Acute bronchitis (patient information)

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Overview
Acute bronchitis is an inflammation of the large bronchi (medium-sized airways) in the lungs. Acute bronchitis may be short-lived, whereas chronic bronchitis lasts a long time and often recurs.

What are the symptoms of Acute bronchitis?
The symptoms of either type of bronchitis may include: chest discomfort; cough that produces mucus (if it's yellow-green, you are more likely to have a bacterial infection); fatigue; fever (usually low); shortness of breath (dyspnea) worsened by exertion or mild activity; wheezing. Additionally, bronchitis caused by Adenoviridae may cause systemic and gastrointestinal symptoms as well. Even after acute bronchitis has cleared, you may have a dry, nagging cough that lingers for several weeks.

What causes Acute bronchitis?
Acute bronchitis can be caused by contagious pathogens. Acute bronchitis generally follows a viral respiratory infection. Typical viruses include respiratory syncytial virus, rhinovirus, influenza]], and others. At first, it affects your nose, sinuses, and throat and then spreads to the lungs. Sometimes, you may get another (secondary) bacterial infection in the airways. This means that bacteria infect the airways, in addition to the virus.

The following things can make bronchitis worse: air pollution; allergies; certain occupations (such as coal mining, textile manufacturing, or grain handling); infections.

Who is at highest risk?
People at risk for acute bronchitis include: the elderly, infants, and young children; persons with heart or lung disease; smokers.

When to seek urgent medical care?
Call your doctor if:


 * You have a cough most days or you have a cough that returns frequently
 * You are coughing up blood
 * You have a high fever or shaking chills
 * You have a low-grade fever for 3 or more days
 * You have thick, greenish mucus, especially if it has a bad smell
 * You feel short of breath or have chest pain
 * You have an underlying chronic illness, like heart or lung disease

Diagnosis
A physical examination will often reveal decreased intensity of breath sounds, wheezing, rhonchi and expiration. Most doctors rely on the presence of a persistent dry or wet cough as evidence of bronchitis. The health care provider will listen to your lungs with a stethoscope. Abnormal sounds in the lungs called rales or other abnormal breathing sounds may be heard.

A variety of tests may be performed in patients presenting with cough and shortness of breath:


 * A Chest x-ray that reveals hyperinflation; collapse and consolidation of lung areas would support a diagnosis of pneumonia. Some conditions that predispose to bronchitis may be indicated by chest radiography.
 * Lung function tests provide information that is useful for diagnosis and your outlook.
 * Pulse oximetry helps determine the amount of oxygen in your blood. This quick and painless test uses a device that is placed onto the end of your finger. Arterial blood gas is a more exact measurement of oxygen and carbon dioxide levels, but it requires a needle stick and is more painful.
 * Sputum samples may be taken to check for signs of inflammation or bacterial infection. A sputum sample would show neutrophil granulocytes (inflammatory white blood cells) and pathogenic microorganisms such as Streptococcus.
 * A blood test would indicate inflammation (as indicated by a raised white blood cell count and elevated C-reactive protein).

Treatment options
Treatment for acute bronchitis is typically symptomatic. Doctors recommend drinking plenty of fluids and resting. Aspirin or acetaminophen (Tylenol) may be taken if you have a fever. DO NOT give aspirin to children. Use of a humidifier or steam in the bathroom is also recommended.

Antibiotics
Only about 5-10% of bronchitis cases are caused by a bacterial infection. Most cases of bronchitis are caused by a viral infection and are "self-limited" and resolve themselves in a few weeks. Acute bronchitis should not be treated with antibiotics unless microscopic examination of the Gram-stained sputum reveals large numbers of bacteria. Treating non-bacterial illnesses with antibiotics leads to the promotion of antibiotic-resistant bacteria, which increase morbidity and mortality.

If your doctor thinks that you have a secondary bacterial infection, antibiotics may be prescribed. Most of the time, antibiotics are not needed or recommended.

Smoking cessation
Many physicians recommend that to help the bronchial tree heal faster and not make bronchitis worse, smokers should quit smoking completely to allow their lungs to recover from the layer of tar that builds up over time. If bronchitis is caught early enough, you can prevent the damage to your lungs.

Antihistamines
Using over-the-counter antihistamines may be harmful in the self-treatment of bronchitis.

An effect of antihistamines is to thicken mucus secretions. Expelling infected mucus via coughing can be beneficial in recovering from bronchitis. Expulsion of the mucus may be hindered if it is thickened. Antihistamines can help bacteria to persist and multiply in the lungs by increasing its residence time in a warm, moist environment of thickened mucus.

Using antihistamines along with an expectorant cough syrup may be doubly harmful encouraging the production of mucus and then thickening that which is produced. Using an expectorant cough syrup alone might be useful in flushing bacteria from the lungs. Using an antihistamine along with it works against the intention of using the expectorant.

Inhalers
If your symptoms do not improve, your doctor may prescribe an inhaler to open your airways if you are wheezing.

Where to find medical care for Acute bronchitis?
Directions to Hospitals Treating Acute bronchitis

Prevention of Acute bronchitis

 * DO NOT smoke.
 * Get a yearly flu vaccine and a pneumococcal vaccine as directed by your doctor.
 * Reduce your exposure to air pollution.
 * Wash your hands (and your children's hands) frequently to avoid spreading viruses and other infections.
 * In 1985, University of Newcastle, Australia Professor Robert Clancy developed an oral vaccine for acute bronchitis. This vaccine was commercialized four years later.

What to expect (Outlook/Prognosis)?
For acute bronchitis, symptoms usually go away within 7 to 10 days if you do not have an underlying lung disorder. It may accompany or closely follow a cold or the flu, or may occur on its own. Bronchitis usually begins with a dry cough, including waking the sufferer at night. After a few days it progresses to a wetter or productive cough, which may be accompanied by fever, fatigue, and headache. The fever, fatigue, and malaise may last only a few days; but the wet cough may last up to several weeks.

Should the cough last longer than a month, some doctors may issue a referral to an otorhinolaryngologist (ear, nose and throat doctor) to see if a condition other than bronchitis is causing the irritation. It is possible that having irritated bronchial tubes for as long as a few months may inspire asthmatic conditions in some patients.

In addition, if one starts coughing mucus tinged with blood, one should see a doctor. In rare cases, doctors may conduct tests to see if the cause is a serious condition such as tuberculosis or lung cancer.

Possible complications
Pneumonia can develop from either acute or chronic bronchitis. If you have chronic bronchitis, you are more likely to develop recurrent respiratory infections. You may also develop:


 * Emphysema
 * Right-sided heart failure or cor pulmonale
 * Pulmonary hypertension