Nursing Interventions:

1. Encourage mobilization of secretion through ambulation, coughing, and deep breathing.

2. Ensure adequate fluid intake to liquefy secretions and prevent dehydration caused by
fever and tachypnea.
3. Encourage rest, avoidance of bronchial irritant, and a good diet to facilitate recovery.
4. Instruct the patient to complete the full course of prescribed antibiotics and explain the
effect of meals on drug absorption.
5. Caution the patient on using over-the-counter cough suppressants, antihistamines, and
decongestants, which may cause drying and retention of secretions. However, cough
preparations containing the mucolytic guaifenesin may be appropriate.
6. Advise the patient that a dry cough may persist after bronchitis because of irritation of
airways. Suggest avoiding dry environments and using a humidifier at bedside.
Encourage smoking cessation.
7. Teach the patient to recognize and immediately report early signs and symptoms of acute
bronchitis.

Acute bronchitis
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Acute bronchitis
Classification and external resources

This image shows the consequences of acute bronchitis.

ICD-10 J20.-J21.
ICD-9 466
MeSH D001991
Acute bronchitis is an inflammation of the large bronchi (medium-sized airways) in the lungs
that is usually caused by viruses or bacteria and may last several days or weeks.[1] Characteristic
symptoms include cough, sputum (phlegm) production, and shortness of breath and wheezing
related to the obstruction of the inflamed airways. Diagnosis is by clinical examination and
sometimes microbiological examination of the phlegm. Treatment for acute bronchitis is
typically symptomatic. As viruses cause most cases of acute bronchitis, antibiotics should not be
used unless microscopic examination of Gram stained sputum reveals large numbers of bacteria.

Contents
[hide]
• 1 Cause/etiology
• 2 Signs and symptoms
• 3 Diagnosis
• 4 Treatment
○ 4.1 Antibiotics
○ 4.2 Smoking cessation
○ 4.3 Antihistamines
• 5 Prognosis
• 6 Prevention
• 7 See also
• 8 References
• 9 External links

[edit] Cause/etiology
Acute bronchitis can be caused by contagious pathogens. In about half of instances of acute
bronchitis a bacterial or viral pathogen is identified. Typical viruses include respiratory syncytial
virus, rhinovirus, influenza, and others.
• Damage caused by irritation of the airways leads to inflammation and leads to neutrophils
infiltrating the lung tissue.
• Mucosal hypersecretion is promoted by a substance released by neutrophils.
• Further obstruction to the airways is caused by more goblet cells in the small airways.
This is typical of chronic bronchitis.
• Although infection is not the reason or cause of chronic bronchitis it is seen to aid in
sustaining the bronchitis.
[edit] Signs and symptoms
Bronchitis may be indicated by an expectorating cough, shortness of breath (dyspnea) and
wheezing. Occasionally chest pains, fever, and fatigue or malaise may also occur. Additionally,
bronchitis caused by Adenoviridae may cause systemic and gastrointestinal symptoms as well.
However the coughs due to bronchitis can continue for up to three weeks or more even after all
other symptoms have subsided.
[edit] Diagnosis
A physical examination will often reveal decreased intensity of breath sounds, wheezing, rhonchi
and prolonged expiration. Most doctors rely on the presence of a persistent dry or wet cough as
evidence of bronchitis.
