Wednesday, March 24, 2010

Acute Bronchitis

What is Acute Bronchitis?

Acute bronchitis is a clinical syndrome caused by the inflammation of the linings of your airway passages (the tracheobronchial tree). The irritated membrane swells and increases its production of mucus which leads to coughing.

woman holding a tissue for her son (10-12) to sneeze
It can affect all age groups but among children, they are more frequently found in those younger than 5 years old.

Acute bronchitis is differentiated from chronic bronchitis by its onset, duration of illness and causative agents. Acute bronchitis is a sudden onset, self-limiting process lasting for about 10-14 days and commonly caused by an infection. Chronic bronchitis, on the other hand, is a long term, recurring, more serious condition with production of sputum for 3 months of the year, for at least 2 years in a row, which is usually a part of an underlying chronic pulmonary disease. It is another lung pathology that requires a separate discussion.

What Causes Acute Bronchitis?

Acute bronchitis is commonly infectious in origin, with 90% of cases caused by viruses and 10% by bacteria. Very rarely, it can be due to fungal agents. The viruses responsible for a common cold may be the same viruses that can bring about an acute bronchitis, except that the damage is further down in the respiratory tree. Acute bronchitis may in fact, accompany or follow a bout of cold or flu.

Although viruses are the usual culprit in acute bronchitis, the damage done in the bronchial linings make it more prone to a secondary attack by bacteria.

Viruses commonly implicated:
  • Influenza
  • Parainfluenza
  • Adenovirus
  • Rhinovirus
      ·    Respiratory syncytial virus
      ·    Coxsackievirus
Bacterial causes:
  • Mycoplasma pneumoniae
  • Chlamydia  pneumoniae
  • Bordatella pertussis- may occur in children that are incompletely vaccinated
Acute bronchitis can be transmitted when you breathe in these germs or touch hands and objects coated with these microorganisms. It can also result from inhaling air pollutants such as smoke and other noxious fumes, and from food or vomit that accidentally enters into your lungs. The body fights back by creating an inflammatory response, which leads to swelling of the walls of the bronchial tree, increasing mucus production with subsequent narrowing or air passages and stimulating the cough reflex.

What are the Symptoms?

  • Dry cough that subsequently loosens and becomes productive of yellowish or greenish phlegm. In children that do not know how to expectorate, the phlegm is swallowed and will only be noted upon vomiting.
  • Nasal discharge that becomes thicker
  • Shortness of breath
  • Low Grade Fever
  • Sore Throat
  • Wheezing
  • “Rattle” sensation in the chest
  • Chest Pain
  • Muscle and joint pains
  • A general feeling of tiredness

How is Acute Bronchitis Diagnosed?
  • Medical history and Physical Examination. No routine laboratory examination can reliably confirm the diagnosis. Rather, it will be heavily dependent on the symptoms that you have observed and on physical examination done by your doctor.
  • Physical findings. The presence of irritation of the eyes and enlargement of the lymph nodes may suggest adenovirus as the causative agent, although this is not specific.  In most cases, the physical findings are unremarkable.
  • Chest X-ray may be requested to exclude the possibility of pneumonia. In uncomplicated cases of acute bronchitis, the lung fields will appear normal on x-ray.
  • Complete blood count may show elevated levels of white blood cells, indicating an ongoing inflammatory process.
  • Gram stain and culture sensitivity of the sputum will aid in the diagnosis if bacteria is entertained as the possible cause. It will likewise determine which antibiotic will be effective.

How is Acute Bronchitis Treated?

1. Drug Therapy
  • Antibiotics have no role in the treatment of acute bronchitis due to viruses. However, it may be prescribed when acute bronchitis is caused by bacteria or is complicated by a secondary bacterial infection. Macrolides are usually chosen because of their activity against Mycoplasma pneumoniae, Chlamydia pneumoniae and Bordatella pertussis, which are the common bacterial offenders.
  • Analgesics/ Antipyretics are used to control fever and body pains
  • Cough preparations including expectorants, mucolytics and antitussives may temporarily alleviate coughing, although their efficacy remains uncertain.
  • Decongestants to relieve nasal congestion
  • Bronchodilators or drugs prescribed for asthma may be especially useful if you experience wheezing. These will help open tight air passages in the lungs.
  • Antiviral agents and influenza vaccinations offer protection for acute bronchitis caused by Influenza A and B.

2. Non-Pharmacologic Therapy
  • Get adequate rest in a well-ventilated room to allow your body regain the energy needed to fight the infection.
  • Warm-compress over the chest to relieve discomfort
  • Increase fluid intake to help thin out the mucus in your lungs
  • Steam inhalation using mentholated vapor can help clear out your nasal discharges and bronchial secretions
  • Smoking cessation. If you smoke, you have to stop, to avoid further damage to your bronchial linings and enable faster healing.

When Do I Consult A Doctor?

You can contact your health care provider if you notice any symptoms of acute bronchitis.  Being a self-limited disease, it can be treated at home. However, these are the signs to look out for that warrant immediate consultation with an expert:
  • Breathlessness, increased difficulty of breathing or wheezing even while at rest
  • Chest pain that is crushing or squeezing in quality
  • High-grade fever or chills
  • Blood in the sputum
  • Symptoms worsening or lasting for more than 2 weeks
  • Presence of chronic lung disorders or other debilitating diseases, especially in older patients
 What Are the Complications of Acute Bronchitis?

In most cases, patients recover totally after 10-14 days. In less than 5% of cases, it can develop into Pneumonia. Persons with asthma or chronic pulmonary disease can have a longer recovery period or may find their symptoms getting worse.

How Do I Avoid Acquiring Acute Bronchitis?

  • Wash your hands often to prevent transmission of germs.
  • Avoid noxious chemicals and other air pollutants.
  • Do not smoke. Smoking damages the protective linings of your bronchial airways.
  • Getting a flu shot may lessen your chances of acquiring acute bronchitis since influenza viruses are commonly implicated in the disease.


Marcia said...

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