainstay of treatment focuses on symptom relief and allowing your body’s immune system to fight off the infection. Here are some key self-care strategies:

• Rest: This allows your body to focus its energy on healing.
• Fluids: Drinking plenty of fluids like water, broth, or warm lemon water helps loosen mucus and prevent dehydration, especially if you have a fever.
• Humidity: Using a humidifier or cool mist vaporizer can moisten the air, soothe a dry cough, and ease congestion.
• Over-the-counter medications:
  • Pain relievers like acetaminophen or ibuprofen can help manage fever, aches, and headaches.
  • Cough suppressants can be helpful for a dry, hacking cough that disrupts sleep or daily activities. However, avoid them if your cough is productive (brings up mucus) as you want to clear that out.
• Saltwater gargle: Gargling with warm salt water can soothe a sore throat that often accompanies a cold or flu.

 In some cases, your doctor might prescribe additional medications to manage specific symptoms:

• Bronchodilators: These medications relax the muscles surrounding the airways, helping to open them up and ease shortness of breath. While not routinely used for uncomplicated acute bronchitis, they might be helpful if you have wheezing or a history of asthma.

Chronic Bronchitis:

Chronic bronchitis requires ongoing management with medications to control symptoms and prevent flare-ups. Here are some common medications used:

• Bronchodilators: These are inhaled medications that relax the airways, making breathing easier. There are different types of bronchodilators, and your doctor will choose the most appropriate one(s) for your specific needs.
• Inhaled steroids: These medications reduce inflammation in the airways, helping to control mucus production and ease breathing difficulties.
• Mucolytics: These medications help thin and loosen mucus, making it easier to cough up.
• Antibiotics: While not routinely used, antibiotics might be prescribed during flare-ups of chronic bronchitis if your doctor suspects a bacterial infection.

Other Therapies:

• Pulmonary Rehabilitation: This program helps improve lung function, exercise tolerance, and overall well-being in people with chronic lung diseases like chronic bronchitis. It involves exercise training, education, and support.
• Oxygen Therapy: In severe cases of chronic bronchitis where oxygen levels are low, supplemental oxygen therapy might be needed to improve breathing.

The most important treatment for chronic bronchitis, however, is:

• Smoking Cessation: If you smoke, quitting is the single most critical step in managing chronic bronchitis. Smoking irritates the airways and worsens symptoms. Quitting smoking can significantly slow disease progression and improve your overall health.

What Medications are most often Prescribed for Bronchitis?

For bronchitis, the medications prescribed will depend on whether you have acute or chronic bronchitis. 

Acute Bronchitis:

• Over-the-counter medications: These are often the mainstay for symptom relief in acute bronchitis since antibiotics are usually not helpful. Here are some common ones:
  • Pain relievers: Medications like acetaminophen or ibuprofen help manage fever, aches, and headaches.
  • Cough suppressants: These can be helpful for a dry, hacking cough that disrupts sleep or daily activities. However, avoid them if your cough is productive (brings up mucus) as you want to clear that out. Dextromethorphan is a common cough suppressant found in over-the-counter medications.
• Medications prescribed by a doctor (in some cases):
  • Bronchodilators: While not routinely used, bronchodilators that relax the airways might be prescribed if you have wheezing or a history of asthma to ease shortness of breath. Common bronchodilators include albuterol, ipratropium, and formoterol.

Chronic Bronchitis:

• Inhaled medications: These are the cornerstone of treatment for chronic bronchitis, aiming to control symptoms and prevent flare-ups. Here are some common types:
  • Bronchodilators: Different types of inhaled bronchodilators help relax the airways, making breathing easier.
  • Inhaled steroids: These medications reduce inflammation in the airways, helping to control mucus production and ease breathing difficulties.
  • Mucolytics: These medications help thin and loosen mucus, making it easier to cough up. Examples include acetylcysteine and hypertonic saline.

Antibiotics:

• It’s important to note that antibiotics are generally not prescribed for bronchitis unless a bacterial infection is strongly suspected. This is because most cases of acute bronchitis are caused by viruses, and antibiotics won’t be effective against them. Overusing antibiotics can contribute to antibiotic resistance, a growing public health concern. Commonly prescribed antibiotics for bronchitis include amoxicillin, azithromycin, and doxycycline.