A variety of tests may be performed in patients presenting with cough and shortness of breath:
• A chest X-ray that reveals hyperinflation; collapse and consolidation of lung areas would
support a diagnosis of pneumonia. Some conditions that predispose to bronchitis may be
indicated by chest radiography.
• A sputum sample showing neutrophil granulocytes (inflammatory white blood cells) and
culture showing that has pathogenic microorganisms such as Streptococcus spp.
• A blood test would indicate inflammation (as indicated by a raised white blood cell count
and elevated C-reactive protein).
[edit] Treatment
[edit] Antibiotics
Only about 5-10% of bronchitis cases are caused by a bacterial infection. Most cases of
bronchitis are caused by a viral infection and are "self-limited" and resolve themselves in a few
weeks. Acute bronchitis should not be treated with antibiotics unless microscopic examination of
the sputum reveals large numbers of bacteria. Treating non-bacterial illnesses with antibiotics
leads to the promotion of antibiotic-resistant bacteria, which increase morbidity and mortality.[2]
[edit] Smoking cessation
For more details on this topic, see Smoking cessation.
Many physicians recommend that to help the bronchial tree heal faster and not make bronchitis
worse, smokers should quit smoking completely to allow their lungs to recover from the layer of
tar that builds up over time.
[edit] Antihistamines
Using over-the-counter antihistamines may be harmful in the self-treatment of bronchitis.
An effect of antihistamines is to thicken mucus secretions. Expelling infected mucus via
coughing can be beneficial in recovering from bronchitis. Expulsion of the mucus may be
hindered if it is thickened. Antihistamines can help bacteria to persist[citation needed] and multiply in
the lungs by increasing its residence time in a warm, moist environment of thickened mucus.
Using antihistamines along with an expectorant cough syrup may be doubly harmful encouraging
the production of mucus and then thickening that which is produced. Using an expectorant cough
syrup alone might be useful in flushing bacteria from the lungs. Using an antihistamine along
with it works against the intention of using the expectorant.
[edit] Prognosis
Acute bronchitis usually lasts a few days or weeks.[3] It may accompany or closely follow a cold
or the flu, or may occur on its own. Bronchitis usually begins with a dry cough, including waking
the sufferer at night. After a few days it progresses to a wetter or productive cough, which may
be accompanied by fever, fatigue, and headache. The fever, fatigue, and malaise may last only a
few days; but the wet cough may last up to several weeks.
Should the cough last longer than a month, some doctors may issue a referral to an
otorhinolaryngologist (ear, nose and throat doctor) to see if a condition other than bronchitis is
causing the irritation. It is possible that having irritated bronchial tubes for as long as a few
months may inspire asthmatic conditions in some patients.
In addition, if one starts coughing mucus tinged with blood, one should see a doctor. In rare
cases, doctors may conduct tests to see if the cause is a serious condition such as tuberculosis or
lung cancer.
[edit] Prevention
In 1985, University of Newcastle, Australia Professor Robert Clancy developed an oral vaccine
for acute bronchitis. This vaccine was commercialised four years later.[4]

