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What is bronchitis?

Bronchitis means that the tubes that carry air to the lungs (the bronchial tubes) are inflamed
and irritated. When this happens, the tubes swell and produce mucus. This makes you cough.
There are two types of bronchitis:
Acute bronchitis usually comes on quickly and gets better after 2 to 3 weeks. Most
healthy people who get acute bronchitis get better without any problems. See a picture
of acute bronchitis .
Chronic bronchitis keeps coming back and can last a long time, especially in people
who smoke. Chronic bronchitis means you have a cough with mucus most days of the
month for 3 months of the year for at least 2 years in a row.
This topic focuses on acute bronchitis. Both children and adults can get acute bronchitis.
What causes acute bronchitis?
Acute bronchitis is usually caused by a virus. Often a person gets acute bronchitis after
having an upper respiratory tract infection such as a cold or the flu. In rare cases, acute
bronchitis is caused by bacteria.
Acute bronchitis also can be caused by breathing in things that irritate the bronchial tubes,
such as smoke. It also can happen if a person inhales food or vomit into the lungs.
What are the symptoms?
The most common symptom of acute bronchitis is a cough that is dry and hacking at first.
After a few days, the cough may bring up mucus. You may have a low fever and feel tired.
Acute bronchitis symptoms usually start 3 or 4 days after an upper respiratory tract infection.
Most people get better in 2 to 3 weeks. But some people continue to have a cough for more
than 4 weeks.
Pneumonia can have symptoms like acute bronchitis. Because pneumonia can be serious, it is
important to know the differences between the two illnesses. Symptoms of pneumonia can
include a high fever, shaking chills, and shortness of breath.
How is acute bronchitis diagnosed?
Your doctor will ask you about your symptoms and examine you. This usually gives the
doctor enough information to find out if you have acute bronchitis.
In some cases, the doctor may take a chest X-ray to make sure that you don't have pneumonia
or another lung problem.
How is it treated?
Most people can treat symptoms of acute bronchitis at home. Drink plenty of fluids. Use an
over-the-counter cough medicine with an expectorant if your doctor recommends it. This can
help you bring up mucus when you cough. Suck on cough drops or hard candies to soothe a
dry or sore throat. Cough drops won't stop your cough, but they may make your throat feel

Acute Bronchitis
(Version franaise disponible)
What is acute bronchitis?
Bronchitis is swelling and irritation in the air passagesthat is, the tubes that connect the
windpipe to the lungs. It causes swelling and irritation of the airways. With acute bronchitis
you usually have a cough that produces phlegm, and pain behind the breastbone when you
breathe deeply or cough.
How does it occur?
Bronchitis often occurs with viral infections of the respiratory tract, such as colds and flu.
Bronchitis may also be caused by bacterial infections. It may occur with childhood illnesses
such as measles and whooping cough.
Attacks are most frequent during the winter or when t

