What is Bronchitis?
If you have a persistent cough, then it is possible that the airways to your lungs (bronchial tubes) could be irritated, causing them to become inflamed and secrete excess mucus.
Types of Bronchitis
Acute bronchitis
Acute bronchitis is characterised by a cough that persists for a week or more. It is usually caused by a viral infection and occasionally a bacterial infection. Therefore, this type of bronchitis can be contagious and can be spread when someone coughs tiny droplets. These can travel in the air and land on surfaces up to a one-metre radius from the infected person. Individuals nearby may breathe in these droplets or touch infected surfaces where the bacteria or virus can live for up to 24 hours.
Chronic bronchitis
Chronic bronchitis is when the bronchial tubes are inflamed for a longer period of time and is part of a serious lung disease called chronic obstructive pulmonary disorder (COPD). It is often a result of irreversible damage to the bronchial tubes that causes them to be persistently inflamed, making it difficult for the cilia (small hairs) in the airways to sweep away mucus. The bronchial tubes become narrower over time and this also makes it more difficult to breathe.
Symptoms
Acute bronchitis
Acute bronchitis is a short-term condition, but it shares some symptoms with chronic bronchitis. These include:
- cough (that produces mucus)
- fever
- fatigue
- shortness of breath
- wheezing/whistling sound when you breathe
- runny nose
- sore throat
- aches and pains
- headache
Chronic bronchitis
Chronic bronchitis shares some symptoms with acute bronchitis but as a more serious and long-term condition, you may experience other symptoms as well including:
- more pronounced crackling or wheezing when breathing
- chest discomfort
- swollen feet
- bluish discolouration of fingernails (due to lack of oxygen)
- high fever
- difficulty breathing
Diagnosis
In order to get a diagnosis of bronchitis, you will need to visit a GP at your local surgery. They will carry out a physical examination to check your symptoms and rule out other causes. The GP will ask you about your medical history and lifestyle choices (such as smoking) as well as your symptoms to try to ascertain the cause of your condition. The GP may use a stethoscope to listen to your chest and heart.
If there may be an infection, then the GP may order a sputum culture (where you provide some mucus from your chest) so that it can be tested to look for bacteria. The GP may also use a spirometer (a machine you blow into) to check how much air you are able to breathe in and out and how long this takes, to check your lung function and see if your symptoms appear to be more serious. A pulse oximeter is less invasive (as it is a small device that is placed on the fingertip and measures the amount of oxygen carried in the blood). An X-ray may also be necessary if the GP is concerned that another condition may be causing bronchitis.
Treatment
Treating acute bronchitis
Medicines
A study by the British Medical Journal found that antibiotics and anti-inflammatory drugs proved to be barely more effective than a placebo (a tablet containing non-active ingredients).2 In addition to this, antibiotics do not work on viruses (the most frequent cause) so it is unlikely that your GP will prescribe them to you for acute bronchitis. Therefore, the main treatments for acute bronchitis are home remedies that help to soothe and relieve symptoms whilst the body recuperates.
Home remedies
Home remedies that help to soothe symptoms such as sore throat or feeling of inflammation in the airways include:
- over-the-counter cough medicine
- a mixture of lemon and honey
To loosen mucus you could:
- Use a humidifier (which produces warm, moist air and helps to thin mucus and therefore loosen it).
Can acute bronchitis be cured without treatment?
As previously mentioned, antibiotics and even anti-inflammatory drugs have little effect on acute bronchitis anyway so this demonstrates that in the majority of cases the body will deal with the symptoms on its own with little intervention.2 Home remedies are only useful to make the patient more comfortable.
Treating chronic bronchitis
Some medicines will focus on reducing the mucus in your lungs. These are called mucolytic medicines. They work by reducing how sticky and thick the mucus is so that it is easier to cough up. They are often called expectorants on the packaging. These medications are usually in tablet or liquid form (they include carbocisteine, erdosteine, alfa and mannitol). These medications however are usually prescribed more frequently for chronic bronchitis and other long-term lung conditions.
Bronchodilator medications
If you have asthma or other lung conditions that cause inflammation, then a bronchodilator medication is central to supporting you to manage chronic bronchitis. These help in reducing inflammation and relaxing the muscles, opening up the airways and making it easier to breathe. Bronchodilators are usually called inhalers because they are breathed in and deliver medication straight to your lungs. There are short-acting bronchodilators that aim to reduce immediate issues with breathlessness and can be used up to a maximum of four times a day. The long-acting bronchodilators are considered to be ‘preventers’ rather than ‘relievers’ of symptoms. They act in a similar way but their effects can last up to 12 hours and so they can be taken twice a day.
