Bronchitis is inflammation of the
bronchi
A bronchus is a passage or airway in the lower respiratory tract that conducts air into the lungs. The first or primary bronchi pronounced (BRAN-KAI) to branch from the trachea at the carina are the right main bronchus and the left main bronch ...
(large and medium-sized airways) in the
lungs that causes
cough
A cough is a sudden expulsion of air through the large breathing passages that can help clear them of fluids, irritants, foreign particles and microbes. As a protective reflex, coughing can be repetitive with the cough reflex following three ph ...
ing. Bronchitis usually begins as an infection in the nose, ears, throat, or sinuses. The infection then makes its way down to the bronchi. Symptoms include
coughing up sputum,
wheezing
A wheeze is a continuous, coarse, whistling sound produced in the respiratory airways during breathing. For wheezes to occur, some part of the respiratory tree must be narrowed or obstructed (for example narrowing of the lower respiratory tract ...
,
shortness of breath
Shortness of breath (SOB), also medically known as dyspnea (in AmE) or dyspnoea (in BrE), is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing di ...
, and
chest pain
Chest pain is pain or discomfort in the chest, typically the front of the chest. It may be described as sharp, dull, pressure, heaviness or squeezing. Associated symptoms may include pain in the shoulder, arm, upper abdomen, or jaw, along with ...
. Bronchitis can be
acute
Acute may refer to:
Science and technology
* Acute angle
** Acute triangle
** Acute, a leaf shape in the glossary of leaf morphology
* Acute (medicine), a disease that it is of short duration and of recent onset.
** Acute toxicity, the adverse eff ...
or
chronic.
Acute bronchitis
Acute bronchitis, also known as a chest cold, is short-term bronchitis – inflammation of the bronchi (large and medium-sized airways) of the lungs. The most common symptom is a cough. Other symptoms include coughing up mucus, wheezing, sho ...
usually has a cough that lasts around three weeks,
and is also known as a chest cold.
In more than 90% of cases the cause is a
viral infection
A viral disease (or viral infection) occurs when an organism's body is invaded by pathogenic viruses, and infectious virus particles (virions) attach to and enter susceptible cells.
Structural Characteristics
Basic structural characteristics, s ...
.
[ These viruses may be spread through the air when people cough or by direct contact.] A small number of cases are caused by a bacterial infection
Pathogenic bacteria are bacteria that can cause disease. This article focuses on the bacteria that are pathogenic to humans. Most species of bacteria are harmless and are often beneficial but others can cause infectious diseases. The number of th ...
such as ''Mycoplasma pneumoniae
''Mycoplasma pneumoniae'' is a very small bacterium in the class Mollicutes. It is a human pathogen that causes the disease mycoplasma pneumonia, a form of atypical bacterial pneumonia related to cold agglutinin disease. ''M. pneumoniae'' is c ...
'' or ''Bordetella pertussis
''Bordetella pertussis'' is a Gram-negative, aerobic, pathogenic, encapsulated coccobacillus of the genus '' Bordetella'', and the causative agent of pertussis or whooping cough. Like '' B. bronchiseptica'', ''B. pertussis'' is motile and expr ...
''.[ Risk factors include exposure to ]tobacco smoke
Tobacco smoke is a sooty aerosol produced by the incomplete combustion of tobacco during the smoking of cigarettes and other tobacco products. Temperatures in burning cigarettes range from about 400 °C between puffs to about 900 °C d ...
, dust, and other air pollution
Air pollution is the contamination of air due to the presence of substances in the atmosphere that are harmful to the health of humans and other living beings, or cause damage to the climate or to materials. There are many different type ...
.[ Treatment of acute bronchitis typically involves rest, ]paracetamol
Paracetamol, also known as acetaminophen, is a medication used to treat fever and mild to moderate pain. Common brand names include Tylenol and Panadol.
At a standard dose, paracetamol only slightly decreases body temperature; it is inferi ...
(acetaminophen), and nonsteroidal anti-inflammatory drug
Non-steroidal anti-inflammatory drugs (NSAID) are members of a therapeutic drug class which reduces pain, decreases inflammation, decreases fever, and prevents blood clots. Side effects depend on the specific drug, its dose and duration of ...
s (NSAIDs) to help with the fever.