Attacks are most frequent during the winter or when the level of air pollution is high.
Infants, young children, older adults, smokers, and people with heart or lung (including
asthma and allergies) are most likely to get acute bronchitis.
What are the symptoms?
Symptoms may include:
A deep cough that produces yellowish or greenish phlegm
Pain behind the breastbone when you breathe deeply or cough
Feeling short of breath
How is it diagnosed?
Your health care provider will examine you and ask about your symptoms. You may have
tests, such as:
A test of phlegm to look for bacteria
Chest x-ray
Blood tests
How is it treated?
Acute bronchitis often does not require medical treatment. All you may need to do to get
in a few days is:
* Rest at home.
* Drinking more liquids (water or tea) to help you cough up mucus more easily.
If your symptoms are severe or you have other health problems (such as heart or lung disease
or diabetes), you may need to take antibiotics. If you are having wheezing, you may need an
inhaler medicine to make it easier to breathe.
How long
How long will the effects last?
Most of the time acute bronchitis clears up in a few days. Your cough may slowly get better
in 1 to 2 weeks.
It may take you longer to recover if:
You are a smoker.
You live in an area where air pollution is a problem.
You have a heart or lung disease, including asthma.
You have any other on-going health problems.
How can I take care of myself?
You can help yourself by:
Following the full treatment your health care provider recommends
Using a humidifier or steam from hot water to add moisture to the air
Drinking plenty of liquids
Taking cough medicine if recommended by your health care provider
Resting in bed
Taking aspirin or acetaminophen to reduce fever and relieve headache and muscle pain
(Check with your healthcare provider before you give any medicine that contains aspirin or
salicylates to a child or teen. This includes medicines like baby aspirin, some cold medicines,
and Pepto-Bismol. Children and teens who take aspirin are at risk for a serious illness called
Reye's syndrome.)
Eating healthy meals
Call your health care provider if:
You have trouble breathing.
You have a fever higher than 38.6 C (101.5 F).
You cough up blood.
You don't begin to feel better in 3 days of treatment.
You have any symptoms that concern you
How can I help prevent acute bronchitis?
To reduce your risk of getting a respiratory infection:
Don't smoke.
Avoid secondhandsmoke.
Wash your hands often, especially when you are around people with colds (upper
respiratory infections).
If you have asthma or allergies, keep your symptoms under good control.
Get regular exercise.
Eat healthy foods.
Developed by McKesson Corporation Published by McKesson Corporation.
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Acute bronchitis is a clinical term implying a self-limited inflammation of the large airways of the
lung that is characterized by cough without pneumonia. The disorder affects approximately 5% of
adults annually,1,2 with a higher incidence observed during the winter and fall than in the summer
and spring. In the United States, acute bronchitis is the ninth most common illness among
outpatients, as reported by physicians. 3 Viruses are usually considered the cause of acute bronchitis
but have been isolated in a minority of patients.1,4 Those isolated in acute bronchitis (from the most
to the least common in large series) include influenza A and B viruses, parainfluenza virus,
respiratory syncytial virus, coronavirus, adenovirus, and rhinovirus. Human metapneumovirus has
been identified as a causative agent.5-7 A recent French study involving adults who had been
vaccinated against influenza showed a viral cause in 37% of 164 cases of acute bronchitis, of which
21% were rhinovirus.4 Thus, the yield of specific pathogens varies according to several factors,
including the presence or absence of an epidemic, the season of the year, and the influenza
vaccination status of the population.Bacterial species commonly implicated in community-acquired
pneumonias are isolated from the sputum in a minority of patients with acute bronchitis.1

However, the role of these species in the disease or its attendant symptoms remains unclear,
because bronchial biopsies have not shown bacterial invasion. In some cases, atypical
bacteria are important causes, including Bordetella pertussis, Chlamydophila (Chlamydia)
pneumoniae, and Mycoplasma pneumoniae.1 Some data have suggested that B. Pertussis may
underlie 13 to 32% of cases of cough lasting 6 days or longer, although in a recent
prospective study, B. pertussis comprised only 1% of cases of acute bronchitis.8

Acute bronchitis is thought to reflect an inflammatory response to infections of the
epithelium of the bronchi. Epithelial-cell desquamation and denuding of the airway to the
level of the basement membrane in association with the presence of a lymphocytic cellular
infiltrate have been demonstrated after influenza A tracheobronchitis9;

microscopical examination has shown thickening of the bronchial and tracheal mucosa
corresponding to the inflamed areas. Such pathological findings are consistent with reports of
proximal lower airway inflammation confined to the bronchi, as detected by positron-
emission tomography with 18F-fluorodeoxyglucose as a tracer, in the setting of acute
bronchitis.10 However, there are wide variations in the anatomical distribution of many
pathogens that cause acute bronchitis. In a study involving volunteers exposed to rhinovirus
infections, for example, virus was detected in specimens of induced sputum
obtained from all the subjects, in approximately one third of bronchial biopsy specimens,
in almost a quarter of bronchoalveolar lavage specimens, and in more than a third of
bronchial brushing specimens.11 Such data indicating viral
infection of the lower airways may help to explain the relationship observed between
rhinovirus infection (and other presumed upper respiratory
viral infections) and exacerbation of asthma.12 Thus, although its name suggests only large-
airway disease, acute bronchitis may be accompanied by an array of symptoms, depending on
the degree of viral involvement of the large and small airways.