Bronchitis
Language: da de en fi fr it nl pt sv

Bronchitis is inflammation of the bronchi (medium-size airways) in the lungs. Acute bronchitis
is usually caused by viruses or bacteria and may last several days or weeks. Chronic bronchitis is
not necessarily caused by infection and is generally part of a syndrome called COPD (chronic
obstructive pulmonary disease); it is defined clinically as a persistent cough that produces
sputum (phlegm), for at least three months in two consecutive years. The remainder of this
article deals with acute bronchitis only.
Acute bronchitis is characterized by cough and sputum (phlegm) production and symptoms
related to the obstruction of the airways by the inflamed airways and the phlegm, such as
shortness of breath and wheeze. Diagnosis is by clinical examination and sometimes
microbiological examination of the phlegm. Treatment may be with antibiotics (if a bacterial
infection is suspected), bronchodilators (to relieve breathlessness) and other treatments.
Signs and symptoms
Bronchitis may be indicated by an expectorating cough,shortness of breath (dyspnea) and
wheeze and occasionally chest pains, fever, and fatigue or malaise. Sputum characteristics do not
correspond with a particular etiology (ie, viral vs bacterial).Fact|date=March 2007
Diagnosis
A physical examination will often reveal decreased intensity of breath sounds, wheeze (rhonchi)
and prolonged expiration. Most doctors rely on the presence of a persistent dry or wet cough as
evidence of bronchitis.
A variety of tests may be performed in patients presenting with cough and shortness of breath:
• A chest X-ray that reveals hyperinflation; collapse and consolidation of lung areas would
support a diagnosis of pneumonia. Some conditions that predispose to bronchitis may be
indicated by chest radiography.
• A sputum sample showing neutrophil granulocytes (inflammatory white blood cells) and
culture showing that has pathogenic microorganisms such as Streptococcus spp.
• A blood test would indicate inflammation (as indicated by a raised white blood cell count
and elevated C-reactive protein).
Pathophysiology
Acute bronchitis often follows a cold or infection. The earliest clinical feature of bronchitis is
increased secretion of mucus bysubmucosal glands of the trachea and bronchi. Damage caused
by irritation of the airways leads to inflammation and infiltration of the lung tissue by
neutrophils. The neutrophils release substances that promote mucosal hypersecretion.
• Neutrophils infiltrate the lung tissue, aided by damage to the airways caused by irritation.
• Damage caused by irritation of the airways leads to inflammation and leads to neutrophils
being present
• Mucosal hypersecretion is promoted by a substance released by neutrophils
• Further obstruction to the airways is caused by more goblet cells in the small airways.
This is typical of chronic bronchitis
• Although infection is not the reason or cause of chronic bronchitis it is seen to aid in
sustaining the bronchitis.
Treatment
In most cases, acute bronchitis is caused by viruses, not bacteria and it will go away on its own
after a few days without antibiotics. To treat acute bronchitis that appears to be caused by a
bacterial infection, or as a precaution,antibiotics may be given. [1]
To help the bronchial tree heal faster and not make bronchitis worse, smokers should cut down
on the number of cigarettes they smoke, or quit altogether.[2]
Prognosis
Acute bronchitis usually lasts approximately 20 or 30 days. It may accompany or closely follow
a cold or the flu, or may occur on its own. It is contagious. Bronchitis usually begins with a dry
cough, including waking the sufferer at night. After a few days it progresses to a wetter or
productive cough, which may be accompanied by fever, fatigue, and headache. The fever,
fatigue, and malaise may last only a few days; but the wet cough may last up to several weeks.
For some people, the cough may last as long as a few months, as the bronchial tubes heal slowly.
Should the cough last longer than a month, some doctors may issue a referral to an
otolaryngologist (ear, nose and throat doctor) to see if a condition other than bronchitis is causing
the irritation. It is possible that having irritated bronchial tubes for as long as a few months may
inspire asthmatic conditions in some patients.
In addition, if one starts coughing mucus tinged with blood, one should see a doctor. In rare
cases, doctors may conduct tests to see if the cause is a serious condition such as tuberculosis or
lung cancer.
Introduction
Background
Bronchitis is one of the top conditions for which patients seek medical care. Bronchitis is
characterized by inflammation of the bronchial tubes (or bronchi), which are the air passages that
extend from the trachea into the small airways and alveoli. Triggers may be infectious agents,
such as viruses or bacteria, or noninfectious agents, such as smoking or inhalation of chemical
pollutants or dust.
Acute bronchitis is manifested by cough and, occasionally, sputum production that last for no
more than 3 weeks. Although bronchitis should not be treated with antimicrobials, it is frequently
difficult to refrain from prescribing them. Accurate testing and decision-making protocols
regarding who might benefit from antimicrobial therapy would be useful but are not currently
available.

Chronic bronchitis is defined clinically as cough with sputum expectoration for at least 3 months
during a period of 2 consecutive years. Chronic bronchitis is associated with hypertrophy of the
mucus-producing glands found in the mucosa of large cartilaginous airways. As the disease
advances, progressive airflow limitation occurs, usually in association with pathologic changes
of emphysema. This condition is called chronic obstructive pulmonary disease (COPD). When a
stable patient experiences sudden clinical deterioration with increased sputum volume, sputum
purulence, and/or worsening of shortness of breath, this is referred to as an acute exacerbation of
chronic bronchitis as long as conditions other than acute tracheobronchitis are ruled out.

Generally, bronchitis is a diagnosis made by exclusion of other conditions such as sinusitis,

pharyngitis, tonsillitis, and pneumonia.
Pathophysiology
Respiratory viruses are the most common causes of acute bronchitis. The most common viruses
include influenza A and B, parainfluenza, respiratory syncytial virus, and coronavirus, although
an etiologic agent is identified only in a minority of cases.1

