Bronchitis is a common condition and one of the main reasons why patients with respiratory symptoms seek medical attention. Most of the time acute bronchitis occurs in fall or winter and usually arises with the cold or flu. It may persist for a few days to weeks. Chronic bronchitis on the other hand is permanent and irreversible. It is mainly caused by long term tobacco smoking and affects as many as 4 in 100 Americans.
Where is the problem in bronchitis?
The bronchi are two tubes that branch out from the trachea (windpipe). Each tube leads to one lung. The bronchi originate behind the breastbone and extends to both sides of the chest. Bronchitis simply means that these tubes are inflamed. As a result the bronchial walls swell and the mucus-producing cells in the bronchi produce excessive mucus. Inflammation also causes discomfort or pain and irritates pulmonary receptors in the bronchial wall that leads to coughing.
Acute bronchitis is mainly due to an infection. Viruses are a more common infective cause but bacteria can also be responsible for acute bronchitis. The infection may not be limited to the bronchi and also involve other parts of the respiratory tract like the trachea (tracheitic) or larynx (laryngitis). It can also extend to the lungs (pneumonia). Chronic bronchitis is a chronic obstructive pulmonary disease (COPD). The permanent damage of the bronchi may also be marked by acute flareups, which are also often due to an infection.
Read more on signs of COPD.
What are the signs of bronchitis?
The signs of bronchitis may not always be immediately evident when a viral infection like the common cold or flu arises. Many people are not aware of the bronchitis while the symptoms of the cold and flu are present. However, cold and flu symptoms resolve within 3 days while bronchitis symptoms may persist up to 3 weeks.
Sometimes bacterial bronchitis may arise secondary to a cold or the flu and the bronchitis symptoms only become apparent once most of the intense cold and flu symptoms ease. Bronchitis is a lower respiratory tract infection. Therefore the presence of a runny nose and sneezing that are characteristic of a cold or flu are not due to bronchitis.
Read more on bronchitis symptoms.
The most common symptom of bronchitis, both acute and chronic, is a persistent cough. It is a productive cough, meaning that there is mucus expectorated when coughing. The coughing can persist for as long as 3 weeks in acute bronchitis, well after other symptoms have resolved. The cough is less severe in chronic bronchitis but also persistent. It is often described as a smoker’s cough and usually one of the first signs that is noticed in COPD. Long term smokers who are experiencing a persistent cough also need to also consider lung cancer as a possible cause.
Mucus production in the airways may occur both in the upper and lower respiratory tract. It is usually copious in the bronchi. This mucus, also referred to as sputum or phlegm, may vary in color from clear, white, yellow or green. Sometimes the sputum may have an offensive taste or even a metallic taste. Mucus which is blood-streaked or completely bloody is a more serious sign. If this bleeding persists in chronic bronchitis then it must be investigated for throat or lung cancer.
Shortness of Breath
Shortness of breath is another common sign of bronchitis. The inflamed bronchial wall and accumulation of mucus narrows the airway. As a result there is less airflow which results in shortness of breath. In acute bronchitis this shortness of breath resolves afer a few days to weeks. Physical activity and lying flat may worsen it. Shortness of breath persists and gradually worsens in chronic bronchitis.
Abnormal Breathing Sounds
Depending on the severity of the bronchitis and shortness of breath, the breathing may be loud with abnormal sounds. There may be both a wheeze and stridor. Both of these sounds are a result of the narrowing of the bronchi. It may only be audible to a person with deep breaths, particularly inspiration. However, in most cases of bronchitis these sounds will be detectable during auscultation (listening to the chest sounds with a stethoscope). Abnormal breathing sounds like wheezing may be more severe in asthmatics with acute bronchitis.
Bronchitis may not always cause overt chest pain but there is usually some degree of chest discomfort. Pain when it does occur in acute bronchitis may be from the inflamed bronchi and experienced in the center of the chest. However, another source of discomfort (and rarely pain) is the strained chest wall and particularly the chest wall muscles. This is due to the persistent coughing and at times labored breathing which strain the chest muscles, costal cartilages and joints.
Fatigue and Malaise
Malaise is a feeling of being unwell and is a common symptom in most diseases. It may be more prominent in acute bronchitis where the symptoms are often sudden and severe and may not be specifically due to the respiratory symptoms. Malaise is common in viral infections, like the flu and cold. Fatigue is usually present in both acute and chronic bronchitis. It may in part be due to the inadequate airflow and lowered oxygen supply which may be felt to a greater degree during physical activity.
Can bronchitis kill you?
Bronchitis is not a deadly condition for most people. It may be severe but viral bronchitis often resolves with little to no treatment. Bacterial bronchitis requires antibiotics and there is rarely any further complications once the infection resolves. However, 5% of bronchitis cases may progress to pneumonia and if severe, bacterial pneumonia can be life-threatening.
There is a greater risk of complications in babies, the elderly and people with pre-existing diseases particularly where the immune system is weakened, like in HIV/AIDS. Bacterial superinfection is another possible complication which can result in life-threatening bronchitis, particularly in high risk individuals. Chronic bronchitis is one type of COPD (chronic obstructive pulmonary disease) which is the third leading cause of death in the United States.