Bronchitis vs Pneumonia

Introduction

Got a cough and chest discomfort but not sure if you are suffering from bronchitis or pneumonia?

Though bronchitis and pneumonia are not the only causes of cough, these are two of the most common respiratory diseases and causes. It can be difficult to differentiate between bronchitis and pneumonia. This article will look at ways to tell apart these two conditions.

What is Bronchitis?

Bronchitis refers to inflammation of the bronchi – the major airways that branch off from the windpipe into the lungs. 

The normal bronchi act as passageways for air into the lungs and secrete a discrete amount of mucus to trap dust and other foreign particles from entering the lungs. The cells lining the bronchi then move these foreign agents up and out of the airway through what is known as a mucociliary function.

In bronchitis, the lining of the bronchi becomes inflamed and swollen with fluid. This causes the functionality of the cells lining the bronchi to become impaired. As a result, the airways are unable to clear out foreign material or debris and the copious amounts of mucus that is secreted. All of this clogs up the airways, irritates them, and results in the characteristic cough that is seen in bronchitis.^{1, 2, 3}

Types

Bronchitis is either acute or chronic. Acute bronchitis is used to describe a type of bronchitis that resolves within 3 weeks. Chronic bronchitis, on the other hand, is bronchitis that lasts at least 3 months a year and occurs for at least 2 consecutive years.^{1, 2, 3}

Causes and Risk Factors

The causes of bronchitis include infectious organisms and irritation from inhaled toxic substances.

Infectious organisms 

The infectious organisms more commonly include viruses and less commonly bacteria. In the majority of infectious bronchitis, the causative agent is the same as that which causes the common cold. These are known as the Influenza viruses. Because the cause is an organism, this type of bronchitis is transmissible when the infected person coughs or sneezes, releasing thousands of tiny droplets that contain the infectious agents. Bronchitis from infectious organisms is usually in the form of acute bronchitis (which is short-lasting). Seldomly, they can cause chronic bronchitis (which is recurring and more serious), especially in people who have an underlying respiratory disease like asthma or cystic fibrosis.

Irritation from inhaled toxic substances 

Bronchitis can also arise from exposure to irritants in inhaled air. This ranges from direct cigarette smoking and second-hand tobacco smoking to smog, chemicals in household products, as well as industrial pollutants such as sulfur dioxide, grain dust, chlorine, and ammonia. Bronchitis developed due to exposure to irritant substances at the workplace is referred to as occupational bronchitis. People who have repeated exposure to inhaled pollutants such as dust and airborne chemicals like sulfur dioxide are more likely to develop chronic bronchitis.^{1, 2, 3}

The risk factors for bronchitis include:

• Smoking
• Repeated exposure to environmental pollutants
• Underlying respiratory diseases such as asthma
• Family history of chronic bronchitis
• Allergies
• Old age
• Chronic gastroesophageal reflux

Symptoms

Acute Bronchitis

The primary symptom is usually a cough. In about 50% of cases, a cough may bring up clear, grey, or yellowish-greenish sputum (phlegm). Other symptoms may be similar to those of common cold or sinusitis, which include runny nostrils or blocked nostrils, sore throat, muscle aches and fatigue, headache, and tiredness. You may also experience noisy breathing (stridor or wheezing) when there is acute bronchitis. Fever is uncommon in bronchitis. In acute bronchitis, the symptoms typically resolve within 1-3 weeks.

Chronic bronchitis

Symptoms may initially present similarly to acute bronchitis, however, the cough persists for months even after other symptoms have gone away.^{1, 2, 3} 

Treatments

Though bronchitis clears up by itself without the need for treatment within 1-3 weeks in most cases (acute bronchitis), in other cases, the symptoms of bronchitis can last much longer and sometimes go on for or beyond 3 months (chronic bronchitis).

To relieve the symptoms of bronchitis, you are advised to:

• Drink lots of fluid 
• Get plenty of rest
• Take lemon and honey to help soothe the sore throat and ease your cough.
• Take paracetamol for headaches, aches, pains, or fever. Paracetamol is generally preferred to NSAIDs like Ibuprofen because they may exacerbate asthma symptoms.

In cases of chronic bronchitis, lifestyle changes can help ease your symptoms and include:

• Eating a healthy diet
• Regular moderate exercise 
• Avoiding cigarette smoking 

In some cases of chronic bronchitis, medicines called bronchodilators and steroids may be prescribed as tablets or inhalers to reduce the inflammation in the bronchi and open up the airways.

Do cough mixtures work?

Cough mixtures are not generally recommended for bronchitis. They should only be used upon advice from a doctor or pharmacist if alternatives like lemon and honey do not work.