Natural History
During the first few days of infection, the symptoms of mild upper respiratory infections
cannot be distinguished from those of acute bronchitis. However, with acute bronchitis,
coughing persists for more than 5 days, and during this protracted period the results of
pulmonary function testing may become abnormal. Forty percent of patients have significant
reductions in the forced expiratory volume in 1 second (i.e., a value below 80% of the
predicted value)13 or bronchial hyperreactivity, as measured by bronchial provocation,14
with improvement during the following 5 to 6 weeks. Cough after acute bronchitis typically
persists for 10 to 20 days but occasionally may last for 4 or
more weeks. In a recent report on a clinical trial of the efficacy of an acellular pertussis
vaccine involving

2781 healthy adults, the median duration of cough from acute bronchitis due to all causes was
18 days (mean, 24).8 In addition, approximately 50% of patients with acute bronchitis report
the production of purulent sputum. In otherwise healthy patients, purulent sputum usually
indicates the presence of sloughed tracheobronchialepithelium and inflammatory cells, and its

predictive value for the presence of alveolar disease is low (approximately 10%).15 A study
of the quality of life of patients with upper respiratory tract infections, some of whomhad
received a diagnosis of acute bronchitis, showed significant decrements in seven subscales
of the Medical Outcomes Study 36-item Short- Form General Health Survey, including
vitality and social functioning,16 but such decrements are presumed to be transient. Data on
short- or long-term outcomes are limited, but one study indicated that within a month after
the initial visit, up to 20% of patients had reconsulted their physicians because of persistent or
recurrent symptoms.1 The effect of an episode of acute bronchitis on a patientsubsequent
lung health is uncertain. In one
study, 34% of patients with acute bronchitis received a new diagnosis of chronicbronchitis or
asthma at 3 years of follow-up.17 In another study, mild bronchial asthma was diagnosed on
the basis of spirometry or bronchial provocation in 65% of patients with recurrent episodes of
acute bronchitis.
8 However, these studies lacked control groups, and it is unclear whether acute bronchitis led
directly to the chronic condition or whether the chronic disorder or the propensity for its
development was present at the time of the inflammation of the large airway.

Strategies and Evidence

Acute bronchitis should be differentiated from acute inflammation of the small airways
asthma or bronchiolitis which typically presents as progressive cough accompanied by
wheezing, tachypnea, respiratory distress, and hypoxemia. It should also be distinguished
from bronchiectasis, 19 a distinct phenomenon associated with permanent dilatation of
bronchi and chronic cough. The diagnosis of chronic bronchitis is reserved for patients who
have cough and sputum production on most days of the month for at least 3 months of the
year during 2 consecutive years.20 The acute exacerbation of chronic bronchitis, identified by
the worsening air flow and symptoms in such patients, is not discussed here. A careful history
taking, including reports of contact with ill people, and physical examination may suggest a
specific cause (Table 1). A common presentation of pertussis is cough of 2 to 3 weeks
duration in an adolescent or young adult; fever is less common in pertussis than in viral
bronchitis. 18,26 However, in the absence of an epidemic, the positive predictive value of
young age, prolonged cough, or the absence of fever is low for pertussis. During an epidemic
of influenza, the finding of both cough and fever was reported to vital signs and the absence
of rales and egophony on chest examination minimize the likelihood of
pneumonia to the point at which further diagnostic testing is usually unnecessary.28 An
exception, however, is cough in elderly patients; pneumonia in elderly patients is often
characterized by an absence of distinctive signs and symptoms. Among patients 75 years of
age or older who had community- acquired pneumonia, only 30% had a temperature above
38C, and only 37% had a heart rate of more than 100 beats per minute.2 Rapid diagnostic
tests exist for several pathogens

currently linked to acute bronchitis. However,
not all the rapid tests are widely available, and their routine use is not cost-effective in an
outpatient setting. Rapid tests should be used primarily when the suspected organism is
treatable, the infection is known to be circulating in the community,
and the patient has suggestive symptoms or signs (e.g., testing for influenza during influenza
season in patients with cough and fever) (Table 1). Multiplex polymerase-chain-reaction
(PCR) testing of nasopharyngeal swabs or aspirates is being developed to diagnose infections
resulting from B. pertussis, M. pneumoniae, or C. pneumoniae with clinically useful
sensitivity and specificity, as compared with culture or monoplex PCR.30

