Bronchitis

Bronchitis is an inflammation of the air passages between the nose and the lungs, including the trachea (windpipe) and the larger air tubes of the lung that bring air in from the trachea (bronchi). Bronchitis can either be of briefduration (acute) or a long-term disease (chronic).

Acute bronchitis is most prevalent in winter. It usually follows a viral infection, such as a cold or the flu, and can be accompanied by a secondary bacterial infection. Acute bronchitis usually begins with the symptoms of a cold,such as a runny nose, sneezing, and dry cough. However, the cough soon becomes deep and painful. Coughing brings up a greenish yellow phlegm or sputum. These symptoms may be accompanied by a fever of up to 102°F (38.8°C). Wheezing after coughing is common.

In uncomplicated acute bronchitis, the fever and most other symptoms disappear after three to five days. While acute bronchitis typically resolves completely within two weeks, the cough associated with it may persist for several weeks longer. Like any upper airway inflammatory process, acute bronchitis mayincrease a person's likelihood of developing pneumonia. Acute bronchitis is often complicated by a bacterial infection, in which case the fever and a general feeling of illness may persist. The bacterial infection should be treatedwith antibiotics.

Anyone can get acute bronchitis, but infants, young children, and the elderlyare more likely to get the disease because they generally have weaker immunesystems. Smokers, people with heart or other lung diseases, and individualsexposed to chemical fumes or high levels of air pollution are also at higherrisk of developing acute bronchitis.

Chronic bronchitis is one of a group of diseases that are called chronic obstructive pulmonary disease (COPD). Other diseases in this category include emphysema and chronic asthmatic bronchitis. Chronic bronchitis may progress to emphysema, or both diseases may be present together.

Chronic bronchitis develops slowly over time. A mild cough, sometimes calledsmokers' cough, is usually the first visible sign of the disease. Coughing brings up phlegm, and wheezing and shortness of breath may accompany the cough.Diagnostic tests will show a decrease in lung function. As the disease advances, breathing becomes difficult and activity decreases. To diagnose chronicbronchitis, these symptoms must be present for at least three months in eachof two consecutive years.

Chronic bronchitis is caused by inhaling bronchial irritants, especially cigarette smoke. The American Lung Association estimates that 80-90% of COPD cases are caused by smoking. Other irritants include chemical fumes, air pollution, and environmental irritants, such as mold or dust. Until recently, more men than women developed chronic bronchitis, but as the number of women who smoke has increased, so has their rate of chronic bronchitis. Because this disease progresses slowly, middle-aged and older people are more likely to be diagnosed with chronic bronchitis.

Initial diagnosis of bronchitis is based on observing the patient's symptomsand health history. The physician will listen to the patient's chest with a stethoscope for sounds that indicate lung inflammation and narrowing of the airways, such as moist rales, crackling, and wheezing. Moist rales are a bubbling sound caused by fluid in the bronchial tubes.

A sputum culture may be performed, particularly if the sputum is green or hasblood in it, to determine whether a bacterial infection is present and to identify the disease-causing organism so that an appropriate antibiotic can beselected. Normally, the patient will be asked to cough deeply, then spit thematerial that comes up from the lungs (sputum) into a cup. This sample is then grown in the laboratory to determine which organisms are present. The results are available in two to three days, except for tests for tuberculosis, which can take as long as two months.

A pulmonary function test is important in diagnosing chronic bronchitis and other variations of COPD. This test involves breathing into an instrument called a spirometer. The spirometer measures the amount of air entering and leaving the lungs. The test is painless and is done in the doctor's office.

To better determine what type of obstructive lung disease a patient has, thedoctor may also do a chest x-ray, electrocardiogram (ECG), and/or blood tests. An electrocardiogram is an instrument that is used to measure the electrical activity of the heart and is useful in the diagnosis of heart conditions.

When no secondary infection is present, acute bronchitis is treated in the same way as the common cold. Home care includes drinking plenty of fluids, resting, not smoking, increasing moisture in the air with a cool mist humidifier,and taking acetaminophen (Datril, Tylenol, Panadol) for fever and pain. Aspirin should not be given to children because of its association with the serious illness Reye's syndrome.

Cough suppressant lozenges (drops) or syrups are used only when the cough isdry and produces no phlegm. If the patient is coughing up phlegm, the cough should be allowed to continue. The purpose of the cough it to bring up extra mucus and irritants from the lungs. When coughing is suppressed, the phlegm accumulates in the plugged airways and can become a breeding ground for pneumonia bacteria.

Expectorant cough medicines, unlike cough suppressants, do not stop the cough. Instead they are used to thin the mucus in the lungs, making it easier to cough up. This type of cough medicine may be helpful to individuals sufferingfrom bronchitis. People who are unsure about what type of medications are inover-the-counter cough syrups should ask their pharmacist for an explanation.

If a secondary bacterial infection is present with the bronchitis, the infection is treated with an antibiotic. Patients need to take the entire amount ofantibiotic prescribed. Stopping the antibiotic early can lead to a return ofthe infection.

The treatment of chronic bronchitis is complex and depends on the stage of chronic bronchitis and whether other health problems are present. Lifestyle changes, such as quitting smoking and avoiding secondhand smoke or polluted air,are an important first step. Controlled exercise performed on a regular basis is also important.

Drug therapy begins with bronchodilators. These drugs relax the muscles of the bronchial tubes and allow increased air flow. They can be taken by mouth orinhaled using a nebulizer. A nebulizer is a device that delivers a regulatedflow of medication into the airways. Common bronchodilators include albuterol (Ventolin, Proventil, Apo-Salvent) and metaproterenol (Alupent, Orciprenaline, Metaprel, Dey-Dose).

Anti-inflammatory medications are added to reduce swelling of the airway tissue. Corticosteroids, such as prednisone, can be taken orally or intravenously. Other steroids are inhaled. Long-term steroid use can have serious side effects. Other drugs, such as ipratropium (Atrovent), are given to reduce the quantity of mucus produced.

As the disease progresses, the patient may need supplemental oxygen. There are many complications of COPD that often require hospitalization in the latterstages of the disease.

Alternative practitioners focus on prevention by eating a healthy diet that strengthens the immune system and practicing stress management. Bronchitis canbecome serious if it progresses to pneumonia, therefore, antibiotics may berequired. In addition, there are a multitude of botanical and herbal medicines that can be formulated to treat bronchitis. Some examples include inhalingeucalyptus or other essential oils in warm steam. Homeopathic medicine and traditional Chinese medicine may also be very useful for bronchitis, and hydrotherapy can contribute to cleaning the chest and stimulating immune response.

When treated, acute bronchitis normally resolves in one to two weeks withoutcomplications, although a cough may continue for several more weeks. The progression of chronic bronchitis, on the other hand, may be slowed, and an initial improvement in symptoms may be achieved. Unfortunately, however, there isno cure for chronic bronchitis, and the disease can often lead to or coexistwith emphysema. Chronic bronchitis is a major cause of disability and death in the United States. The American Lung Association estimates that about 14 million Americans suffer from the disease.

The best way to prevent bronchitis is not to begin smoking or to stop smoking. Other preventative steps include avoiding chemical and environmental irritants, such as air pollution, and maintaining good overall health. Immunizations against certain types of pneumonia (as well as influenza) are an importantpreventative measure for anyone with lung or immune system diseases.

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