Bronchitis history and symptoms

Overview
Bronchitis is usually a diagnosis of exclusion. Presence of cough without fever lasting more than 5 days and with normal vitals (no tachypnea or tachycardia) is suggestive of acute bronchitis. The presentation may vary according to the pathogen involved.

History

 * Bronchitis is common in patients with a history of smoking, low socio-economic status, residing in industrial or heavy pollutant areas, and exposure to toxic substance. Thus, obtaining a personal and socio-economic history is very important.
 * Bronchitis is usually a diagnosis of exclusion. Thus, past medical history to rule out asthma, and allergic history is important.

Acute bronchitis

 * Cough with sputum production (clear, yellow, green, or even blood-tinged) is the (commonest) symptom. Initially, it may be difficult to distinguish a acute bronchitis from upper respiratory tract infection. However, a cough lasting > 5 days indicates a diagnosis of Bronchitis. Cough usually last for 1-2 weeks in acute bronchitis. Even after acute bronchitis has cleared, you may have a dry, nagging cough that lingers for several weeks. A yellow-green sputum production is more likely to be a bacterial infection.
 * Sore throat, runny nose.
 * Fatigue, muscle aches
 * Fever -- may suggest pathogens like influenza or adenovirus as causative organisms
 * Shortness of breath, worsened by exertion or mild activity
 * Wheezing
 * Chest discomfort
 * Difficulty in breathing and blue discoloration of extremities can be seen in late stages of the disease

Additional symptoms of chronic bronchitis include:
 * Ankle, feet, and leg swelling
 * Blue-colored lips from low levels of oxygen
 * Frequent respiratory infections (such as colds or the flu)

Influenza virus, Adenovirus

 * Fever, chills, headache, myalgia

Parainfluenza virus

 * Children may present with a hoarse, ringing cough and stridulous, difficult breathing
 * Common in autumn season
 * Common cause of outbreak in nursing homes.

Respiratory syncytial virus

 * Common in winter and spring.
 * family history of exposure to an infant with bronchiolitis is important.

Rhinovirus

 * Mild symptoms

Bordetella pertusis

 * Commonly affects young adults
 * Incubation 1-3 weeks
 * cough lasting > 2 weeks
 * Fever uncommon

Mycoplasma pneumoniae and Chlamydiae pneumonia

 * Subacute onset, 2-3 week (helps in differentiating from Influenza)
 * Common in closed environment (military bases, schools, hostels)

Chronic bronchitis

 * Cough with sputum expectoration for at least 3 months a year during a period of 2 consecutive years. The patient may give a history of seasonal worsening of cough (winters)followed by progression of cough from seasonal to perennial, increased frequency, duration and severity of symptoms.
 * Difficulty in breathing and blue discoloration of extremities can be seen in late stages of the disease.
 * Shortness of breath, worsened by exertion or mild activity
 * Wheezing
 * Chest discomfort