How Do I Know That I Have Bronchitis and How Is It Treated?

Bronchitis is one of the most common conditions that bring patients to the doctor or clinic. Almost all people present with a cough that begins early in the course of bronchitis. The cough may become more severe as you continue to develop further symptoms.

Key takeaways:
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    Bronchitis can be acute or chronic.
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    Bronchitis is a diagnosis of exclusion, meaning other illnesses should be ruled out first.
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    Treatment is mostly symptomatic and highly individualized.
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    Home remedies for the common cold are often sufficient unless the patient’s symptoms worsen or there are other medical illnesses present, such as Strep throat.

It may be difficult, if not impossible, to distinguish acute bronchitis from an upper respiratory tract infection, but if the cough lasts more than five days, it is most likely bronchitis. Most people do not have a fever.

Many other possible diagnoses can look like bronchitis, so a thorough medical workup is often necessary to rule out more severe illness.

The main goal of treatment is symptomatic relief. Most people will be prescribed a combination of medications that promote the alleviation of lung and airway obstruction, thin the mucus, and suppress the cough.

What exactly is bronchitis?

Your lower respiratory tract consists of the lungs, bronchi, bronchioles, and tiny air sacs called alveoli, which allow for gas exchange. The bronchi and bronchioles are the tubes that carry air, and they decrease in size once they attach to the alveoli.

Bronchitis has two components: inflammation of the bronchial lining and bronchoconstriction or narrowing of the airways (bronchi and bronchioles).

There are two main types of bronchitis:

I. Acute bronchitis (most common). Caused by viral infections such as the cold or flu. Rarely, a bacterial infection can cause bronchitis, but in these cases, often there are also signs of pneumonia as well.

II. Chronic bronchitis. This is an ongoing cough for months, or it returns twice or more within two years. The cough is productive. The lining of the airways is constantly inflamed. Most patients complain of difficulty breathing, and it can be part of chronic obstructive pulmonary disease or COPD. These patients are most often long-term cigarette smokers. Others have been exposed to secondhand smoke, have a family history of lung disease, have had childhood respiratory diseases, or have gastroesophageal reflux disease or GERD.

What is the best prevention for bronchitis?

The best treatment is always prevention. The keys to prevention include:

  • Quitting smoking
  • Avoiding noxious fumes, air pollution, secondhand smoke, or things that you may be allergic to
  • Getting the flu shot and COVID-19 shot and boosters

What are the symptoms of bronchitis?

A complete history must be obtained, including information on exposure to toxic substances and smoking.

Symptoms of bronchitis include the following:

Cough (the most commonly observed symptom).

Sputum production (clear, yellow, green, or even blood-tinged).

Fever (relatively unusual; in conjunction with cough, suggestive of influenza or pneumonia).

Nausea, vomiting, and diarrhea (rare).

General malaise and chest pain (in severe cases).

Dyspnea and cyanosis (only seen with underlying chronic obstructive pulmonary disease or COPD or another condition that impairs lung function).

Your doctor will diagnose bronchitis based on your clinical presentation in most cases. Bronchitis is considered a “diagnosis of exclusion,” meaning the doctor will suspect and rule out other possible respiratory illnesses first by performing tests such as:

Complete blood count (CBC) with differential or blood culture (if bacterial superinfection is suspected).

Procalcitonin levels (to distinguish bacterial from non-bacterial infections).

Sputum cytology (if the cough is persistent).

Chest radiography (if the patient is elderly or physical findings suggest pneumonia).

Bronchoscopy (to exclude foreign body aspiration, tuberculosis, tumors, and other chronic diseases).

Influenza tests.

Spirometry.

Laryngoscopy (looking down the throat with a lighted scope to exclude epiglottitis or a serious infection in the throat which can be life-threatening).

What other diagnoses will my doctor consider?

Many patients with bronchitis also have Strep throat, so that must be ruled out and treated if necessary.

Other medical issues/problems to consider include the following:

  • Exercise-induced asthma
  • Bacterial tracheitis (throat infection)
  • Cough
  • Cystic fibrosis
  • Influenza
  • Hyperreactive airway disease
  • Retained foreign body
  • Tonsillitis (Strep) or viral pharyngitis (sore throat)
  • Sinusitis
  • COPD
  • Occupational exposures

How is bronchitis treated?

The key factors in treatment are focused on alleviating the symptoms. These symptoms must be differentiated as either acute or chronic.

Acute bronchitis treatment is supportive, and the patient should be getting adequate oxygen. Bed rest is recommended.

Chronic bronchitis treatment is also supportive, but it is more preventative. Controlling cough and sputum production is paramount, along with stopping smoking and avoidance of allergens or environmental irritants.

Symptomatic treatment

Cough suppressants such as codeine and dextromethorphan are recommended for short-term symptomatic relief of coughing in patients with acute and chronic bronchitis.

Short-acting beta-agonists such as ipratropium bromide and theophylline can be used to control symptoms such as bronchospasm, dyspnea, and chronic cough in stable patients with chronic bronchitis.

Beta2-agonist bronchodilators may be useful in patients who have associated wheezing with cough and underlying lung disease. Examples include Albuterol sulfate (Proventil HFA, Ventolin HFA, ProAir HFA, ProAir RespiClick, and ProAir Digihaler).

Nonsteroidal anti-inflammatory drugs such as ibuprofen help treat constitutional symptoms of acute bronchitis, including mild-to-moderate pain.

Albuterol and guaifenesin products treat cough, dyspnea, and wheezing.

Mucolytics are often helpful, including acetylcysteine, bromhexine, ambroxol, and carbocisteine. Mucolytics break down mucus.

Expectorants reduce the thickness or viscosity of the bronchial secretions. Common examples of Expectorants include guaifenesin and ammonium chloride combined with diphenhydramine.

Antibiotics

Among otherwise healthy patients, antibiotics have not demonstrated any consistent benefit in the symptoms or natural history of acute bronchitis. The only exception is if the patient also has a bacterial infection at the same time, such as a throat or lung infection.

The interesting point is that at least three-quarters of patients with suspected bronchitis receive some antibiotic treatment.

This is usually of no significant benefit unless the patient has suspected or confirmed pertussis or whooping cough or the patient has an acute exacerbation of chronic bronchitis.

It may be that antibiotics are overused for the treatment of bronchitis in common medical practice.

Influenza vaccines

The influenza vaccine may reduce the incidence of upper respiratory tract infections. Therefore, it may reduce acute bronchitis.

The COVID-19 vaccine may also be proven to be beneficial.

Influenza or COVID-19 vaccines may be less effective in preventing illness than in preventing serious complications and death. The research is still under investigation.

Zinc

Zinc may be beneficial if taken orally. Most studies show favorable results, but patients are warned that they may have a bad taste or significant nausea.

On June 16, 2009, the U.S. Food and Drug Administration (FDA) issued a public health advisory and notified consumers and healthcare providers to discontinue the use of intranasal zinc products.

The intranasal zinc products included Zicam Nasal Gel/Nasal Swab products. Therefore, intranasal zinc is no longer recommended.

Bronchitis is an inflammation of the bronchial lining of your lungs and can be either acute or chronic. Avoid getting sick by getting a flu shot or the COVID-19 vaccine, and avoid triggers such as air pollution. See your healthcare provider for diagnosis and treatment.

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