Chronic bronchitis
Bronchitis is inflammation of the bronchi (large and medium-sized airways) in the lungs that causes coughing. Bronchitis usually begins as an infection in the nose, ears, throat, or sinuses. The infection then makes its way down to the bronchi. ...
is defined as a productive cough
A cough is a sudden expulsion of air through the large breathing passages that can help clear them of fluids, irritants, foreign particles and microbes. As a protective reflex, coughing can be repetitive with the cough reflex following three phas ...
– one that produces sputum
Sputum is mucus that is coughed up from the lower airways (the trachea and bronchi). In medicine, sputum samples are usually used for a naked eye examination, microbiological investigation of respiratory infections and cytological investigation ...
– that lasts for three months or more per year for at least two years.[ Many people with chronic bronchitis also have ]chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease characterized by long-term respiratory symptoms and airflow limitation. The main symptoms include shortness of breath and a cough, which may or may not produce ...
(COPD). Tobacco smoking
Tobacco smoking is the practice of burning tobacco and ingesting the resulting smoke. The smoke may be inhaled, as is done with cigarettes, or simply released from the mouth, as is generally done with pipes and cigars. The practice is belie ...
is the most common cause, with a number of other factors such as air pollution
Air pollution is the contamination of air due to the presence of substances in the atmosphere that are harmful to the health of humans and other living beings, or cause damage to the climate or to materials. There are many different type ...
and genetics
Genetics is the study of genes, genetic variation, and heredity in organisms.Hartl D, Jones E (2005) It is an important branch in biology because heredity is vital to organisms' evolution. Gregor Mendel, a Moravian Augustinian friar worki ...
playing a smaller role. Treatments include quitting smoking
Smoking cessation, usually called quitting smoking or stopping smoking, is the process of discontinuing tobacco smoking. Tobacco smoke contains nicotine, which is addictive and can cause dependence. As a result, nicotine withdrawal often make ...
, vaccination
Vaccination is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism. In stimulating ...
s, rehabilitation
Rehabilitation or Rehab may refer to:
Health
* Rehabilitation (neuropsychology), therapy to regain or improve neurocognitive function that has been lost or diminished
* Rehabilitation (wildlife), treatment of injured wildlife so they can be return ...
, and often inhaled bronchodilator
A bronchodilator or broncholytic (although the latter occasionally includes secretory inhibition as well) is a substance that dilates the bronchi and bronchioles, decreasing resistance in the respiratory airway and increasing airflow to the l ...
s and steroids
A steroid is a biologically active organic compound with four rings arranged in a specific molecular configuration. Steroids have two principal biological functions: as important components of cell membranes that alter membrane fluidity; and ...
.[ Some people may benefit from long-term oxygen therapy.]
Acute bronchitis is one of the more common diseases. About 5% of adults and 6% of children have at least one episode a year. Acute bronchitis is the most common type of bronchitis.[ By contrast in the United States, in 2018, 9.3 million people were diagnosed with the less common chronic bronchitis.]
Acute bronchitis
Acute bronchitis, also known as a chest cold, is short term inflammation
Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irritation, irritants, and is a protective response involving im ...
of the bronchi
A bronchus is a passage or airway in the lower respiratory tract that conducts air into the lungs. The first or primary bronchi pronounced (BRAN-KAI) to branch from the trachea at the carina are the right main bronchus and the left main bronch ...
of the lungs.[ The most common symptom is a ]cough
A cough is a sudden expulsion of air through the large breathing passages that can help clear them of fluids, irritants, foreign particles and microbes. As a protective reflex, coughing can be repetitive with the cough reflex following three ph ...
, that may or may not produce sputum.[ Other symptoms may include coughing up mucus, ]wheezing
A wheeze is a continuous, coarse, whistling sound produced in the respiratory airways during breathing. For wheezes to occur, some part of the respiratory tree must be narrowed or obstructed (for example narrowing of the lower respiratory tract ...
, shortness of breath
Shortness of breath (SOB), also medically known as dyspnea (in AmE) or dyspnoea (in BrE), is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing di ...
, fever
Fever, also referred to as pyrexia, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using val ...
, and chest discomfort.[ Fever when present is mild.][ The infection may last from a few to ten days.][ The cough may persist for several weeks afterwards, with the total duration of symptoms usually around three weeks.][ Symptoms may last for up to six weeks.][
]
Cause
In more than 90% of cases, the cause is a viral infection
A viral disease (or viral infection) occurs when an organism's body is invaded by pathogenic viruses, and infectious virus particles (virions) attach to and enter susceptible cells.
