Where exactly do bronchitis end and common cold start? Are they even the same thing? Well, one thing is that bronchitis is not always as severe as it sounds.
What then is bronchitis? We will slowly analyze what bronchitis involves.
What is bronchitis?
Bronchitis is the medical term for inflammation of the membranes lining the passage or tubes of the lungs.1 These tubes are responsible for carrying air to and from the lungs. Hence the pain that one feels whenever they breathe makes sense because the air is basically passing through/ over injured surfaces.
There are numerous factors that could contribute to this inflammation of the airway of the lungs. According to Yankaskas J.R.(2010),1 these factors are mostly infectious or environmental, but there could also be genetic elements in play. This could end up as acute or chronic inflammation, depending on the nature, severity, and duration of the causative factor. A few common associative conditions of the inflammation are:
- Shortness of breath, also known as Dyspnea
- Mucus/Sputum production and
- Obstructive lung disease
A cough is described as being productive when one coughs out or expels phlegm. It is also referred to as a chesty cough because you feel it in your chest. Your chest feels sort of heavy and you feel relieved after a few coughing bouts (which mostly end in phlegm expulsion or “loosening and swallowing”).
There are two medically recognized types or manifestations of bronchitis. They are:
- Acute Bronchitis
- Chronic Bronchitis
Acute bronchitis manifests as a result of viral or bacterial infection and lasts about two to three weeks. Its short duration is the reason it is also known as short-term bronchitis.
Here, viruses, such as rhinoviruses, adenoviruses, and influenza, infect the respiratory lining.1 Bacteria that could cause acute bronchitis are Mycoplasma pneumonia, Chlamydia pneumonia, or Bordetella pertussis.1 However, bacterial involvement happens in less than 10% of all acute bronchitis cases. An estimated 95% of acute bronchitis cases are secondarily caused by viruses.
Additionally, while the direct actions of these organisms in causing bronchitis are not completely understood, the effects of their presence have been documented. After infection and significant damage to the airway epithelia, they:
- Cause release of chemicals that promote inflammation,
- Increase production of secretions such as mucus and
- Decreased defence mechanism of the lungs, known as mucociliary clearance1
The damage caused makes it effortless for the airways to be easily irritated. This is why a patient's nostrils could be relatively “fully blocked”, but the idea or feeling that you smelled something would have you coughing out your insides.
Did you know that chronic bronchitis could last for as long as 2 years at a stretch? That is quite unsettling to imagine. Chronic bronchitis could last for as short as 3 months. But a few years are not out of the question in severe cases.
Chronic bronchitis develops as a result of a persistent injury and the resultant inflammatory responses.1 More than 30% of chronic bronchitis patients who participated in various surveys and tests were shown to have already had Chronic Obstructive Pulmonary Disease (COPD).3
COPD and/ or smoking have been found to be common factors in all cases of chronic bronchitis. Additionally, genetic diseases affecting the innate defence mechanism of the lungs may add to the severity of chronic bronchitis1
Other than the already listed viral, allergic, and rarely occurring bacterial causes, there are cases of upper respiratory tract infections worsening to cause acute bronchitis.
Risk factors for acute bronchitis include:
- Living in a polluted place
- History of asthma
- Specific allergens like pollens, perfume, and vapors4
Cough is the single most common telltale symptom of acute bronchitis. Especially when all other chronic diseases or conditions that cause cough (such as asthma, exacerbation of existing Chronic Obstructive Pulmonary Disease- COPD, heart failure, or pneumonia) have been ruled out.2
Other symptoms include:
- Chest wall pain when coughing
- Sore throat
- Increased sputum production and thickening
- Nasal congestion
Bronchitis could appear really similar to a common cold. So in addition to the already listed symptoms, the physician checks for other signs such as wheezing sound, and rhonchi (which is basically an irregular “gurgling” sound from the lungs during breathing).
Most diagnostic steps are taken simply to rule out other diseases and respiratory tract infections (as mentioned earlier). For instance, elevated white blood cell count is generally more indicative of bacterial infection than bronchitis. While any x-ray imaging test is done mainly to rule out pneumonia. Chest x-ray (CXR) helps rule out pneumonia from the list of suspected conditions when “infiltrates” are not present.