During an episode of acute bronchitis, the cells of the bronchial-lining tissue are irritated and the
mucous membrane becomes hyperemic and edematous, diminishing bronchial mucociliary
function. Consequently, the air passages become clogged by debris and irritation increases. In
response, copious secretion of mucus develops, which causes the characteristic cough of
bronchitis. For instance, with mycoplasmal pneumonia, bronchial irritation results from the
attachment of the organism (Mycoplasma pneumoniae) to the respiratory mucosa, with eventual
sloughing of affected cells. Acute bronchitis usually lasts approximately 10 days. If the
inflammation extends downward to the ends of the bronchial tree, into the small bronchi
(bronchioles), and then into the air sacs, bronchopneumonia results.
Chronic bronchitis is a condition associated with excessive tracheobronchial mucus production
sufficient to cause cough with expectoration for at least 3 months for more than 2 consecutive
years. The alveolar epithelium is both the target and the initiator of inflammation in chronic
bronchitis.
A predominance of neutrophils and the peribronchial distribution of fibrotic changes result from
the action of interleukin 8, colony-stimulating factors, and other chemotactic and
proinflammatory cytokines. Airway epithelial cells release these inflammatory mediators in
response to toxic, infectious, and inflammatory stimuli, in addition to decreased release of
regulatory products such as ACE or neutral endopeptidase.
Chronic bronchitis can be categorized as simple chronic bronchitis, chronic mucopurulent
bronchitis, or chronic bronchitis with obstruction. Mucoid sputum production characterizes
simple chronic bronchitis. Persistent or recurrent purulent sputum production in the absence of
localized suppurative disease, such as bronchiectasis, characterizes chronic mucopurulent
bronchitis. Chronic bronchitis with obstruction must be distinguished from chronic infective
asthma. The differentiation is based mainly on the history of the clinical illness. Patients who
have chronic bronchitis with obstruction present with a long history of productive cough and a
late onset of wheezing, whereas patients who have asthma with chronic obstruction have a long
history of wheezing with a late onset of productive cough.
Chronic bronchitis may result from a series of attacks of acute bronchitis, or it may evolve
gradually because of heavy smoking or inhalation of air contaminated with other pollutants in the
environment. When so-called smoker's cough is continual rather than occasional, the mucus-
producing layer of the bronchial lining has probably thickened, narrowing the airways to the
point where breathing becomes increasingly difficult. With immobilization of the cilia that
sweep the air clean of foreign irritants, the bronchial passages become more vulnerable to further
infection and the spread of tissue damage.
Frequency
United States
In one study, acute bronchitis affected 44 of 1000 adults annually, and 82% of episodes occurred
in fall or winter.2 By way of comparison, 91 million cases of influenza, 66 million cases of the
common cold, and 31 million cases of other acute upper respiratory tract infections occurred
during that same year.

According to estimates from national interviews taken by the National Center for Health
Statistics in 2006, approximately 9.5 million people, or 4% of the population, were diagnosed
with chronic bronchitis. These statistics may underestimate the prevalence of COPD by as much
as 50% because many patients underreport their symptoms and their conditions remain
undiagnosed. However, an overdiagnosis of chronic bronchitis by patients and clinicians has also
been suggested. The term bronchitis is often used as a common descriptor for a nonspecific and
self-limited cough, thereby falsely increasing its incidence even though the patient does not meet
the criteria for diagnosis.
International
Acute bronchitis is common throughout the world and is one of the top 5 reasons for seeking
medical care in countries that collect such data.
Mortality/Morbidity
Bronchitis is almost always self-limited in individuals who are otherwise healthy, although it
may result in absenteeism from work and school. Severe cases occasionally produce
deterioration in patients with significant underlying cardiopulmonary disease or other
comorbidities.
Race
No difference in racial distribution is reported; however, bronchitis occurs more frequently in
populations with a low socioeconomic status and in people who live in urban and highly
industrialized areas.
Sex
Bronchitis affects males more than females.
Age
Although found in all age groups, acute bronchitis is most frequently diagnosed in children
younger than 5 years, whereas chronic bronchitis is more prevalent in people older than 50 years.
In the United States, up to two thirds of men and one fourth of women have emphysema at death.
Clinical
History
Obtain a complete history, including information on exposure to toxic substances and smoking.
Patients with chronic bronchitis are often overweight and cyanotic. Initially, cough is present in
the winter months. Over the years, the cough progresses from hibernal to perennial, and
mucopurulent relapses increase in frequency, the duration and severity of which increase to the
point of exertional dyspnea.