Structural Characteristics
Basic structural characteristics, s ...
.[ These viruses may spread through the air when people cough or by direct contact.][ Risk factors include exposure to ]tobacco smoke
Tobacco smoke is a sooty aerosol produced by the incomplete combustion of tobacco during the smoking of cigarettes and other tobacco products. Temperatures in burning cigarettes range from about 400 °C between puffs to about 900 °C d ...
, dust
Dust is made of fine particles of solid matter. On Earth, it generally consists of particles in the atmosphere that come from various sources such as soil lifted by wind (an aeolian process), volcanic eruptions, and pollution. Dust in ...
, and other air pollutants
Air pollution is the contamination of air due to the presence of substances in the atmosphere that are harmful to the health of humans and other living beings, or cause damage to the climate or to materials. There are many different ty ...
.[ A small number of cases are due to ]bacteria
Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were am ...
such as ''Mycoplasma pneumoniae
''Mycoplasma pneumoniae'' is a very small bacterium in the class Mollicutes. It is a human pathogen that causes the disease mycoplasma pneumonia, a form of atypical bacterial pneumonia related to cold agglutinin disease. ''M. pneumoniae'' is c ...
'' or ''Bordetella pertussis
''Bordetella pertussis'' is a Gram-negative, aerobic, pathogenic, encapsulated coccobacillus of the genus '' Bordetella'', and the causative agent of pertussis or whooping cough. Like '' B. bronchiseptica'', ''B. pertussis'' is motile and expr ...
''.[
]
Diagnosis
Diagnosis is typically based on a person's signs and symptoms.[ The color of the sputum does not indicate if the infection is viral or bacterial.][ Determining the underlying organism is usually not required.][ Other causes of similar symptoms include ]asthma
Asthma is a long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wheezing, c ...
, pneumonia
Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severi ...
, bronchiolitis
Bronchiolitis is inflammation of the small airways in the lungs. Acute bronchiolitis is due to a viral infection usually affecting children younger than two years of age. Symptoms may include fever, cough, runny nose, wheezing, and breathi ...
, bronchiectasis
Bronchiectasis is a disease in which there is permanent enlargement of parts of the airways of the lung. Symptoms typically include a chronic cough with mucus production. Other symptoms include shortness of breath, coughing up blood, and chest ...
, and COPD
Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease characterized by long-term respiratory symptoms and airflow limitation. The main symptoms include shortness of breath and a cough, which may or may not produce ...
.[ A ]chest X-ray
A chest radiograph, called a chest X-ray (CXR), or chest film, is a projection radiograph of the chest used to diagnose conditions affecting the chest, its contents, and nearby structures. Chest radiographs are the most common film taken in me ...
may be useful to detect pneumonia.[
Another common sign of bronchitis is a cough which lasts ten days to three weeks. If the cough lasts for longer than a month, it may become chronic bronchitis. In addition, a fever may be present. Acute bronchitis is normally caused by a viral infection. Typically, these infections are ]rhinovirus
The rhinovirus (from the grc, ῥίς, rhis "nose", , romanized: "of the nose", and the la, vīrus) is the most common viral infectious agent in humans and is the predominant cause of the common cold. Rhinovirus infection proliferates in te ...
, parainfluenza
Human parainfluenza viruses (HPIVs) are the viruses that cause human parainfluenza. HPIVs are a paraphyletic group of four distinct single-stranded RNA viruses belonging to the ''Paramyxoviridae'' family. These viruses are closely associated with ...
, or influenza
Influenza, commonly known as "the flu", is an infectious disease caused by influenza viruses. Symptoms range from mild to severe and often include fever, runny nose, sore throat, muscle pain, headache, coughing, and fatigue. These symptom ...
. No specific testing is normally needed in order to diagnose acute bronchitis.
Treatment
One form of prevention is to avoid smoking and other lung irritants.[ Frequent hand washing may also be protective.] Treatment for acute bronchitis usually involves rest, paracetamol
Paracetamol, also known as acetaminophen, is a medication used to treat fever and mild to moderate pain. Common brand names include Tylenol and Panadol.
At a standard dose, paracetamol only slightly decreases body temperature; it is inferi ...
