What is acute bronchitis?
An acute bronchitis is an acute inflammation of the mucous membranes in the bronchi . It is usually associated with inflammation of the upper airways (nose and throat) and is widespread, especially in the winter months. Bronchitis is one of the most common diseases. For every 100,000 inhabitants, around 80 patients per week. In the winter months, this number doubles. Women and men are equally affected. In general, bronchitis is more common in children and adolescents than in adults.
Very often, acute bronchitis is preceded by upper airway infection. 90 percent of the cases are caused by infections with viruses. Rarely, bacteria, fungi or chemical stimuli cause the disease. Acute bronchitis can also occur in the context of other infectious diseases (such as measles).
The pathogens of bronchitis are passed on by droplet infection. The fine, often invisible droplets are formed when coughing , especially when it is unrestrained. That’s why you should hold your hand not only out of courtesy. They damage the cells of the bronchial mucosa and thus also switch their cilia out. Some viruses paralyze the ciliated epithelium, other viruses destroy it. As a result, the cilia can only slow down or even eliminate mucus and pathogens from the bronchi. At the same time, mucus production increases. The mucus builds up and acts in the airways as a foreign body, which irritates the cough sensors and thus causes coughing. Through coughing fits, the body tries to get rid of the mucus. A strong cough develops not only as a result of the irritation of the mucous membranes, but also represents a replacement mechanism that is due to the destroyed or paralyzed cilia for the purification of the respiratory tract ( mucociliary clearance ) is required.
Causes & Risk Factors
An acute bronchitis is caused in 90 percent of cases by viruses. In adults, the disease is usually caused by myxoviruses such as influenza or parainfluenza viruses. Often the pathogens are not known at all. Increased travel nowadays exposes us to more viral types than before, which is why acute bronchitis has become more common.
Only in five to ten percent of cases does the viral infection be followed by secondary bacterial infection. This is based on the pre-damaged by viruses bronchial mucosa. A primary bacterial bronchitis, however, is rare and occurs mainly in the context of underlying diseases. The most common bacterial agents of acute bronchitis are: streptococci , haemophilus and chlamydia
Mushrooms and chemicals
In rare cases, infection with fungi may be the cause of acute bronchitis in patients with immune deficiency. Other causes include damage to the mucous membranes by ammonia, hydrochloric acid, sulfur dioxide, nitrous gases and radiation in the context of cancer.
Beneficial factors are smog, tobacco smoke , cold, and moisture.
Illness & course
In the beginning, acute bronchitis usually manifests itself as a dry cough, often accompanied by a cold. If the viruses spread to the entire body (which happens in about half of the cases), fever and other common cold symptoms such as cervical, head and body aches, hoarseness, a burning sensation behind the sternum, general malaise and night sweats often occur ,
Bronchitis with productive cough
Only after a few days a productive cough develops with viscous, clear to whitish expectoration . This can later turn yellowish or greenish, if an additional bacterial infection sets in (see also “bacterial superinfection”). In severe cases, it may also come in the ejection to slight admixtures of blood. These can be caused by small injuries of the mucous membranes and usually have no disease significance. Nevertheless, blood in the ejection in any case should be clarified by the doctor.
Bronchitis with unproductive cough
It can also stay without coughing when coughing. Then the acute bronchitis is usually already over after 8 to 10 days. In 5-10% of patients, however, there is an additional bacterial infection (bacterial superinfection: see below).
Main complaints of uncomplicated bronchitis
The main symptom is the often tormenting cough, which can increasingly cause a feeling of soreness in the chest. Frequently, the throat is red and the lymph nodes in the area of the head are swollen. The uncomplicated bronchitis heals usually within about one to two weeks (maximum four weeks) without further consequences. If not, the doctor must be consulted.
When acute bronchitis lasts longer than 7 to 10 days, a disease change often occurs because of additional infection (super or secondary infection) by bacteria. In this case, a doctor should be consulted. In most cases, bacteria from the oral cavity multiply on the mucosa that has been previously damaged by viruses and cause renewed inflammation. The sputum changes color, becomes yellowish or, in the case of worse forms, greenish. Often the patient suffers from breathing noises (rattling, wheezing), sometimes even when the air is short of breath. Then complicated (obstructive or spastic) bronchitis developed from uncomplicated bronchitis. Sometimes in such cases also developed pneumonia ( pneumonia), especially if there is already a chronic bronchitis.
The investigation of acute bronchitis depends on the patient’s individual complaints and also serves to exclude other diseases with similar symptoms, such as atypical pneumonia . This inflammation of the lungs, caused mainly by mycoplasma and chlamydia, usually begins – much like acute bronchitis – with flu-like symptoms , with only a slight increase in temperature and a dry cough .
Questioning and general examination
A survey of the patient (anamnesis) and a physical examination with tapping and listening to the chest by stethoscope are usually sufficient. In a bacterial superinfection , the doctor in the lungs and bronchi quite often find so-called rattle noise. These can also be missing. They are caused by loose and retractable mucus in the respiratory tract. In most cases, the ears, mouth, throat and lymph nodes in the neck area are also examined.
