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Bronchitis

Is inflammation of the lining of the bronchial tubes, which connect the trachea to the lungs. This sensitive tissue that produces mucus, covers and protects the respiratory system, organs and tissues involved in breathing. When a person is suffering from bronchitis, may be more difficult for the air to perform its normal route in and out of the lungs, the tissues become irritated and the result is to produce more mucus. The most common symptom of bronchitis is a cough.

When you inhale or get air breathing, tiny villi near the hole in your nostrils filter out dust, pollen and other bacteria that breed in the air. Other particles are not filtered in this process will adhere to the surface of mucous membrane called cilia. But sometimes the germs pass through the cilia and other defense systems in the respiratory tract causing the disease. 

Bronchitis can be acute or chronic. An acute medical condition occurs rapidly and can cause severe symptoms, but is of short duration (less than a few weeks). Acute bronchitis is caused by a number of viruses that can infect the respiratory tract and attack the bronchial tubes. The infection can also cause some bacteria cause acute bronchitis. Most people have acute bronchitis at some point in their lives. 
On the other hand, chronic bronchitis can be mild or severe, and lasts longer - from several months to years. With chronic bronchitis, the bronchial tubes continue inflamed (red and swollen), irritated, and eventually produce excess mucus. The most common cause of chronic bronchitis is smoking. 
People suffering from chronic bronchitis are more susceptible to bacterial infections in the airways and lungs, such as pneumonia. (In some people with chronic bronchitis, the airways are permanently infected with bacteria). Pneumonia is more common among people who smoke or are exposed to smoke from smokers. 

What are the symptoms?

Bronchitis usually begins with a dry, hacking cough that is caused by inflammation of the lining of the bronchial tubes. Other symptoms may include: 

• A cough that may bring thick white mucus, yellow or greenish
• Headache
• general ill feeling (a)
• Chills
• Difficulty breathing
• Hoarseness or a feeling of tightness in the chest
• Wheezing (wheezing), labored breathing

Chronic bronchitis is more common among smokers, although people have repeated episodes of acute bronchitis sometimes develop the chronic condition. Except for chills and fever, a person with chronic bronchitis, is suffering from a chronic cough, and most of the symptoms include difficulty breathing and chest tightness during most days of the month or months of the year . 
A person with chronic bronchitis often takes longer than normal to recover from colds and other common respiratory illnesses. Wheezing, difficulty breathing and coughing can become part of daily life. Breathing can become difficult. 
In people with asthma, bronchitis outbreaks can begin suddenly and trigger episodes in those who experience chest tightness, difficulty breathing, wheezing and difficulty exhaling (expel air).During a severe episode of asthmatic bronchitis air ducts may shrink and become congested making breathing difficult. 

What causes bronchitis?

Acute bronchitis is usually caused by viruses and can occur during or after other respiratory infections. Germs such as viruses can be spread between people by coughing. Equally, they can also spread when you touch your mouth, nose, or eyes after coming into contact with respiratory flows from an infected person. 
Smoking (even if for a short period) and be in contact with cigarette smoke, chemical fumes and other pollutants in the air for long periods of time, exposes people to the risk of developing chronic bronchitis. 
Some people who suffer from repeated bouts of bronchitis - accompanied by coughing, wheezing and difficulty breathing - you may have asthma. 

What can doctors do?

If a doctor thinks you have bronchitis, he or she will examine you and hear the sound coming from your chest with a stethoscope for signs of wheezing and congestion. 

Besides a physical exam, the doctor will ask about any concerns or symptoms you may have, your past health, your family's health, the medications you are taking, allergies you might have and other issues such as if you smoke. This type of information is known as medical history.Your doctor can order a radiograph to rule out a condition called pneumonia, and can even order a breathing test (called spirometry) to rule out asthma. 

Because acute bronchitis is usually caused by a virus, the doctor may not prescribe an antibiotic (because antibiotics fight bacteria but not viruses). 

The doctor will recommend you drink plenty of fluids, rest and may suggest that you take cough medicine sales in pharmacies or stronger prescription to relieve your symptoms as you recover. 

In some cases, may prescribe a bronchodilator or other medication typically used to treat asthma. These drugs generally are administered through inhalers or nebulizadore to help relax and open up the bronchial tubes and remove mucus to make it easier to breathe. 
If you suffer from chronic bronchitis, the goal is to reduce your exposure to any agent that irritates your bronchial tubes. For people who smoke, this means that should stop the habit!Quitting smoking can be difficult, therefore, we recommend that oppress the Resources section to access articles that may help with this issue. 
If you suffer from bronchitis but not smoking, avoiding exposure to smoke from other smokers. 