The American College of Chest Physicians (ACCP) have guideline in place which recommend carrying out a CXR only when:
- Heart rate rises above 100 per minute
- Respiratory rate rise exceeds 24 breaths per minute, and
- Oral body temperature exceeds 38oC
However, when these factors are normal, there is no need for further tests, except in elderly patients (above 70).4
If the symptoms persist for longer than 3 weeks, other causative factors for bronchitis should be considered 4. They could be:
- Acute/chronic sinusitis
- Viral pharyngitis
- Pulmonary embolism or even
- Asthma: Acute asthma is commonly misdiagnosed as acute bronchitis in about a third (⅓) of the patients who present with acute cough4
Those who work or live in areas of polluted air are also advised to move to locations of cleaner air. While COPD and chronic bronchitis might not totally be cured immediately, positive changes will be noticed in no time.
This is majorly prevented by observing necessary precautions similar to those taken when dealing with other respiratory tract infections.
Take a flu vaccine
Bronchitis, pneumonia, whooping cough and many other complications arise from seasonal flus. Vaccines help keep you and those close to you considerably safer during flu season. Unlike certain personal opinions, the Center for Disease Control (CDC) assures that flu vaccines do not cause flu.8
One thing to remember about the treatment of acute bronchitis is that it will eventually resolve on its own.
Hence its “treatment” involves taking measures to tackle the symptoms. Use of antibiotics is not particularly encouraged. Infact, the American College of Chest Physicians, as well as all other treatment guidelines, discourage the use of antibiotics for acute bronchitis (unless pertussis infection is confirmed).2
The guidelines in place suggest trying the following:
Get lots of rest
In acute bronchitis, all that is left to do is allow your body to rest and naturally heal itself. Proper rest is mostly paired with the appropriate intake of vitamins and supplements to ward off feelings of fatigue associated with bronchitis.
Drink plenty of fluids
Fluids such as hot tea and warm water are found to be particularly soothing. Although there is no concrete test in place for the effectiveness of fluids, most people just tend to feel somewhat better when they take water after bouts of cough. So take as much water as possible. .
Take honey to help with cough
Honey has been traditionally used to alleviate symptoms of cough. According to the Mayo Clinic, giving 2 teaspoons of honey to kids is particularly effective in alleviating intense nighttime bouts of coughing.5 At most 4 teaspoons of honey in tea or any lemon drink works wonderfully for adults.
Honey is especially needed for kids as the guidelines from the American Academy of Pediatrics, discourage the use of cough and cold medication in children younger than 4 years old.2
Use sinus rinses
Sinus rinses are quite effective in clearing the sinuses. However, some people find them really uncomfortable. But if you do not mind, then they are really effective in clearing thickened mucus (especially resulting from allergies, dust, or pollen).
Most of them contain menthol or its derivatives, which help loosen thickened clumps of mucus in the throat and provide temporary relief. But be careful not to overindulge in them (regardless of how tasty and “candy-like” they might be).
Use a humidifier
Humidifiers are particularly helpful with dry cough and whooping cough.
Take over the counter (OTC) pain medicine
When instances of body pains associated with bronchitis occur, OTC pain meds should be used. The use of stronger pain medications is not usually the best approach. This is why the use of morphine and codeine in the treatment or management of bronchitis has been slowly phased away. The best ones are those that also have antipyretic (fever-alleviating) effects.
Here, lung function was found to improve rapidly in a few weeks for those who stopped smoking (either directly or secondhand).1
Anti inflammatory drugs (corticosteroids)
Steroids are used to alleviate the inflammation, mucus production, and potentially the pain associated with chronic bronchitis. The most commonly administered corticosteroid is prednisolone. They are given together with bronchodilators in most cases.
Depending on the exact symptoms, short-acting β2 antagonists, SABA, (for instance, salbutamol) could suffice. But in the case of more severe chronic bronchitis, the patients could be put on long-acting β2 antagonists, LABA, such as salmeterol. They lead to an increase in the rate of mucociliary clearance and increased ciliary beat frequency, both of which alleviate violent bouts of coughing.3
They are only used when the benefits outweigh any potential adverse effects.
