Bronchitis Main page
Bronchitis is an inflammation of the bronchi (medium and large size airways). Acute bronchitis is a self-limiting disease usually caused by viruses or bacteria. Chronic bronchitis is a subtype of the chronic obstructive pulmonary disease (COPD), and it is defined as a chronic productive cough for at least three months in two consecutive years, after excluding other causes of chronic cough. The inflammatory response of the bronchial epithelium to infections or irritants that involve the medium and large-sized airways results in thickening of the bronchial and tracheal mucosa. Hallmark features of the pathophysiology of chronic bronchitis include hyperplasia and hypertrophy of the goblet cells of the airway, resulting in an increased mucus secretion, which contributes to the airway obstruction. Microscopically, there is infiltration of the walls of the airway with inflammatory cells, particularly neutrophils. Inflammation is followed by scarring and remodeling that thickens the walls, resulting in narrowing of the small airway. Further progression leads to metaplasia and fibrosis of the lower airway. The consequence of these changes is a limitation of airflow. Acute bronchitis affects young children and old people. Its overall incidence is approximately 5% in the U.S. There is no racial or gender predilection for this disease.Although chronic bronchitis is common among geriatric patients, it occurs more commonly among caucasian individuals compared to other races, and there is no sexual predilection. Age, season of the year and the immunization status are the main determining risk factors for acquiring acute bronchitis. The most potent risk factor in the development of chronic bronchitis is cigarette smoking. Other risk factors are occupational pollutants such as cadmium and silica, air pollutants, and genetic factors such as alpha 1 antitrypsin deficiency Acute bronchitis is a self limiting lower respiratory tract infection that usually presents with cough that lasts for up to 3 weeks. Chronic bronchitis gradually worsens over time and can result in death. The rate of deterioration varies between individuals and depends on the level of airflow obstruction. The prognosis is dependent on early recognition and smoking cessation, which improves the outcome significantly. Smoking cessation, good hand hygiene, vaccination, and a reduction in occupational exposure to known risk factors, are important to ensure decreased severity and risk of bronchitis.
- Acute Bronchitis: may be caused by either viruses, bacteria or environmental factors.
- Viruses: Influenza virus, parainfluenza virus, respiratory syncytial virus, coronavirus, adenovirus, enterovirus, rhinovirus, coxsackievirus, and human metapneumovirus
- Bacteria: Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Bordetella pertussis
- Environmental factors: Toxic fume inhalation, tobacco, dust, and aerosols
- Chronic Bronchitis: may be caused by smoking, air pollutants and occupational exposures in a genetically susceptible person.
Bronchitis is classified into two major categories based on symptom chronicity:
|Organ System||Disease||Symptoms||Signs||Laboratory findings||Diagnostic modality||Management|
|Cardiac||HFpEF||Exertional dyspnea, reduced exercise tolerance, orthopnea, paroxysmal nocturnal dyspnea, edema||Elevated JVP, fine crackles, edema||Increased BNP||Echocardiography (normal EF)||Control of volume overload and hypertension,|
|HFrEF||Exertional dyspnea, reduced exercise tolerance, orthopnea, paroxysmal nocturnal dyspnea, edema||Elevated JVP, fine crackles, edema||Increased BNP||Echocardiography (reduced EF)||Diuretics, ACE inhibitors, ARBs, beta blockers, nitrates|
|Pericardial disease||Exercise intolerance, dyspnea, fatigue||Elevated JVP, pericardial knock, kussmaul's sign, pulsus paradoxus||-||Echocardiography, ECG||Diuretics, pericardiectomy|
|Hypertrophic cardiomyopathy||Dyspnea, chest pain, palpitation, lightheadedness||Systolic murmur||-||Echocardiography, ECG||Beta blockers, verapamil|
|Valvular disease||Edema, fatigue, exercise intolerance, dyspnea, lightheadedness||Cardiac murmur||-||Echocardiography, ECG||Valve repair or replacement, diuretics, beta blockers|
|Pulmonary||Chronic airway disease||Cough, dyspnea, chest pain, exercise intolerance||Tachypnea, respiratory distress, cyanosis, edema, rhonchi and crackles||Hypoxemia, hypercapnea, polycythemia,||PFT, chest imaging||Bronchodilators, corticosteroids, anticholinergics|
|Interstitial lung diseaee||Exercise intolerance, cough||Crackles, clubbing, cyanosis||Hypoxemia||PFT, Chest imaging, lung biopsy||Corticosteroids, bronchodilators|
|Pulmonary hypertension||Dyspnea, fatigue, chest pain, syncope, palpitation||Edema, clubbing, elevated JVP, TR murmur||Elevated BNP, elevated d-dimer||Echocardiography, cardiac cathaterization||Diuretics, calcium channel blockers, endothelin receptor antagonist, phosphodiesterase 5 inhibitor|
|Sleep apnea||Snoring, somnolence, headache, fatigue, irritability||Tachypnea, hypertension, tachycardia||Hypoxemia, polycythemia||Polysomnography||Weight reduction, CPAP|
|Asthma||Dry cough, dyspnea, wheezing||Wheezing, tachypnea||Hypoxemia||PFT||Bronchodilators, corticosteroids, anticholinergics|
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