Bronchitis

Bronchitis is an inflammation of the lining of your bronchial tubes, which carry air to and from your lungs. Bronchitis may be either acute or chronic.

A common condition, acute bronchitis often develops from a cold or other respiratory infection. Chronic bronchitis, a more serious condition, is a constant irritation or inflammation of the lining of the bronchial tubes, often due to smoking.

Acute bronchitis usually improves within a few days without lasting effects, although you may continue to cough for weeks. However, if you have repeated bouts of bronchitis, you may have chronic bronchitis, which requires medical attention. Chronic bronchitis is one of the conditions included in chronic obstructive pulmonary disease (COPD).

Treatment for bronchitis focuses on relieving your symptoms and easing your breathing.


Symptoms

For either acute bronchitis or chronic bronchitis, signs and symptoms may include:

* Cough
* Production of mucus (sputum), either clear or white or yellowish-gray or green in color
* Shortness of breath, made worse by mild exertion
* Wheezing
* Fatigue
* Slight fever and chills
* Chest discomfort

If you have acute bronchitis, you may have a nagging cough that lingers for several weeks after the bronchitis resolves. However, bronchitis symptoms can be deceptive. You don't always produce sputum when you have bronchitis, and children often swallow coughed-up material, so parents may not know there's a secondary infection. You can develop chronic bronchitis without first developing acute bronchitis. And many smokers have to clear their throats every morning when they get up, which, if it continues for more than three months, may be chronic bronchitis.

Symptoms of chronic bronchitis
If you have chronic bronchitis, long-term inflammation leads to scarring of the bronchial tubes, producing excessive mucus. Over time, the lining of the bronchial tubes thickens, and your airways eventually may become scarred. Signs and symptoms of chronic bronchitis may also include:

* Cough that's worse in the mornings and in damp weather
* Frequent respiratory infections (such as colds or the flu) with a worsening productive cough

If you have chronic bronchitis, you're likely to have periods when your signs and symptoms worsen. At those times, you may have superimposed acute bronchitis, either viral or bacterial, in addition to chronic bronchitis.

When to see a doctor
Acute bronchitis usually resolves on its own in a few days. See your doctor if:

* Your cough is severe or prevents you from sleeping. Your doctor may recommend prescription cough suppressants to help you rest.
* You have a low-grade fever that persists more than three days or a fever higher than 101 F (38.3 C), you're breathless, or you cough up bloody or yellow or green mucus. You may have pneumonia. Discolored mucus usually indicates a bacterial infection, which would respond to antibiotics. You also may have developed a bacterial sinusitis.
* Your cough lasts more than three weeks. The inflammation from a chronic infection can lead to asthma in some people.
* You have chronic lung or heart problems, including asthma, emphysema or congestive heart failure, and think you may have developed bronchitis. These conditions put you at greater risk of developing complications from bronchial infections.
* You have repeated bouts of bronchitis. You may have chronic bronchitis or another serious health condition, such as asthma or bronchiectasis, a stretching of the respiratory passages caused by mucus blockage.


Causes

Acute bronchitis
The same viruses that cause colds often cause acute bronchitis. But you can also develop noninfectious bronchitis from exposure to your own or someone else's tobacco smoke and from pollutants such as household cleaners and smog.

Bronchitis may also occur when acids from your stomach consistently back up into your food pipe (esophagus) and a few drops go into your upper airway, a condition known as gastroesophageal reflux disease (GERD). And workers exposed to certain dusts or fumes may develop occupational bronchitis, an acute disease that generally clears up when exposure to the irritant stops.

Chronic bronchitis
Sometimes inflammation and thickening of the lining of your bronchial tubes become permanent — a condition known as chronic bronchitis. You're generally considered to have chronic bronchitis if you cough most days for at least three months a year in two consecutive years. Often, however, smokers with chronic bronchitis cough almost every day, even if it's just to "clear their throats" in the morning.

Unlike acute bronchitis, chronic bronchitis is an ongoing, serious disease. Smoking is the major cause, but air pollution and dust or toxic gases in the environment or workplace also can contribute to the condition.

Risk factors

Factors that increase your risk of bronchitis include:

* Cigarette smoke. People who smoke or who live with a smoker are at greatest risk of both acute bronchitis and chronic bronchitis. Children in households where someone smokes also are susceptible to bronchitis, as well as to asthma, pneumonia, colds and middle ear infections (otitis media).
* Low resistance. This may result from another acute illness, such as a cold, or from a chronic condition that compromises your immune system. Older adults, infants and young children have greater vulnerability to infection.
* Gastroesophageal reflux disease (GERD). Stomach acids that persistently back up into your esophagus may cause a chronic cough.
* Exposure to irritants on the job. You run the risk of developing occupational bronchitis if you work around certain lung irritants, such as grains or textiles, or are exposed to chemical fumes from ammonia, strong acids, chlorine, hydrogen sulfide, sulfur dioxide or bromine. The cough associated with occupational bronchitis may be dry (nonproductive). Occupational bronchitis usually clears up when you're no longer exposed to these substances. This type of bronchitis isn't related to any infectious agent, but the irritation of the airways makes you more susceptible to getting an infection.