(acetaminophen), and NSAIDs to help with the fever.[ ]Cough medicine
Cold medicines are a group of medications taken individually or in combination as a treatment for the symptoms of the common cold and similar conditions of the upper respiratory tract. The term encompasses a broad array of drugs, includin ...
has little support for its use, and is not recommended in children under the age of six.[ There is tentative evidence that ]salbutamol
Salbutamol, also known as albuterol and sold under the brand name Ventolin among others, is a medication that opens up the medium and large airways in the lungs. It is a short-acting β2 adrenergic receptor agonist which works by causing rel ...
may be useful in treating wheezing
A wheeze is a continuous, coarse, whistling sound produced in the respiratory airways during breathing. For wheezes to occur, some part of the respiratory tree must be narrowed or obstructed (for example narrowing of the lower respiratory tract ...
; however, it may result in nervousness and tremors.[ ]Antibiotic
An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting pathogenic bacteria, bacterial infections, and antibiotic medications are widely used in the therapy, ...
s should generally not be used. An exception is when acute bronchitis is due to pertussis
Whooping cough, also known as pertussis or the 100-day cough, is a highly contagious bacterial disease. Initial symptoms are usually similar to those of the common cold with a runny nose, fever, and mild cough, but these are followed by two o ...
.[ Tentative evidence supports ]honey
Honey is a sweet and viscous substance made by several bees, the best-known of which are honey bees. Honey is made and stored to nourish bee colonies. Bees produce honey by gathering and then refining the sugary secretions of plants (primar ...
and pelargonium
''Pelargonium'' () is a genus of flowering plants that includes about 280 species of perennials, succulents, and shrubs, commonly called geraniums, pelargoniums, or storksbills. ''Geranium'' is also the botanical name and common name of a sepa ...
to help with symptoms.[ Getting plenty of rest and drinking enough fluids are often recommended as well. Chinese medicinal herbs are of unclear effect.
]
Epidemiology
Acute bronchitis is one of the most common diseases.[ About 5% of adults are affected, and about 6% of children have at least one episode a year.] It occurs more often in the winter. More than 10 million people in the US visit a doctor each year for this condition, with about 70% receiving antibiotics which are mostly not needed. There are efforts to decrease the use of antibiotics in acute bronchitis. Acute bronchitis is the most common type of bronchitis.[
]
Chronic bronchitis
Chronic bronchitis is a lower respiratory tract disease, defined by a productive cough
A cough is a sudden expulsion of air through the large breathing passages that can help clear them of fluids, irritants, foreign particles and microbes. As a protective reflex, coughing can be repetitive with the cough reflex following three phas ...
that lasts for three months or more per year for at least two years. The cough is sometimes referred to as a ''smoker's cough'' since it often results from smoking. When chronic bronchitis occurs together with decreased airflow it is known as chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease characterized by long-term respiratory symptoms and airflow limitation. The main symptoms include shortness of breath and a cough, which may or may not produce ...
(COPD). Many people with chronic bronchitis have COPD however, most people with COPD do not also have chronic bronchitis. Estimates of the number of people with COPD who have chronic bronchitis are 7 to 40%. Estimates of the number of people who smoke and have chronic bronchitis who also have COPD is 60%.
The term "chronic bronchitis" was used in previous definitions of COPD but is no longer included in the definition. The term is still used clinically.[ While both chronic bronchitis and ]emphysema
Emphysema, or pulmonary emphysema, is a lower respiratory tract disease, characterised by air-filled spaces ( pneumatoses) in the lungs, that can vary in size and may be very large. The spaces are caused by the breakdown of the walls of the a ...
are often associated with COPD, neither is needed to make the diagnosis. A Chinese consensus commented on symptomatic types of COPD that include chronic bronchitis with frequent exacerbations.
Chronic bronchitis is marked by mucus hypersecretion
Mucus ( ) is a slippery aqueous secretion produced by, and covering, mucous membranes. It is typically produced from cells found in mucous glands, although it may also originate from mixed glands, which contain both serous and mucous cells. It is ...
and mucin
Mucins () are a family of high molecular weight, heavily glycosylated proteins ( glycoconjugates) produced by epithelial tissues in most animals. Mucins' key characteristic is their ability to form gels; therefore they are a key component in m ...
s. The excess mucus is produced by an increased number of goblet cell
Goblet cells are simple columnar epithelial cells that secrete gel-forming mucins, like mucin 5AC. The goblet cells mainly use the merocrine method of secretion, secreting vesicles into a duct, but may use apocrine methods, budding off their se ...
s, and enlarged submucosal gland Submucosal glands can refer to various racemose exocrine glands of the mucous type. These glands secrete mucus to facilitate the movement of particles along the body's various tubes, such as the throat and intestines. The mucosa is the lining of the ...