Are antibiotics used for bronchitis?

Antibiotics are also not routinely prescribed for bronchitis because the majority of bronchitis is caused by viruses or irritant substances in the air. Antibiotics do not have any beneficial action against viruses or irritant substances and may instead lead to the development of antibiotic resistance (where antibiotics are no longer effective when they should be).^{1, 2, 3}

What is Pneumonia?

Pneumonia, unlike bronchitis, is an infection and inflammation of the lung tissues (not the airways).

Pneumonia usually occurs when the body’s natural defences, such as mucus secretion and mucociliary action, are unable to keep harmful pathogens from entering the lungs. These pathogens multiply in the lungs and activate the immune system. The inflammatory action causes the lung tissue to become filled with secretions, fluid, or pus. This causes impaired breathing and coughing.⁴

Causes and Risk Factors

Pneumonia is usually the result of a bacterial infection. However, less seldomly, it may be caused by viruses (viral pneumonia), fungi (fungal pneumonia), or aspiration of foreign substances such as vomit into the lungs (aspiration pneumonia).⁴

Symptoms

Symptoms of pneumonia include:

• Coughing may be dry or produce sputum (phlegm)
• Difficulty breathing – your breathing may be rapid and shallow, and you may feel breathless, even when resting
• Noisy breathing (wheezing)
• Palpitations or rapid heartbeat
• Fever or high temperature
• Feeling generally unwell
• Chest pain which is worse when breathing or coughing
• Rarer symptoms of pneumonia include coughing up blood (hemoptysis) and feeling confused or disoriented⁴

Treatments

Pneumonia treatment includes antibiotics. Pneumonia is likely to be caused by a bacterial infection. This should, however, be prescribed by a medical professional. Other things that can be done include:

• Getting plenty of rest
• Drinking plenty of fluids
• Paracetamol for pain, aches, and fever

In more severe cases of pneumonia, which can be fatal and lead to serious complications, admission to the hospital may be warranted for respiratory support with intranasal oxygen or facemask and other advanced care.⁴

Diagnosis of Bronchitis and Pneumonia

To make a diagnosis of either bronchitis or pneumonia, a doctor may ask you questions that will help differentiate the two conditions, such as: 

• Are you feeling breathless, or have you started breathing faster than usual?
• How long have you been coughing? 
• Is the cough producing sputum or not? 
• What is the colour and smell of the sputum? 
• Do you have a fever? 
• Is the pain in your chest worse when you breathe in or out?

The doctor may also listen to your chest and back with a stethoscope or by tapping it to check for particular sounds. 

If pneumonia is likely, the doctor will probably ask that you have a chest X-ray to confirm the diagnosis. Other tests include blood tests and tests on the sputum (phlegm).

What are the Similarities and Differences?

Bronchitis and Pneumonia are similar as they both cause coughing. However, they can be told apart by symptoms that are more likely in one condition than the other.^{2, 3, 4}

The differences are summed up below:

Fever:

• Bronchitis: Less Likely

• Pneumonia: More Likely

Breathlessness:

• Bronchitis: No breathlessness

• Pneumonia: Breathlessness

Chest Pain:

• Bronchitis: Not as common

• Pneumonia: More common (and worse when breathing or coughing)

Sputum (phlegm):

• Bronchitis: More likely to be clear or grey

• Pneumonia: More likely to be yellowish-greenish with foul-smell

Rate of breathing:

• Bronchitis: Usually normal

• Pneumonia: Faster rate

Heart Rate:

• Bronchitis: Palpitations or fast heart rate unlikely

• Pneumonia: May have palpitations or fast heart rate

Which is worse: Bronchitis or Pneumonia?

Though symptoms may be similar, pneumonia is a more serious condition than bronchitis and has the potential for major complications and may even be fatal if very severe.⁵

When should I contact my doctor?

You should visit your local hospital if you notice any of the following signs:

• Very high temperature
• Feeling breathless
• Coughing up blood
• Symptoms lasting more than 3 weeks
• Bluish discolouration of skin or mouth
• Becoming confused or very drowsy
• Falling unconscious

Note that this list is non-exhaustive, and you should visit your hospital for any sign that is concerning.

Summary

Though bronchitis and pneumonia may have similar symptoms and features, they are 2 different conditions. These 2 conditions can usually be differentiated by differences in the symptoms they present with. Fever, breathlessness, chest pain that is worse when breathing or coughing, yellow-green sputum with foul smell, palpitations and fast breathing are more likely to be seen in someone with pneumonia than with bronchitis.