Complications

A single episode of bronchitis
Although a single episode of bronchitis usually isn't cause for concern, it can lead to pneumonia in some people. Older adults, infants, smokers and people with chronic respiratory disorders or heart problems are at greatest risk of getting pneumonia.

Repeated bronchitis
Take repeated bouts of bronchitis seriously. They may signal:

* Chronic bronchitis
* Asthma
* Other lung disorders

Also, if you have chronic bronchitis and you continue to smoke, your risk of lung cancer increases beyond the normal risk that smokers face.


Preparing for your appointment

You're likely to start by seeing your family doctor or a general practitioner. If you have chronic bronchitis, you may be referred to a pulmonologist, a doctor who specializes in lung diseases.

To get all the information you need from your doctor, it's good to be prepared for your appointment. Here's how.

What you can do

* Write down any symptoms you're experiencing, even if they seem unrelated to the reason for which you scheduled the appointment, and how long you've had them.
* Write down key personal information, including any major stresses, recent life changes or exposure to irritants in your home or workplace.
* Make a list of all medications, vitamins and supplements that you're taking.
* Tell your doctor whether you get yearly flu shots and whether you've had a pneumonia shot. If so, write down the year.
* Tell your doctor if you smoke, even if you've cut down to two or three cigarettes a day. Smoking two or three cigarettes a day may not seem like much, but it may be enough to perpetuate bronchitis.
* Go with a family member or friend, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
* If you've ever seen another physician for your cough, let your present doctor know what tests were done, and if possible, bring the reports with you, including results of a chest X-ray and pulmonary function test.
* Tell your doctor about any prescription medications you've taken for your cough that seemed to help, and whether you stopped taking them because they were too expensive.
* Write down questions to ask your doctor.

Preparing a list of questions before your appointment will help you make the most of your time with your doctor. List your questions from most important to least important. For bronchitis, some basic questions to ask your doctor include:

* What is likely causing my symptoms or condition?
* Could I be allergic to my pet?
* Other than the most likely cause, what are other possible causes for my symptoms or condition?
* What kinds of tests do I need?
* Is my condition likely temporary or chronic?
* What is the best course of action?
* What are the alternatives to the primary approach that you're suggesting?
* I have these other health conditions. How can I manage them together?
* Are there any restrictions that I need to follow?
* Would I be better off living in a warmer climate?
* If I have GERD, will treating it help my bronchitis?
* Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
* Is there a generic alternative to the medicine you're prescribing for me?
* Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?
* What's the best way to quit smoking?

In addition to the questions you prepare, don't hesitate to ask questions during your appointment anytime you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:

* Have you recently had a cold or the flu?
* Have you ever had pneumonia? (If so, he or she may want the chest X-ray from your pneumonia diagnosis.)
* Are you a smoker or have you been around smokers or other pollutants or fumes?
* When did you first begin experiencing symptoms?
* Have your symptoms been continuous, or occasional?
* How severe are your symptoms?
* How much has your stamina decreased in the last year?
* Do you exercise? Can you climb one flight of stairs without difficulty? Can you walk as fast as you used to?
* Do you have chest pain?
* What, if anything, seems to improve your symptoms?
* Do you snore loudly at night?
* Do you wake up in the morning feeling like you didn't get much sleep?
* What, if anything, appears to worsen your symptoms?
* Does cold air bother you?

What you can do in the meantime
The following may help ease your symptoms:

* Rest. Try to get plenty of sleep a night.
* Drink plenty of fluids.
* Avoid exposure to tobacco smoke.
* Keep the air in your home warm and moist.


Tests and diagnosis

To diagnose bronchitis, your doctor may take the following approaches:

* Use a stethoscope to listen for wheezing and other abnormal sounds in your lungs
* Have you get a chest X-ray
* Have you undergo blood tests
* Analyze a sputum culture — a test that checks for the presence of bacteria in sputum produced when you cough
* Have you take a pulmonary function test (PFT), to rule out other causes for your symptoms

Pulmonary function test
This test checks for signs of asthma or emphysema. During a pulmonary function test, you blow into a device called a spirometer, which measures the volume of air in your lungs after you've taken a deep breath and blown it out. The spirometer also shows how quickly you can get air out of your lungs.

The test is painless and takes just a few minutes. If you have repeated bouts of bronchitis and your doctor doesn't suggest a pulmonary function test, ask to have one done.