s in response to long-term irritation.[ The mucous glands in the submucosa secrete more than the goblet cells.] Mucins thicken mucus, and their concentration has been found to be high in cases of chronic bronchitis, and also to correlate with the severity of the disease. Excess mucus can narrow the airways, thereby limiting airflow and accelerating the decline in lung function, and result in COPD. Excess mucus shows itself as a chronic productive cough and its severity and volume of sputum can fluctuate in periods of acute exacerbations.[ In COPD, those with the chronic bronchitic phenotype with associated chronic excess mucus, experience a worse quality of life than those without.]
The increased secretions are initially cleared by coughing.[ The cough is often worse soon after awakening, and the sputum produced may have a yellow or green color and may be streaked with specks of blood.] In the early stages, a cough can maintain mucus clearance. However, with continued excessive secretion mucus clearance is impaired, and when the airways become obstructed a cough becomes ineffective. Effective mucociliary clearance
Mucociliary clearance (MCC), mucociliary transport, or the mucociliary escalator, describes the self-clearing mechanism of the airways in the respiratory system. It is one of the two protective processes for the lungs in removing inhaled parti ...
depends on airway hydration, ciliary beating, and the rates of mucin secretion. Each of these factors is impaired in chronic bronchitis. Chronic bronchitis can lead to a higher number of exacerbations and a faster decline in lung function. The ICD-11
The ICD-11 is the eleventh revision of the International Classification of Diseases (ICD). It replaces the ICD-10 as the global standard for recording health information and causes of death. The ICD is developed and annually updated by the World ...
lists chronic bronchitis with emphysema (emphysematous bronchitis) as a "certain specified COPD".
Cause
Most cases of chronic bronchitis are caused by tobacco smoking
Tobacco smoking is the practice of burning tobacco and ingesting the resulting smoke. The smoke may be inhaled, as is done with cigarettes, or simply released from the mouth, as is generally done with pipes and cigars. The practice is belie ...
. Chronic bronchitis in young adults who smoke is associated with a greater chance of developing COPD. There is an association between smoking cannabis
''Cannabis'' () is a genus of flowering plants in the family Cannabaceae. The number of species within the genus is disputed. Three species may be recognized: '' Cannabis sativa'', '' C. indica'', and '' C. ruderalis''. Alternativel ...
and chronic bronchitis. In addition, chronic inhalation of air pollution
Air pollution is the contamination of air due to the presence of substances in the atmosphere that are harmful to the health of humans and other living beings, or cause damage to the climate or to materials. There are many different type ...
, or irritating fumes or dust from hazardous exposures in occupations such as coal mining, grain handling, textile manufacturing, livestock farming, and metal moulding may also be a risk factor for the development of chronic bronchitis. Bronchitis caused in this way is often referred to as industrial bronchitis, or occupational bronchitis. Rarely genetic factors also play a role.
Air quality can also affect the respiratory system with higher levels of nitrogen dioxide
Nitrogen dioxide is a chemical compound with the formula . It is one of several nitrogen oxides. is an intermediate in the industrial synthesis of nitric acid, millions of tons of which are produced each year for use primarily in the productio ...
and sulfur dioxide
Sulfur dioxide ( IUPAC-recommended spelling) or sulphur dioxide (traditional Commonwealth English) is the chemical compound with the formula . It is a toxic gas responsible for the odor of burnt matches. It is released naturally by volcanic ...
contributing to bronchial symptoms. Sulfur dioxide can cause inflammation which can aggravate chronic bronchitis and make infections more likely.
Air pollution in the workplace is the cause of several non-communicable disease
A non-communicable disease (NCD) is a disease that is not transmissible directly from one person to another. NCDs include Parkinson's disease, autoimmune diseases, strokes, most heart diseases, most cancers, diabetes, chronic kidney disease, os ...
s (NCDs) including chronic bronchitis.
Treatment
Decline in lung function in chronic bronchitis may be slowed by stopping smoking. Chronic bronchitis may be treated with a number of medication
A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy ( pharmacotherapy) is an important part of the medical field an ...
s and occasionally oxygen therapy
Oxygen therapy, also known as supplemental oxygen, is the use of oxygen as medical treatment. Acute indications for therapy include hypoxemia (low blood oxygen levels), carbon monoxide toxicity and cluster headache. It may also be prophylactic ...