Symptoms of acute bronchitis include the following:

• Cough and sputum production
• Cough is the most commonly observed symptom. It begins early in the
course of many acute respiratory infections and becomes more
prominent as the disease progresses.
• Cough begins within 2 days of infection in the majority of patients. In
patients with acute bronchitis, cough generally lasts from 10-20 days.
• Sputum production is reported in approximately half the patients in
whom cough occurred. Sputum may be clear, yellow, green, or even
blood-tinged.
• Purulent sputum is reported in 50% of persons with acute bronchitis.
Changes in sputum color are due to peroxidase released by leukocytes
in sputum; therefore, color alone cannot be considered indicative of
bacterial infection.
• Sore throat
• Runny or stuffy nose
• Headache
• Muscle aches
• Extreme fatigue
• Fever: This is a relatively unusual sign and, when accompanied by cough,
suggests either influenza or pneumonia.
• Nausea, vomiting, and diarrhea: These are rare. Severe cases may cause
general malaise and chest pain. With severe tracheal involvement, burning,
substernal chest pain associated with respiration, and coughing may occur.
• Dyspnea and cyanosis: These are not observed in adults unless the patient
has underlying COPD or another condition that impairs lung function.
Physical
The physical examination findings in acute bronchitis can vary from normal-to-pharyngeal
erythema, localized lymphadenopathy, and rhinorrhea to coarse rhonchi and wheezes that change
in location and intensity after a deep and productive cough. Diffuse wheezes, high-pitched
continuous sounds, and the use of accessory muscles can be observed in severe cases.
Occasionally, diffuse diminution of air intake or inspiratory stridor occurs; these findings
indicate obstruction of a major bronchi or the trachea, which requires sequentially vigorous
coughing, suctioning, and, possibly, intubation or even tracheostomy.
• Sustained heave along the left sternal border indicates right ventricular
hypertrophy secondary to chronic bronchitis.
• Clubbing on the digits and peripheral cyanosis indicate cystic fibrosis.
• Bullous myringitis may suggest mycoplasmal pneumonia.
• Conjunctivitis, adenopathy, and rhinorrhea suggest adenovirus infection.
Causes
Acute bronchitis is usually caused by infections, such as those caused by Mycoplasma species,
Chlamydia pneumoniae, Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus
influenzae, and by viruses, such as influenza, parainfluenza, adenovirus, rhinovirus, and
respiratory syncytial virus. Exposure to irritants, such as pollution, chemicals, and tobacco
smoke, may also cause acute bronchial irritation.

• Cigarette smoking is indisputably the predominant cause of chronic

bronchitis. Estimates suggest that cigarette smoking accounts for 85-90% of
chronic bronchitis and COPD. Studies indicate that smoking pipes, cigars, and
marijuana causes similar damage.
○ Smoking impairs ciliary movement, inhibits the function of alveolar
macrophages, and leads to hypertrophy and hyperplasia of mucus-
secreting glands.
○ Smoking can also increase airway resistance via vagally mediated
smooth muscle constriction.
○ Unless some other factor can be isolated as the irritant that produces
the symptoms, the first step in dealing with chronic bronchitis is for the
patient to stop smoking.
• Air pollution levels have been associated with increased respiratory health
problems among people living in affected areas. The Air Pollution and
Respiratory Health Branch of the National Center for Environmental Health
directs the fight of the US Centers for Disease Control and Prevention (CDC)
against respiratory illness associated with air pollution.
○ According to the Healthy People 2000 report, each year in the United
States, the following occur:
 "The health costs of human exposure to outdoor air pollutants
range from $40 to $50 billion."
 "An estimated 50,000 to 120,000 premature deaths are
associated with exposure to air pollutants."
 "People with asthma experience more than 100 million days of
restricted activity, costs for asthma exceed $4 billion, and about
4,000 people die of asthma."
• A growing body of literature has demonstrated that specific occupational
exposures are associated with the symptoms of chronic bronchitis. The list of
agents includes coal, manufactured vitreous fibers, oil mist, cement, silica,
silicates, osmium, vanadium, welding fumes, organic dusts, engine exhausts,
fire smoke, and secondhand cigarette smoke.