Treatments and drugs

The goal of treatment for bronchitis is to relieve symptoms and ease breathing. Sometimes, all you may need to recover from acute bronchitis may be:

* Rest
* Drinking fluids
* Breathing in warm, moist air
* Taking an over-the-counter (OTC) cough suppressant and acetaminophen (Tylenol, others) or aspirin (for adults)

Medications
In some circumstances, your doctor may prescribe medications:

* Antibiotics. Bronchitis usually results from a viral infection, so antibiotics aren't effective. However, your doctor may prescribe an antibiotic if he or she suspects that you have a bacterial infection. If you have a chronic lung disorder or if you smoke, your doctor may also prescribe antibiotics to reduce your risk of a serious, secondary infection.
* Cough medicine. It's best not to suppress a cough that brings up mucus, because coughing helps remove irritants from your lungs and air passages. If your cough keeps you from sleeping, use enough OTC cough medicine so that you can rest, but not enough to suppress your cough completely. If your cough is seriously depriving you of sleep, your doctor may recommend a prescription cough suppressant.
* Other medications. If you have asthma or chronic obstructive pulmonary disease (COPD), your doctor may recommend an inhaler and other medications to reduce inflammation and open narrowed passages in your lungs.

Therapies
If you have chronic bronchitis, talk to your doctor about pulmonary rehabilitation. Pulmonary rehabilitation is a breathing exercise program in which you work with a respiratory therapist to help you learn to breathe more easily and increase your ability to exercise.


Lifestyle and home remedies

Besides the basic treatments of rest, liquids and over-the-counter cough medications, these suggestions can help make you more comfortable, speed recovery and prevent complications of acute bronchitis and help control the symptoms of chronic bronchitis:

* Avoid exposure to irritants, such as tobacco smoke. Don't smoke. Wear a mask when the air is polluted or if you're exposed to irritants, such as paint or household cleaners with strong fumes.
* Use a humidifier in your room. Warm, moist air helps relieve coughs and loosens mucus in your airways. But be sure to clean the humidifier according to the manufacturer's recommendations to avoid the growth of bacteria and fungi in the water container.
* Use over-the-counter medications. To relieve pain and lower a high fever, acetaminophen (Tylenol, others) and ibuprofen (Advil, Motrin, others) may help.
* Consider a face mask outside. If cold air aggravates your cough and shortness of breath, put on a cold-air face mask before you go outside.
* Try pursed-lip breathing. If you have chronic bronchitis, you may breathe too fast. Pursed-lip breathing helps slow your breathing, and may make you feel better. Take a deep breath, then slowly breathe out through your mouth while pursing your lips (hold them as if you're going to kiss someone.) Repeat. This technique increases the air pressure in your airways.


Alternative medicine

Some people believe that some herbal remedies offer relief from acute bronchitis.

* Chinese herbs. There's no evidence from randomized, controlled studies to recommend the use of Chinese herbs for bronchitis, and the safety of Chinese herbs is unknown.
* Pelargonium sidoides. This South African geranium is an herb that has shown some effectiveness in alleviating symptoms of acute bronchitis. More study is needed. Check with your doctor before trying any herbal remedy.


Prevention

If you have frequent, repeated attacks of bronchitis, the culprit may be something in your environment. Cold, damp locations — especially combined with air pollution or tobacco smoke — can make you more susceptible to acute bronchitis. When the problem is severe, you may need to consider changing where and how you live and work.

These measures also may help lower your risk of bronchitis and protect your lungs in general:

* Avoid smoking and exposure to secondhand smoke. Tobacco smoke increases your risk of chronic bronchitis and emphysema.
* Try to avoid people who have colds or flu. The less you're exposed to the viruses that lead to bronchitis, the lower your risk of getting it. Avoid crowds during flu season.
* Get an annual flu vaccine. Many cases of acute bronchitis result from influenza, a virus. Getting a yearly flu vaccine can help protect you from getting the flu, which in turn, may reduce your risk of bronchitis.
* Ask your doctor about a pneumonia shot. If you're older than 60 or you have risk factors such as diabetes, heart disease and emphysema, consider having a pneumonia shot. In addition, a vaccine known as Prevnar can help protect young children against pneumonia. It's recommended for all children under age 2 and for children 2 to 5 years old who are at particular risk of pneumococcal disease, such as those with an immune system deficiency, asthma, cardiovascular disease or sickle cell anemia. Side effects of the pneumococcal vaccine are generally minor and include mild soreness or swelling at the injection site. If you had a pneumonia shot five or more years ago, your doctor may recommend that you get another one.
* Wash your hands or use hand sanitizers regularly. To reduce your risk of catching a viral infection, wash your hands frequently and get in the habit of using hand sanitizers. And don't touch the inside of your nose or rub your eyes.
* When practical, wear a mask. If you have to spend a lot of time around other people who are coughing and sneezing, it's a good idea to wear a mask that covers your mouth and nose to reduce your risk of infection.