.[ ]Pulmonary rehabilitation
Pulmonary rehabilitation, also known as respiratory rehabilitation, is an important part of the management and health maintenance of people with chronic respiratory disease who remain symptomatic or continue to have decreased function despite stand ...
may also be used.[
A distinction has been made between ]exacerbation An exacerbation, in medicine, is the worsening of a disease or an increase in its symptoms. Examples includes an acute exacerbation of chronic obstructive pulmonary disease and acute exacerbation of congestive heart failure.
See also
* Flare-up ...
s (sudden worsenings) of chronic bronchitis, and otherwise stable chronic bronchitis. Stable chronic bronchitis can be defined as the normal definition of chronic bronchitis, plus the absence of an acute exacerbation in the previous four weeks. A Cochrane review found that mucolytics
Mucoactive agents are a class of chemical agents that aid in the clearance of mucus or sputum from the upper and lower airways, including the lungs, bronchi, and trachea. Mucoactive drugs include expectorants, mucolytics, mucoregulators, and muco ...
in chronic bronchitis may slightly decrease the chance of developing an exacerbation. The mucolytic guaifenesin
Guaifenesin, also known as glyceryl guaiacolate, is an expectorant medication that aids in the elimination of sputum from the respiratory tract. Chemically it is an ether of guaiacol and glycerine. It is often used in combination with other m ...
is a safe and effective treatment for stable chronic bronchitis. This has an advantage in that it is available as an extended use tablet which lasts for twelve hours. Erdosteine
Erdosteine is a molecule with mucolytic activity. Structurally it is a thiol derivative characterized by the presence of two thiol groups. These two functional sulfhydryl groups contained in the molecule are released following first-pass metab ...
is a mucolytic recommended by NICE. GOLD also supports the use of some mucolytics that are advised against when inhaled corticosteroids are being used, and singles out erdosteine as having good effects regardless of corticosteroid use. Erdosteine also has antioxidant properties. Erdosteine has been shown to significantly reduce the risk of exacerbations, shorten their duration, and hospital stays. In those with the chronic bronchitic phenotype of COPD, the phosphodiesterase-4 inhibitor
A phosphodiesterase-4 inhibitor, commonly referred to as a PDE4 inhibitor, is a drug used to block the degradative action of phosphodiesterase 4 (PDE4) on cyclic adenosine monophosphate (cAMP). It is a member of the larger family of PDE inhibitor ...
roflumilast
Roflumilast, sold under the trade name Daxas among others, is a drug that acts as a selective, long-acting inhibitor of the enzyme phosphodiesterase-4 (PDE-4). It has anti-inflammatory effects and is used as an orally administered drug for the ...
may decrease significant exacerbations.
Epidemiology
Chronic bronchitis affects about 3.4% to 22% of the general population. Individuals over 45 years of age, smokers, those that live or work in areas with high air pollution, and anybody with asthma all have a higher risk of developing chronic bronchitis. This wide range is due to the different definitions of chronic bronchitis that can be diagnosed based on signs and symptoms or the clinical diagnosis of the disorder. Chronic bronchitis tends to affect men more often than women. While the primary risk factor for chronic bronchitis is smoking, there is still a 4%-22% chance that non smokers can get chronic bronchitis. This might suggest other risk factors such as the inhalation of fuels, dusts, fumes and genetic factor.[ In the United States, in 2016, 8.6 million people were diagnosed with chronic bronchitis, and there were 518 reported deaths. Per 100,000 of population the death rate of chronic bronchitis was 0.2.][
]
History
The condition of bronchitis has been recognised for many centuries, in several different cultures including the Ancient Greek, Chinese, and Indian, with the presence of excess phlegm and cough noted in recognition of the same condition. Early treatments of chronic bronchitis included garlic, cinnamon and ipecac
Syrup of ipecac (), or simply ipecac, is a drug that was once widely used as an expectorant (in low doses) and a rapid-acting emetic (in higher doses). It is obtained from the dried rhizome and roots of the ipecacuanha plant (''Carapichea ipecac ...
, among others. Modern treatments were developed during the second half of the 20th century.
In Britain in 1808, a physician Charles Badham
Reverend Charles Badham (18 July 1813 – 27 February 1884) was an English classical philologist, textual critic, headmaster, and university professor, active in England and even more so in Australia.