In a bacterial superinfection, the doctor may then examine the white blood cell count and make laboratory tests, such as blood sedimentation or the more common determination of inflammatory markers (CRP), to determine whether the use of antibiotics (those effective against bacteria only, but not against viruses are) makes sense. A slight increase in CRP inflammation markers (ESR) and a reduction in the number of white blood cells indicates a viral, high erythrocyte sedimentation rate, and an increase in the number of white blood cells for a bacterial infection. In addition, there are often cases in which all these laboratory values can be normal, although there is a bacterial infection (sometimes even very severe).
An X-ray of the chest is always required if pneumonia is suspected, or to exclude a lung tumor – especially if the symptoms do not subside and the disease worsens or if the expectoration is bloody.
Lung function test
At the latest in patients with complicated bronchitis a pulmonary function measurement should be made. In this way, an existing airway constriction (obstruction) can be detected as early as possible and then treated accordingly. A developing non- allergic asthma may still be prevented. In the complicated form of bronchitis, limitations of the lung function and thus the load capacity of the affected patients may be quite pronounced. Whether a previously unrecognized chronic obstructive bronchitis If the condition has deteriorated due to an infection and needs to be treated accordingly, the doctor can also determine with this examination method.
An uncomplicated bronchitis heals mostly without treatment. However, it is important to abstain from tobacco smoke and in case of fever the observance of bed rest. Otherwise, the treatment will be depending on which complaints are present.
Chest wraps or rubs relieve the complaints pretty well. Why, is not known exactly. The increase in body heat that these agents cause will likely accelerate the production of antibodies, thereby boosting the immune system . For this reason, in otherwise healthy people existing fever should not be lowered. Because, if they go through the fever phase, the bronchitis is in all experience much faster survived.
Recommended are steam baths or steam saunas, as the inhaled water vapor quite large amounts of heat to the mucous membrane of the respiratory tract brings. Especially at the beginning of a disease, some viruses can be killed. An addition of chamomile should, however, be used with caution: Although this may flatter the nose and acts to a small extent germicidal, but can also cause allergies in rare cases .
Coughing has the purpose of purifying our airways . Sometimes it can become too violent and then damages the mucous membrane even more by frequent attacks. Therefore, cough suppressants, for example, in severe acute bronchitis, are very helpful when the coughing gets out of hand and is anyway unproductive (dry, without sputum).
Cough blockers can also be used to treat the patient during a restful night’s sleep. These so-called antitussives, such as codeine, dampen the cough center in the brain and thereby suppress the coughing stimulus. They should not be used for more than a week, and in any case only as long as the cough is still dry and tormenting. As soon as mucus has formed in the bronchi and can be coughed off, coughing usually loses its tormenting character. In case of bronchitis with productive (purulent or non-purulent) cough, cough-killers are often prescribed. Even though their effectiveness has been scientifically proven only in a few studies, cough removers in individual cases can undoubtedly be helpful in speeding up the cleansing of the respiratory tract. In practice, you often have to try different substances to find out which one helps.
The so-called secretolytics or mucolytics (such as N-acetylcysteine or ambroxol) liquefy the mucus so it can be easily coughed off. So-called secretomotor oils (for example, essential oils of thyme, menthol or ivy and sufficient fluid intake through copious drinking) can also promote the removal of mucus. Basically, cough-dissolving (chemical and herbal) preparations should only be taken in tablet form. On the other hand, inhaling these medications may irritate the mucous membranes and cause asthma attacks in patients with bronchial hypersensitivity .
Although inhaling neutral inhalation solutions is not absolutely necessary in cases of acute bronchitis, it can significantly relieve discomfort due to its expectorant effect. It is recommended to use a physiological saline solution or Emser salt ready-to-inhalate, the latter additionally having the advantage of accelerating the removal of mucus via the ciliates (bronchial clearance).
Against a bacterial superinfection (see “disease picture & history”) antibiotics (tetracyclines or cephalosporin tablets) are used. At the latest when the sputum (the expectorated cough-sputum) is discolored by pus yellowish or greenish for more than 10 to 14 days, an antibiotic should be prescribed in any case. Co-trimoxazole is sometimes quite effective against infection with Haemophilus influenzae pathogens, which often complicate virus flu , although it is no longer officially recommended by medical societies.
The effect of antibiotics is enhanced when short-term (for about 7 to 10 days) anti-inflammatory steroid tablets are taken. This is especially true when a constriction of the bronchi (obstruction) is added. These lead to a swelling of the mucous membrane, so that the contagious and waste-containing mucus can be better transported away again. If the sputum does not decolourise after 3 to 4 days during the antibiotic treatment, the chosen antibiotic appears to have no effect and should be replaced with a combination preparation (for example a macrolide antibiotic combined with quinolone or amoxicillin combined with clavulanic acid). This is especially true in high-risk patients. These include: patients over the age of 65,Lung function or with cystic fibrosis . If a patient does not respond to the second antibiotic treatment, it is highly recommended that a specialist (pneumologist) be included, who may also performs bronchoscopy with germ count in addition to an X-ray and pulmonary function test.