Antimicrobial Therapy
Antimicrobial agents are not recommended in most cases of acute bronchitis. Systematic
analyses of clinical trials have suggested that antibiotics may reduce the duration of
symptoms, but at best modestly. Specifically, a meta-analysis of eight trials involving
patients with acute bronchitis suggested that symptoms were reduced by a fraction a day with
the use of erythromycin, doxycycline, or trimethoprim
sulfamethoxazole. The results were statistically significant but clinically trivial.31 Results of
a randomized, double-blind trial comparing a 5-day course of azithromycin in 112 patients
with vitamin C in 108 patients (total dose of
each agent, 1.5 g), published after the meta-analysis had been completed, showed no
difference between groups in the health-related quality of life at 7 days (the primary outcome)
or in the proportionof patients who returned to work, school, or usual activities at home on
day 3 or 7.32 A Cochrane Review of nine randomized, controlled trials of antibiotic agents
(including three trials not included in the previous review31) alsoshowed a significant but
minor reduction in the duration of cough (0.6 day).33 There was a nonsignificant reduction in
the number of days of feeling ill and a nonsignificant increase in adverse events attributed to
antibiotics (relative risk of adverse events, 1.22; 95% confidence interval, 0.94 to 1.58).
Antimicrobial therapy may be more beneficial when a treatable pathogen is identified than
when a treatable pathogen is not identified. For example, anti-influenza agents (including
oseltamivir and zanamivir) decrease the duration of symptoms by approximately 1 day and
result in an earlier return to normal activity (by 0.5 day) among patients with infections
caused by susceptible viruses.
Prompt antibiotic treatment of patients with pertussis is indicated to limit transmission, but
(with the possible exception of therapy initiated during the first week of symptoms) there are
no compelling data to support the prospect that cough will be less severe or less prolonged
with antibiotic therapy. Similarly, although several classes
of antibiotics have in vitro activity against M. pneumoniae and C. pneumoniae, it is unclear
whether antibiotic treatment of bronchitis linked to these organisms influences outcomes.
Table 1 includes suggested antimicrobial therapy for cases in which such therapy is

Other Therapy
The few randomized, placebo-controlled trials that have examined the effect of 2-agonists
administered orally or by aerosol for cough associated with acute bronchitis have involved
small numbers ofpatients and have had mixed results.34-36 In these studies, among patients
without preexisting lung disease, daily cough scores and the likelihood of persistent cough
after 7 days did not differ significantly between the active treatment and placebo groups.
However, in one trial, a subgroup of patients with evidence of airflow limitation had
significantly lower scores for symptoms on day 2 after treatment with 2-agonists.34 A
recent Cochrane Review of five trials involving 418 adults showed that even among patients
with airflow obstruction, the potential benefit of 2-agonists is not well supported and should
be balanced against the adverse effects of treatment.37 In practice, a brief trial (7 days) of
inhaled or oral corticosteroids may be reasonable for troublesome cough (i.e., cough
persisting for more than 20 days), but there are no clinical trial data to support this approach.

Acute bronchitis
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Acute Bronchitis
Classification and external resources

This image shows the consequences of acute bronchitis.
ICD-10 J20-J21
ICD-9 466
MedlinePlus 001087
eMedicine article/297108
MeSH D001991
Acute bronchitis is an inflammation of the large bronchi (medium-size airways) in the lungs
that is usually caused by viruses or bacteria and may last several days or weeks.