Early life
Badham was born at Ludlow, Shro ...
was the first person to describe the condition and name the acute form as ''acute bronchitis''. This was written of in a book entitled ''Inflammatory conditions of the bronchia''. In this book Badham distinguished three forms of bronchitis including acute and chronic. A second edition of this book was renamed ''An Essay on Bronchitis'' and published in 1814. Bradham used the term catarrh to refer to the cardinal symptoms of chronic cough and mucus hypersecretion
Mucus ( ) is a slippery aqueous secretion produced by, and covering, mucous membranes. It is typically produced from cells found in mucous glands, although it may also originate from mixed glands, which contain both serous and mucous cells. It is ...
of chronic bronchitis, and described chronic bronchitis as a disabling disorder.
In 1901 an article was published on the treatment of chronic bronchitis in the elderly. The symptoms described have remained unchanged. The cause was thought to be brought on by dampness, cold weather, and foggy conditions, and treatments were aimed towards various cough mixtures, respiratory stimulants, and tonics. It was noted that something other than the weather was thought to be at play. Exacerbations of the condition were also described at this time. Another physician Harry Campbell was referred to who had written in the ''British Medical Journal'' a week before. Campbell had suggested that the cause of chronic bronchitis was due to toxic substances, and recommended pure air, simple food, and exercise to remove them from the body.[
A joint research programme was undertaken in Chicago and London from 1951 to 1953 in which the clinical features of one thousand cases of chronic bronchitis were detailed. The findings were published in the Lancet in 1953.] It was stated that since its introduction by Badham, chronic bronchitis had become an increasingly popular diagnosis. The study had looked at various associations such as the weather, conditions at home, and at work, age of onset, childhood illnesses, smoking habits, and breathlessness. It was concluded that chronic bronchitis invariably led to emphysema, particularly when the bronchitis had persisted for a long time.
In 1957 it was noted that at the time there were many investigations being carried out into chronic bronchitis and emphysema in general, and among industrial workers exposed to dust. Excerpts were published dating from 1864 in which Charles Parsons had noted the occurring consequence of the development of emphysema from bronchitis. This was seen to be not always applicable. His findings were in association with his studies on chronic bronchitis among pottery workers.
A CIBA (now Novartis
Novartis AG is a Swiss-American multinational pharmaceutical corporation based in Basel, Switzerland and
Cambridge, Massachusetts, United States (global research).name="novartis.com">https://www.novartis.com/research-development/research-loc ...
) meeting in 1959, and a meeting of the American Thoracic Society The American Thoracic Society (ATS) is a nonprofit organization focused on improving care for pulmonary diseases, critical illnesses and sleep-related breathing disorders. It was established in 1905 as the
American Sanatorium Association, and ...
in 1962, defined chronic bronchitis as a component of COPD, in the terms that have not changed.
Eosinophilic bronchitis
Eosinophilic bronchitis
Eosinophilic bronchitis (EB) is a type of airway inflammation due to excessive mast cell recruitment and activation in the superficial airways as opposed to the smooth muscles of the airways as seen in asthma. It often results in a chronic cou ...
is a chronic dry cough, defined by the presence of an increased number of a type of white blood cell
White blood cells, also called leukocytes or leucocytes, are the cells of the immune system that are involved in protecting the body against both infectious disease and foreign invaders. All white blood cells are produced and derived from mult ...
known as eosinophil
Eosinophils, sometimes called eosinophiles or, less commonly, acidophils, are a variety of white blood cells (WBCs) and one of the immune system components responsible for combating multicellular parasites and certain infections in vertebrates. ...
s. It has a normal finding on X-ray and has no airflow limitation.
Protracted bacterial bronchitis
Protracted bacterial bronchitis in children, is defined as a chronic productive cough with a positive bronchoalveolar lavage
Bronchoalveolar lavage (BAL) (also known as bronchoalveolar washing) is a diagnostic method of the lower respiratory system in which a bronchoscope is passed through the mouth or nose into an appropriate airway in the lungs, with a measured amoun ...
that resolves with antibiotic
An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting pathogenic bacteria, bacterial infections, and antibiotic medications are widely used in the therapy, ...
s. Protracted bacterial bronchitis is usually caused by ''Streptococcus pneumoniae
''Streptococcus pneumoniae'', or pneumococcus, is a Gram-positive, spherical bacteria, alpha-hemolytic (under aerobic conditions) or beta-hemolytic (under anaerobic conditions), aerotolerant anaerobic member of the genus Streptococcus. They a ...