Effects & complications
Normally, acute bronchitis occurs without complications, disappears after a few days to a maximum of four weeks and heals without health consequences. Contrary to what is often feared, acute bronchitis usually causes no chronic bronchitis. Possibly, a dry irritated cough may persist for some time.
But there are also patients who suffer from acute bronchitis especially frequently and over and over again. In children, “above average often means more than 6-10 bronchitis per year, in adults more than 3-4 episodes per year. Then there is the suspicion that a chronic paranasal sinus infection, Bronchiectasis (bronchiectasis), a bronchial tumor or an immunodeficiency disease could be present, which can lead to recurrent infections, sometimes occlusions of a bronchus. The most common cause of recurrent bronchitis, however, is a mild, often unrecognized bronchial asthma , which is a cough in cases of deterioration with viscous mucus makes noticeable. A shortage of air, on the other hand, can be quite mild. Affected patients should definitely contact a pulmonologist.
A small proportion of patients who suffer from complicated chronic obstructive pulmonary disease – such as may develop from common acute bronchitis following a bacterial superinfection – are at an increased risk of developing non-allergic asthma. In addition, Chlamydia pneumoniae is thought to cause bronchial asthma in some patients. But certain viruses can cause asthma.
Another complication is the development of bronchopneumonia. It is a herd-shaped inflammation of the lungs , with the individual sites of inflammation can vary greatly in size and developmental stage.
Viral infections of the lungs (by measles, RS, adenoviruses, influenza viruses or mycoplasmas ) lead to inflammation of the finest bronchial branches (bronchioles), especially in infants, but increasingly also in adults., In rare cases, there are scarred changes and permanent closures of the bronchioles ( bronchiolitis obliterans ). Especially in infancy, bronchiectasis or permanent airway narrowing (obstructive ventilation disorders) may develop in later life. These patients also commonly experience bronchial asthma. Typical signs of bronchiolitis obliterans are fever, increased heartbeat rate and wheezing or greatly attenuated breath sounds. In the X-ray image often find signs of hyperinflation (emphysema).
In the filigree and not yet fully developed respiratory organs of infants and young children, acute bronchitis is often associated with a narrowing (obstruction) of the respiratory tract . The most common viral agents in children are so-called RS viruses, parainfluenza viruses, rhinoviruses and adenoviruses. The most common bacterial pathogens are: Chlamydia pneumoniae , Streptococcus pneumoniae , Haemophilus influenzae , Mycoplasma pneumoniae and Moxarella catarrhalis . Often, children develop acute bronchitis in combination with measles or whooping cough .
The diagnosis results from the questioning of the small patients or their parents (anamnesis) and the present complaints. In addition, the doctor will try to rule out that the child has inhaled a foreign body ( foreign body aspiration ). For this an x-ray examination may be necessary.
The treatment of acute bronchitis in an infection with viruses in the administration of expectorant drugs (cough remedy, expectorants). The active ingredient acetylcysteine, for example, changes the structure of the mucus, makes it less tough and thus facilitates its removal. Active ingredients such as ambroxol or bromhexine stimulate the production of a thin liquid mucus. Cough removers are available – depending on the active ingredient – in different dosage forms as juice, capsules, effervescent tablets or granules for dissolution. The latter preparations have the advantage that the patient takes in addition to the drug equal to liquid, which in turn promotes the removal of mucus.
For bacterial superinfections The doctor will use antibiotics specifically. These drugs are ineffective against viruses and therefore only useful if bacteria have actually settled on the mucous membranes of the bronchi. The doctor will decide if their use with your child is necessary.
If obstructive bronchitis is present, additional medication (beta-2-sympathomimetic and cortisone ) may be necessary, leading to enlargement of the small bronchi (bronchioles) . These drugs are usually inhaled and can thus develop their effect directly at the destination and even in small amounts.
Otherwise, the treatment is based on the symptoms: fever is lowered (for example, by calf wrap or drugs with the active ingredient paracetamol or ibuprofen). The inhalation of neutral carriers is certainly recommended, but for children from a certain age at all practicable.
Infectious children are recommended to stay at the seaside with their salty, expectorant, stimulating climate. At the North or Baltic Sea, the air is also allergen – and low in pollutants. The inhalation of seawater aerosols during sports and games on the beach leads to a stronger circulation of the mucous membranes. Sea baths harden and generally strengthen the body’s defenses. In addition, the treatment success can be supported by seawater inhalations. Thus, the susceptibility to bronchitis can be significantly reduced. At home, special attention should be paid to the prevention of tobacco smoke in order to prevent renewed irritation and respiratory infection.