Smoking and bronchitis

Snuff smoke causes more than 80 per cent of cases of chronic bronchitis. People who smoke tend to have a harder time recovering from acute bronchitis and other respiratory infections. 
Smoking causes damage to the lungs in different ways. For example, can cause temporary paralysis of the cilia, and eventually completely destroys the fabric of cilia lining the airways.Eventually, this tissue fails to protect the channels of particles from the snuff, including irritants and excess mucus. When this happens, the lungs of smokers (a), become even more vulnerable to infection. Over time, the harmful substances of snuff permanently damage the airways, increasing the risk of developing emphysema, cancer and other serious lung diseases.Smoking also causes the mucus-producing glands responsible for increase in size and produce more mucus. The toxic particles and chemicals from cigarettes, can cause chronic cough in people who suffer. 
What is the best way to prevent bronchitis? Wash hands frequently usually helps prevent the spread of germs that cause the condition - especially during cold season. If you do not smoke, do not start ever - and if you smoke, try to reduce how much you smoke. Try not to be around smokers because even snuff the smoke coming from the people who smoke makes you more susceptible to viral infections and increase congestion in your airway. Also, make sure you get enough rest and feed you well for your body to defend against diseases that can be exposed. 
Reviewed by: Aaron Chidekel, MD 
Revision Date: October 2007 
It is an inflammation of the main airways to the lungs (bronchi) and which usually lasts for a short time. 
It is not the same as chronic bronchitis, which often persists for a longer time period. 

Causes, incidence and risk factors:

Acute bronchitis is one of the most common conditions seen in medical offices and is mainly caused by a virus that infects the respiratory system. There are many different respiratory viruses that can do this, including the rhinovirus, which causes the common cold. 

The person is at increased risk for bronchitis if you've suffered an illness or a recent respiratory infection (which reduces their ability to fight infection) or have chronic lung problems like asthma, cystic fibrosis or chronic obstructive pulmonary disease. Similarly, the risk of bronchitis if you smoke. 

Lungs 

Bronchitis 

Lung anatomy 

Bronchitis and Normal Condition in Tertiary Bronchus 

Respiratory System 

• Review Date: 5/20/2007
• English version Reviewed By: Allen J. Blaivas, DO, Pulmonary, Critical Care, and Sleep Medicine, Department of Veteran Affairs, VA New Jersey Health Care System, East Orange, NJ. Review provided by VeriMed Healthcare Network.
• translation and localization by: Greenville Hospital Inc

References

Knutson D. Diagnosis and Management of Acute Bronchitis. Am Fam Physician. May 2002, 65 (10): 2039-44. 

Aagaard E. Management of Acute Bronchitis in Healthy Adults. Infect Dis Clin North Am Dec 2004, 18 (4): 919-37. 

American Academy of Pediatrics. Cough Illness / Bronchitis. In: Pickering LK, ed. Red Book: 2003 Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2003:696. 

The infection of the bronchial tree can affect respiratory function in various ways, depending on previous attacks of bronchial mucosa, especially those in the respiratory tract disorders from exposure to external agents. It is important to distinguish between acute infection that occurs in previously healthy individuals and acute infectious exacerbations of chronic respiratory disorder.

ACUTE BRONCHITIS

Acute bronchitis is an inflammatory response of the bronchial tree due to an infectious process.It occurs usually in winter periods during which increase respiratory infectious diseases known. 

The most common etiologic agent are viruses: influenza and parainfluenza, adenovirus, rhinovirus, respiratory syncytial virus and myxoviruses. As non-viral infectious agents include Mycoplasma pneumoniae, Bordetella pertussis and Chlamydia pneumoniae. The role of Streptococcus pneumoniae and Haemophilus influenzae is not easy to confirm because these pathogens are common residents of the upper airway. Apart from whooping cough, is extremely rare primary acute bacterial bronchitis. 
It is possible that the severity of the attacks were related to smoking and exposure to toxic gases. These factors may be responsible for a permanent injury which facilitate respiratory tract infection acute episode. 
Acute bronchitis should not be confused with an exacerbation of chronic bronchitis, because the management is different (Table 1). 

Symptoms and Diagnosis

The first symptoms are those of the preceding upper respiratory infection: malaise, coryza, headache, sore throat and hoarseness. The most prominent symptom is persistent cough, dry, painful, retrosternal pain and paroxysmal. The fever is presented according to the official to the table. Usually the mucous and sputum is scanty. 
In patients without other underlying lung disease, dyspnea and cyanosis were absent. Physical examination found bilateral little hoarse without any evidence of consolidation. 
Laboratory tests indicate a normal or slightly elevated count of white blood cells without neutrophilia. The chest radiograph is normal. 
In the section for exacerbation of chronic bronchitis are discussed sputum examination. 
Table No.1

FEATURES OF ACUTE BRONCHITIS 
Type Bronchitis Causes Symptoms Duration 
Acute Bronchitis cough 
Mucus - 
History of upper tract infection viral Usually 1-2 weeks 

Exacerbation of chronic bronchitis, increased cough 
sputum production in chronic 
Dyspnea 
No history of previous infection of the upper airways bacterial Usually 1-2 weeks 

TREATMENT

Treatment of acute bronchitis requires only supportive measures if the cough is very annoying and painful. Codeine or dextromethorphan are indicated, without seeking to abolish it entirely, because the cough is a protective mechanism to remove bronchial secretions. Also, decongestants and antihistamines to relieve symptoms such as runny nose, should be used carefully because eventually dry out bronchial secretions to hinder removal. Therefore, oral hydration is recommended. Aspirin relieves the symptoms induced by inflammation and fever.If the patient breathes with difficulty, and expiratory flow has shown prolonged bronchodilator therapy with inhaled beta agonist such as salbutamol or terbutaline. 