A mucus clearing device
The National Health Service (NHS) offers guidelines on how to use mucus-clearing devices such as the Flutter to clear chest and lung mucus congestions.6
According to the British Thoracic Society, pulmonary rehabilitation should be offered to patients with chronic obstructive pulmonary disease (COPD) so as to aid in improving exercise capacity by a clinically essential amount. They advocate the use of guidelines set by the National Institute for Health and Clinical Excellence (NICE).7
This requires the intake of extra oxygen and is only necessary in more severe cases. It usually involves the attachment of an oxygen mask or line. Here, the patient is struggling to get enough air to breathe.
These are used when chronic bronchitis patients already have a known history of bacterial infection. In most cases, broad-spectrum antibiotic regimens are used to target upper and lower respiratory tract infections.
Possible side effects
- Unnecessary antibiotic prescriptions result in adverse effects and contribute to rising health care costs and antimicrobial resistance2
- Dependence could arise from the overuse of certain pain medications. So, adhere strictly to prescriptions for pain medications and use only when necessary
- Possible side effects of bronchodilators include tremors, shakiness, and even nausea
What is the best treatment for bronchitis?
The best treatment is prevention so don’t forget your annual flu shot and use your nose masks.
Depending on the type of bronchial infection, one could simply wait it out while taking steps to alleviate symptoms. Or they could visit a physician who will prescribe any needed medications. However, taking codeine or any drug which builds dependence or antibiotics right off the bat is definitely not the way to go.
Unless there are other underlying respiratory tract infections, you should be good as new in about 2 weeks. Of course, the cough could persist longer than the actual disease. But do not worry, that will clear up in no time.
Before you start loading yourself on drugs, see a physician to confirm for bronchitis. If it has been confirmed, relax, you will be as good as new in no time.
- Yankaskas JR. Chapter 26 - Bronchitis, bronchiectasis and cystic fibrosis. In: Cohen J, Opal SM, Powderly WG, editors. Infectious Diseases (Third Edition) [Internet]. London: Mosby; 2010 [cited 2023 Sep 11]. p. 276–83. Available from: https://www.sciencedirect.com/science/article/pii/B9780323045797000265
- SCOTT K., and NATALIE A.L. Acute Bronchitis. American Family Physician. 2016;94(7):560-565.Available from; https://pubmed.ncbi.nlm.nih.gov/27929206/
- Yaniv D., Jennifer Y. S., Victor K. Chronic Bronchitis: Where Are We Now? Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation.2019; 6(2): 178-192. doi: http://doi.org/10.15326/jcopdf.6.2.2018.0151
- Anumeha S., Akshay A., Elise Z.Acute Bronchitis.From: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. https://www.ncbi.nlm.nih.gov/books/NBK448067/ Accessed on June 31, 2022.
- Pritish K.T. Is it true that honey calms coughs better than cough medicine does? Mayo Clinic., 2022. Online source: https://www.mayoclinic.org/symptoms/cough/expert-answers/honey/faq-20058031#:~:text=Drinking%20tea%20 or%20 warm%20 lemon,milliliters)%20 of%20 honey%20at%20bedtime. Accessed on: June 31, 2022.
- The Flutter. NHS-Respiratory Physiotherapy Reference No: 6258-2: 1-3. Online: https://www.wsh.nhs.uk/CMS-Documents/Patient-leaflets/Physiotherapy/6258-1-The-Flutter.pdf. Accessed on: June 31, 2022
- Charlotte E.B.Elaine F.B-S., John D.B., Patrick C., Sarah L.E., Rachel G., Neil J.G., Karen H., James H.H., William D-C M., Michael D.M., David P., Michael C.R., Louise S., Sally J.S., Paul P. W., Sandy W. British Thoracic Society Guideline on Pulmonary Rehabilitation in Adults. Thorax An International Journal Of Respiratory Medicine,2013.68(2). Online: https://www.brit-thoracic.org.uk/document-library/guidelines/pulmonary-rehabilitation/bts-guideline-for-pulmonary-rehabilitation-in-adults/. Accessed on: June 31, 2022.
- U.S. Department of Health and Human Services Centers for Disease Control and Prevention. Vaccine Information Statement: Influenza (Flu) Vaccine (Inactivated or Recombinant): What you need to know. [Online] https://www.cdc.gov/vaccines/hcp/vis/vis-statements/flu.pdf. Accessed on: July 1, 2022.