Bronchitis history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Bronchitis Microchapters
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Overview

Bronchitis is usually a diagnosis of exclusion. Presence of cough without fever lasting more than 5 days and with normal vitals (no tachypnea or tachycardia) is suggestive of acute bronchitis. The presentation may vary according to the pathogen involved.

History

• Bronchitis is common in patients with a history of smoking, low socio-economic status, residing in industrial or heavy pollutant areas, and exposure to toxic substance. Thus, obtaining a personal and socio-economic history is very important.
• Bronchitis is usually a diagnosis of exclusion. Thus, past medical history to rule out asthma, and allergic history is important.

Symptoms

Acute Bronchitis

• Cough with sputum production (clear, yellow, green, or even blood-tinged) is the (commonest) symptom. Initially, it may be difficult to distinguish a acute bronchitis from upper respiratory tract infection. However, a cough lasting > 5 days indicates a diagnosis of Bronchitis. Cough usually last for 1-2 weeks in acute bronchitis. Even after acute bronchitis has cleared, you may have a dry, nagging cough that lingers for several weeks. A yellow-green sputum production is more likely to be a bacterial infection.
• Sore throat, runny nose.
• Fatigue, muscle aches
• Fever -- may suggest pathogens like influenza or adenovirus as causative organisms
• Shortness of breath, worsened by exertion or mild activity
• Wheezing
• Chest discomfort
• Difficulty in breathing and blue discoloration of extremities can be seen in late stages of the disease

Additional symptoms of chronic bronchitis include:

• Ankle, feet, and leg swelling
• Blue-colored lips from low levels of oxygen
• Frequent respiratory infections (such as colds or the flu)

Additional Symptoms Based on Different Pathogens

Influenza Virus, Adenovirus

• Fever, chills, headache, myalgia

Parainfluenza Virus

• Children may present with a hoarse, ringing cough and stridulous, difficult breathing
• Common in autumn season
• Common cause of outbreak in nursing homes.

Respiratory Syncytial Virus

• Common in winter and spring.
• Family history of exposure to an infant with bronchiolitis is important.

Rhinovirus

• Mild symptoms

Bordetella Pertusis

• Commonly affects young adults
• Incubation 1-3 weeks
• Cough lasting > 2 weeks
• Fever uncommon

Mycoplasma Pneumoniae and Chlamydiae Pneumonia

• Subacute onset, 2-3 week (helps in differentiating from Influenza)
• Common in closed environment (military bases, schools, hostels)

Chronic Bronchitis

• Cough with sputum expectoration for at least 3 months a year during a period of 2 consecutive years. The patient may give a history of seasonal worsening of cough (winters)followed by progression of cough from seasonal to perennial, increased frequency, duration and severity of symptoms.
• Difficulty in breathing and blue discoloration of extremities can be seen in late stages of the disease.
• Shortness of breath, worsened by exertion or mild activity
• Wheezing
• Chest discomfort