BRONCHITIS

Bronchitis is an illness caused by inflammation of the mucous lining of the airways, called bronchi. Bronchitis occurs when the bronchial tubes become irritated. The irritation may be caused by cigarette smoking or by bacterial or viral respiratory infections. The viral infections responsible for the common cold are the most frequent cause of bronchitis, which occurs when the virus spreads to the airways. The walls of the airways respond to the irritation by secreting copious, thick mucus, which clogs the inflamed, swollen airways and obstructs the flow of air through them.

Air pollution and inhalation of industrial particles are also associated with bronchitis. Workers exposed to dust, such as coal miners, grain handlers and metal workers, tend to have higher than normal rates of a form of the illness that may be referred to as industrial bronchitis.

Symptoms

Bronchitis may be acute or chronic. In the acute form, bronchitis is a common infection that usually occurs at the same time as or following a chest cold and has as its primary symptom a productive cough. There may also be a sensation of tightness and generalized pain in the area of the chest, chills, a low fever, feelings of malaise and a wheezing sound during breathing. Acute bronchitis is caused by a virus in 90 percent of cases, and typically the condition is not helped by antibiotics. Acute bronchitis almost always clears up in less than a week without lasting effects, although a cough may persist for four to six weeks.

Chronic bronchitis is defined by a persistent cough that produces mucus and recurs on most days for three months of the year over a period of two successive years without another identifiable underlying disease. This disease is most common among those who smoke cigarettes, especially those older than 35. Being overweight is a risk factor for chronic bronchitis.

A cough that produces yellowish gray phlegm is the most common symptom of both forms of bronchitis. The illness generally follows a characteristic pattern of development in which the initial symptoms are similar to those of acute bronchitis. Those symptoms may resolve, but the distinguishing productive cough of bronchitis may last for several weeks afterward. In chronic bronchitis, as the disease progresses, the cough lasts throughout the year. There is often severe coughing that brings up yellow or green phlegm upon awakening in the morning. The cough associated with chronic bronchitis is distinctive in that it sounds loud, deep and wet. Bouts of coughing may last several minutes, and shortness of breath is often experienced at the same time as or directly following an episode of coughing. In the United States, chronic bronchitis is almost always associated with smoking.

Diagnosis and Treatment

The short-lived symptoms of acute bronchitis following a cold generally do not merit a doctor's attention unless chronic heart or lung problems are present, including asthma, emphysema and congestive heart failure. When medical consultation is sought, the diagnosis is generally based on the discolored sputum that is produced by coughing. If the phlegm is yellow, gray or green, an antibiotic may be prescribed. In some cases, one of the bronchodilators may be prescribed to open the narrowed airways. Otherwise, treatment is generally based on self-help strategies, including aspirin for fever (do not use aspirin for children), bed rest and increased fluids. Over-the-counter cough medicine may be helpful if coughing interferes with sleep. Avoiding inhaled irritants, especially cigarette smoking and secondhand smoke, is essential. The use of a vaporizer may be beneficial because warm, humid air helps ease the irritated airways.

Chronic bronchitis is diagnosed by the characteristic cough and its ongoing occurrence over several years. The diagnosis may be confirmed by a medical history, a physical examination, and an evaluation of lung function test results and chest X-rays. If detected early and if the person who has chronic bronchitis does not smoke, he or she may expect a good survival rate. However, survival rates are low for people with severe forms of this illness that go untreated.

The first line of treatment is to stop smoking. Care must be taken to avoid respiratory infections that will exacerbate chronic bronchitis by limiting exposure to people who have colds or other infections and by being vaccinated for pneumonococcal pneumonia. Annual flu shots are recommended for people who have chronic bronchitis. Aggravating factors to avoid include dust, cold air, inhalation of noxious fumes including paint fumes, automobile exhaust, and, in some cases, common household cooking odors and perfumes. Increased fluid intake can help thin the thick mucus so that it is coughed up more easily.

If the sputum of a person with chronic bronchitis abruptly changes in color, quantity or density, a broad-spectrum antibiotic, such as tetracycline or ampicillin, may be prescribed for seven to 10 days. If wheezing is present or reversible bronchial constriction is detected on lung function tests, a bronchodilator may be prescribed. Chronic bronchitis may impede the body's ability to get oxygen from the lungs; if this occurs, oxygen therapy may become necessary either in a hospital setting or via oxygen delivery devices suitable for home or portable use.