Antibiotics should not be used routinely. Are only indicated if signs and findings of a secondary bacterial infection. In this case, antibiotic therapy is based on the findings of sputum Gram, if this is not possible we suggest the use of erythromycin, 500 mg every 8 hours for 7 to 10 days, since it is active not only against S. pneumoniae but also against Mycoplasma peumoniae. The trimethoprim sulfamethoxazole (160/800 mg twice daily for 7 days), may be the alternative, as it is effective against three of the most common pathogens (S. pneumoniae, H. influenzae and Moraxella catarrhalis). 

Acute exacerbation of chronic bronchitis

Chronic bronchitis is defined by the American Thoracic Society, is a disorder characterized by excessive secretion of mucus and is manifested by chronic or recurrent productive cough for several days, for at least three months a year, over a period of not less than two successive years, except for disorders with similar manifestations as bronchiectasis, asthma, or tuberculosis. From the pathological point of view, the hallmark of chronic bronchitis are the hyperplastic and hypertrophic mucous glands of the submucosa of the large bronchi. 
Etiologically this type of bronchitis is related to smoking. The prevalence of the disease in smokers is about four times higher than subjects without this habit. Other factors involved in the evolution of the disease are environmental pollution and occupational exposure, especially to inorganic dust. In our country cooking with wood in poorly ventilated spaces is a major cause in women with no history of smoking. 
Chronic bronchial disease predisposes patients to more frequent and severe episodes of acute bronchitis, which thereby increases the rates of hospitalization, increases the incidence of infection and impairs respiratory conditions. 

PATHOPHYSIOLOGY

Chronic bronchitis is more common in men than in women and its prevalence is highest among people older than forty. The structures that suffer the most severe anatomic changes are the conducting airways, especially the peripheral. As a result of chronic inflammation, vasodilation, congestion and mucosal edema, bronchial walls tighten, and establishing the obstruction. If irritation persists, bronchial glands are enlarged and increases the number of goblet cells, resulting in excessive production of mucus. The cilia lining the tracheobronchial tree decreased in number and peripheral bronchi totally or partially occluded by mucus plugs, causing hyperinflation of the alveoli. 

The pathological and physiological changes of the bronchial system predisposing the patient to bacterial infection, probably by the synergistic effect caused by the mucociliary disorder, the decline in lung defense mechanisms, bronchial obstruction and the chronic presence of bacteria in the bronchial epithelium. 
The chronic colonization by H. influenza and pneumococcal show at least 50% of those infected. Other bacteria such as Staphylococcus pneumoniae and Gram-negative bacilli are less common (5-10%). Mycoplasma pneumoniae can occasionally be identified. The viruses are also common in winter seasons. 

CLINICAL

The symptoms of an acute exacerbation is not always easy to detect but the key findings focus on the observation of changes in the sputum (color and consistency), the increase in frequency as well as the severity of cough. In addition, the patient complains of malaise and fever. On physical examination are audible gasps, grunts and little wheezing. 

DIAGNOSIS

It is based on clinical findings, chest radiography and sputum examination. The chest radiograph may reveal other pulmonary diseases such as pneumonia or pleurisy. 
As for the sputum to perform the extended or the Gram-stained culture is considered useful only if at least ten cells are observed squamous and over 25 leukocytes per field. You can go to the aid of bronchial brushing bronchoscopy, if the clinical picture warrants. 





SYMPTOMS

TREATMENT AND RECOMMENDATIONS

The appropriate medical management and a healthy lifestyle can help people with the disease to enjoy a better quality of life, increase tolerance to regular physical activity and reduce the prospects of complications. 

1. Medication-Bronchodilators: By relaxing and widening of the bronchi, these drugs allow more oxygen enters the lungs. There bronchodilators as liquids, tablets or sprays. Vaccines. Since some common diseases, relatively mild in other patients, may present serious health risks to patients, often recommended in these patients an influenza vaccine (given in October or November before the start of flu season) and a vaccine pneumonia (one injection at one time).Antibiotics may be necessary to treat an acute respiratory infection and in some cases, to help prevent bacterial infection. 

2. Exercise: A program of moderate exercise under medical supervision can help patients to lead more active lives. The physical form can not improve lung function but may increase a person's tolerance to effort, to allow the heart and other muscles use oxygen more efficiently available. Sometimes you may need a bronchodilator medication before a workout. They are very important breathing exercises to increase strength and endurance of the muscles that control inspiration and expiration as well as techniques to help clear the lungs of mucus. 

3. Nutrition and hydration: good nutritional habits play an important role in fitness and resistance to infection. Patients who experience dyspnea while eating, can better tolerate small, frequent meals. 

Now under investigation may improve the quality of life of people who develop chronic obstructive pulmonary disease. Clearly, however, that the best way to prevent this disease is so crippling to create a world free of smoke. 

Dr. Gustavo Castillo R. Ced. Prof. 1256736