Short-term bronchodilators typically include:
- salbutamol and terbutaline (known as Beta-2 agonist inhalers)
- Ipratropium (known as an antimuscarinic inhaler)
Long-term bronchodilators typically include:
- salmeterol, formoterol and indacaterol (Beta-2 agonist inhalers)
- tiotropium, glycopyrronium and aclidinium (antimuscarinic inhalers)
Steroids
If inhalers are not enough to control the symptoms of chronic bronchitis, then corticosteroids, commonly known as steroids, may also be prescribed. They are usually given as tablets but inhaled forms can also be prescribed. These tablets can work in two ways. They mainly focus on reducing the number of eosinophils (special cells found in inflamed lungs), which helps to reduce inflammation and mucus production and thickness. Unlike bronchodilators that act on the tissues of the lungs to widen the airways, they may also switch off the immune system's response to inflammatory genes. They are more frequently prescribed if chronic bronchitis is accompanied by asthma symptoms which are caused by an overreaction of the immune system to certain triggers in the lungs.
Antibiotics
Antibiotics are not recommended for bronchitis as it usually clears up by itself and prescribing them when not needed may be harmful, as bacteria become immune to them over time. However, if your GP has taken diagnostic tests that confirm a bacteria is causing bronchitis or you are at risk of developing pneumonia, then antibiotics may be prescribed. You may be given a 5-day course of amoxicillin or doxycycline.
Oxygen therapy
Having low levels of oxygen in the blood is called hypoxemia and it can have detrimental effects on your health. Therefore, if you find it difficult to manage chronic bronchitis, your GP may prescribe oxygen, delivered through a mask or a tube in your nose. However, it is essential that the oxygen is given in controlled amounts because it can also elevate carbon dioxide levels in the blood (hypercapnia), which can be fatal by making the pH of the blood too acidic. However, if your GP or specialist decides that you do require oxygen therapy, it can have several benefits such as reducing your risk of heart failure, increasing your energy levels, improving mood/concentration and increasing life expectancy.1 So whilst it needs to be used with extreme care, it can be used as long-term therapy to improve the quality of life of those with chronic bronchitis who are finding it difficult to breathe on their own.
Surgery
Surgery may be recommended for some individuals with chronic bronchitis if tests carried out by specialists show areas of damaged tissue in the lungs. It involves the surgical removal of the damaged tissue and is called lung volume reduction surgery. Whilst it reduces the size of an inflated lung, it means that the healthy parts of the lung can function better as air is no longer trapped in diseased sections. It is usually recommended for people who have damage to the air sacs in their lungs (a condition called emphysema) but is usually only given to individuals under the age of 75 and who have not smoked in the last six months.
Pulmonary rehabilitation
Pulmonary rehabilitation can be supported by learning new breathing techniques and an exercise programme that can help to strengthen the lungs and balance levels of oxygen and carbon dioxide. According to the Lung Foundation Australia (June 2022), an exercise programme carefully tailored to the individual needs of those with chronic bronchitis or other long-term lung conditions can have a lot of benefits.3
One testimonial from a patient stated that
“The most beneficial part of pulmonary rehabilitation was gaining the knowledge to understand what was happening to me and being able to control my breathing. This in turn assisted in controlling periods of depression and anxiety as well as accepting I have a serious health condition. (Eric, Bundaberg, lives with COPD).”
There are many organisations around the world that promote pulmonary rehabilitation and all provide similar testimonials of its positive outcomes.
Lifestyle changes
Pulmonary rehabilitation is rehabilitating yourself through education and lifestyle changes. It requires an individual to develop positive health practices, such as regular exercise and good nutrition, to eliminate negative ones such as smoking. It can also be helpful to avoid people who have respiratory infections, avoid heat and high altitudes and lung irritants such as ammonia in cleaning or hair products.
Outlook
The outlook for acute bronchitis is positive as it is most likely to clear itself up within 2-3 weeks without any intervention. If you are living with chronic bronchitis or other COPD-related conditions, the outlook depends on the causes of each individual condition and how much damage has been caused to the lung. It is generally good in most cases if you are able to make some lifestyle changes and educate yourself about how to manage your medication to ensure you maintain the health of your airways.
Summary
Acute and long-term bronchitis can often be avoided by making positive lifestyle choices and exercising to keep your lungs strong and healthy. However, if you suffer conditions that make bronchitis more likely such as asthma, then you can still have a good quality of life as the lungs can be quite resilient if supported by positive changes, the right medication and management of individual circumstances.
References
- Brill SE, Wedzicha JA. Oxygen therapy in acute exacerbations of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis [Internet]. 2014 [cited 2022 Jul 4]; 9:1241–52.
- Llor C, Moragas A, Bayona C, Morros R, Pera H, Plana-Ripoll O, et al. Efficacy of anti-inflammatory or antibiotic treatment in patients with non-complicated acute bronchitis and discoloured sputum: randomised placebo controlled trial. BMJ [Internet]. 2013 [cited 2022 Jul 4]; 347(oct04 2):f5762–f5762.
- Lung Foundation Australia [Internet]. Pulmonary Rehabilitation; [cited 2022 Jul 4].
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