Characteristic symptoms include cough, sputum (phlegm) production, and shortness of breath
and wheezing related to the obstruction of the inflamed airways. Diagnosis is by clinical
examination and sometimes microbiological examination of the phlegm. Treatment for acute
bronchitis is typically symptomatic. As viruses cause most cases of acute bronchitis,
antibiotics should not be used unless microscopic examination of gram-stained sputum
reveals large numbers of bacteria.
1 Signs and symptoms
2 Cause
3 Diagnosis
4 Prevention
5 Treatment
o 5.1 Antibiotics
o 5.2 Smoking cessation
o 5.3 Antihistamines
6 Prognosis
7 References
8 External links
Signs and symptoms
Bronchitis may be indicated by an expectorating cough, shortness of breath (dyspnea), and
wheezing. On occasion, chest pains, fever, and fatigue or malaise may also occur. In addition,
bronchitis caused by Adenoviridae may cause systemic and gastrointestinal symptoms as well.
However, the coughs due to bronchitis can continue for up to three weeks or more even after
all other symptoms have subsided.
Acute bronchitis can be caused by contagious pathogens, most commonly viruses. Typical
viruses include respiratory syncytial virus, rhinovirus, influenza, and others. Bacteria are
uncommon pathogens but may include Mycoplasma pneumoniae, Chlamydophila
pneumoniae, Bordetella pertussis, Streptococcus pneumoniae, and Haemophilus
[citation needed]

Damage caused by irritation of the airways leads to inflammation and leads to neutrophils
infiltrating the lung tissue.
Mucosal hypersecretion is promoted by a substance released by neutrophils.
Further obstruction to the airways is caused by more goblet cells in the small airways. This is
typical of chronic bronchitis.
Although infection is not the reason or cause of chronic bronchitis, it is seen to aid in
sustaining the bronchitis.
A physical examination will often reveal decreased intensity of breath sounds, wheezing,
rhonchi, and prolonged expiration. Most physicians rely on the presence of a persistent dry or
wet cough as evidence of bronchitis.
A variety of tests may be performed in patients presenting with cough and shortness of
A chest X-ray that reveals hyperinflation; collapse and consolidation of lung areas would
support a diagnosis of pneumonia. Some conditions that predispose to bronchitis may be
indicated by chest radiography.
A sputum sample showing neutrophil granulocytes (inflammatory white blood cells) and
culture showing that has pathogenic microorganisms such as Streptococcus species
A blood test would indicate inflammation (as indicated by a raised white blood cell count
and elevated C-reactive protein).
In 1985, University of Newcastle, Australia Professor Robert Clancy developed an oral
vaccine for Haemophilus influenza. This vaccine was commercialised four years later.

Only about 5-10% of bronchitis cases are caused by a bacterial infection. Most cases of
bronchitis are caused by a viral infection and are self-limited and resolve themselves in a few
weeks. Acute bronchitis should not be treated with antibiotics unless microscopic
examination of the sputum reveals large numbers of bacteria. Treating non-bacterial illnesses
with antibiotics leads to the promotion of antibiotic-resistant bacteria, which increase
morbidity and mortality.

Smoking cessation
For more details on this topic, see Smoking cessation.
Many physicians recommend that, to help the bronchial tree heal faster and not make
bronchitis worse, smokers should quit smoking completely in order to allow their lungs to
recover from the layer of tar that builds up over time.
An effect of antihistamines is to thicken mucus secretions. Expelling infected mucus via
coughing can be beneficial in recovering from bronchitis. Expulsion of the mucus may be
hindered if it is thickened. Antihistamines can help bacteria to persist
and multiply in the
lungs by increasing its residence time in a warm, moist environment of thickened mucus.
Acute bronchitis usually lasts a few days or weeks.
It may accompany or closely follow a
cold or the flu, or may occur on its own. Bronchitis usually begins with a dry cough,
including waking the sufferer at night. After a few days, it progresses to a wetter or
productive cough, which may be accompanied by fever, fatigue, and headache. The fever,
fatigue, and malaise may last only a few days; but the wet cough may last up to several weeks.
Should the cough last longer than a month, some physicians may issue a referral to an
otorhinolaryngologist (ear, nose and throat doctor) to see if a condition other than bronchitis
is causing the irritation. It is possible that having irritated bronchial tubes for as long as a few
months may inspire asthmatic conditions in some patients.
In addition, if one starts coughing mucus tinged with blood, one should see a physician. In
rare cases, physicians may conduct tests to see whether the cause of the bloody sputum is a
serious condition such as tuberculosis or lung cancer.