'', non-typable ''Haemophilus influenzae
''Haemophilus influenzae'' (formerly called Pfeiffer's bacillus or ''Bacillus influenzae'') is a Gram-negative, non-motile, coccobacillary, facultatively anaerobic, capnophilic pathogenic bacterium of the family Pasteurellaceae. The bacte ...
'', or ''Moraxella catarrhalis
''Moraxella catarrhalis'' is a fastidious, nonmotile, Gram-negative, aerobic, oxidase-positive diplococcus that can cause infections of the respiratory system, middle ear, eye, central nervous system, and joints of humans. It causes the i ...
''. Protracted bacterial bronchitis (lasting more than 4 weeks) in children may be helped by antibiotics.
Plastic bronchitis
Plastic bronchitis
Plastic bronchitis (PB) is a disorder in which branching casts of the airways are expectorated. PB is not a single disease with a defined mechanism that explains the cast formation in all conditions. Examples of diseases associated with expectora ...
is a rarely found condition in which thickened secretions plug the bronchi. The plugs are rubbery or plastic-feeling (thus the name). The light-colored plugs take the branching shape of the bronchi that they fill, and are known as ''bronchial casts''. When these casts are coughed up, they are firmer in texture from typical phlegm
Phlegm (; , ''phlégma'', "inflammation", "humour caused by heat") is mucus produced by the respiratory system, excluding that produced by the nasal passages. It often refers to respiratory mucus expelled by coughing, otherwise known as sputum. ...
or the short, softer mucus plugs seen in some people with asthma. However, some people with asthma have larger, firmer, and more complex plugs. These differ from the casts seen in people whose plastic bronchitis is associated with congenital heart disease
A congenital heart defect (CHD), also known as a congenital heart anomaly and congenital heart disease, is a defect in the structure of the heart or great vessels that is present at birth. A congenital heart defect is classed as a cardiovascular ...
or lymphatic vessel abnormalities mainly because eosinophil
Eosinophils, sometimes called eosinophiles or, less commonly, acidophils, are a variety of white blood cells (WBCs) and one of the immune system components responsible for combating multicellular parasites and certain infections in vertebrates. ...
s and Charcot–Leyden crystals Charcot–Leyden crystals are microscopic crystals composed of eosinophil protein galectin-10 found in people who have allergic diseases such as asthma or parasitic infections such as parasitic pneumonia or ascariasis.
Appearance
Charcot–Leyden ...
are present in the asthma-associated casts but not in the others.
Casts obstruct the airflow, and can result in the overinflation of the opposite lung. Plastic bronchitis usually occurs in children. Some cases may result from abnormalities in the lymphatic vessel
The lymphatic vessels (or lymph vessels or lymphatics) are thin-walled vessels (tubes), structured like blood vessels, that carry lymph. As part of the lymphatic system, lymph vessels are complementary to the cardiovascular system. Lymph vess ...
s. Advanced cases may show imaging similarities to bronchiectasis
Bronchiectasis is a disease in which there is permanent enlargement of parts of the airways of the lung. Symptoms typically include a chronic cough with mucus production. Other symptoms include shortness of breath, coughing up blood, and chest ...
.
Aspergillus bronchitis
Aspergillus bronchitis is one of the ''Aspergillosis
Aspergillosis is a fungal infection of usually the lungs, caused by the genus '' Aspergillus'', a common mould that is breathed in frequently from the air around, but does not usually affect most people. It generally occurs in people with lung di ...
'' spectrum of diseases, in which the bronchi are specifically subject to a fungal infection. This differs from the other pulmonary aspergillosis conditions, in that it need not affect just the immunocompromised
Immunodeficiency, also known as immunocompromisation, is a state in which the immune system's ability to fight infectious diseases and cancer is compromised or entirely absent. Most cases are acquired ("secondary") due to extrinsic factors that a ...
.
References
External links
* NIH
The National Institutes of Health, commonly referred to as NIH (with each letter pronounced individually), is the primary agency of the United States government responsible for biomedical and public health research. It was founded in the late 1 ...
entry o
Bronchitis
* MedlinePlus
MedlinePlus is an online information service produced by the United States National Library of Medicine. The service provides curated consumer health information in English and Spanish with select content in additional languages.
The site brings t ...
entries o
Acute bronchitis
an
* Mayo Clinicbr>factsheet on bronchitis
{{Authority control
Chronic lower respiratory diseases
Bronchus disorders
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