Around this time of year, it seems like everyone has a cough or nasal congestion. Often, these are simple colds that go away quickly on their own with little more than a runny or stuffy…
Around this time of year, it seems like everyone has a cough or nasal congestion. Often, these are simple colds that go away quickly on their own with little more than a runny or stuffy nose. But other times, the viruses that cause these colds can trigger an additional problem — acute bronchitis.
“Bronchitis is an inflammation of the lower respiratory tract,” says Dr. Paul Simonelli, chair of pulmonary and critical care medicine at Geisinger. The lower respiratory tract includes the bronchial tubes that branch from the throat into the lungs.
Dr. Jason Turowski, associate director of the Adult Cystic Fibrosis Program at the Cleveland Clinic, explains how it works. “Air comes in through the mouth and the nose through the largest airway, called the trachea. The trachea breaks into the right and left bronchi.” These bronchi continue to branch off and decrease in size as they go farther into the lungs in a tree-like structure. “I tell my lung transplant patients that these airways look like a tree that’s been flipped over. The trunk of the tree is the trachea and the main branches are the bronchi. Bronchitis is when those airways become inflamed,” he says.
Bronchitis results from an infection of the lower respiratory tract and is a very common ailment with the hallmark symptom of coughing. Some people refer to it as a chest cold. “It’s one of the most frequent reasons people end up going to a doctor,” Simonelli says. In fact, a report in the October 2016 issue of the American Family Physician, a peer-reviewed journal of the American Academy of Family Physicians, noted that “cough is the most common illness-related reason for ambulatory care visits, accounting for 2.7 million outpatient visits and more than 4 million emergency department visits annually.” Many of these cases are determined to be bronchitis.
Acute bronchitis is “almost always caused by a virus,” Simonelli says, and “there’s a whole battery of respiratory tract viruses” that can trigger it, from rhinoviruses that cause the common cold to influenza and parainfluenza that cause the flu and flu-like illnesses.
In the fall and winter, rhinoviruses are frequent culprits in triggering cases of bronchitis, Turowski says. “A lot of people think that when they start coughing, it’s going to be something like influenza, but there’s far more common stuff that cause the common cold like rhinovirus, coronavirus, parainfluenza,” and other viruses that we can pick up in our daily travels that lead to bronchitis.
How Is Bronchitis Diagnosed?
Bronchitis is relatively easy to diagnose, and Simonelli says there’s not much in the way of testing that needs to be done in most cases. “Most of the time you can figure it out by the history and examining the patient.” Ruling out other, more serious conditions is important in some cases, particularly for patients who have a compromised immune system or other comorbidities, such as another lung condition, that could make a bout of bronchitis worse.
Simonelli says that if a case of bacterial bronchitis is suspected, your doctor may order a blood test looking at procalcitonin levels, a substance the body produces in response to bacterial infections. Your doctor may also order a chest X-ray or other tests if there’s concern that your cough isn’t being caused by a simple case of bronchitis. These tests are used to rule out more dangerous conditions like pneumonia.
What Signs and Symptoms Might Indicate I Have Bronchitis?
Most cases of bronchitis start out with classic cold symptoms — a runny nose and sore throat. After a few days, the problem seems to move farther down, into the chest, and sets up shop as a persistent cough that often brings up mucus or sputum that may be white, yellow or green in color. “People usually describe it as settling in the chest,” Simonelli says. “The way you know you have acute bronchitis, generally is because you develop a cough that has lasted at least five days, and typically the cough can take from one to three weeks” to clear up.
Should I See a Doctor for Bronchitis?
Most cases of bronchitis will resolve on their own. However, if you have a cough that persists for more than three weeks or that worsens or has an accompanying fever, you should see your doctor for further evaluation to make sure you haven’t developed pneumonia or that another condition isn’t causing your cough.
“One doesn’t usually get fevers with bronchitis,” Simonelli says, and although shortness of breath and chest pain can occur, they usually aren’t severe. Therefore, “if those things happen to you, that’s a time when you might want to see the doctor for testing,” which may include a chest X-ray to look for masses or obstructions or spirometry testing, which measures how well you can empty your lungs.
“It can be,” Simonelli says. This is because the viruses that trigger bronchitis — such as rhinovirus and influenza — are highly contagious. “If someone is sick with influenza or a cold virus, that is contagious, as opposed to asthma, which is not contagious. If someone has asthma and has been coughing for weeks and weeks, they’re probably not contagious, but in an acute setting bronchitis is absolutely contagious.”
How Is Bronchitis Treated?
Although many of us likely had the experience as kids of being prescribed an antibiotic to clear up a case of bronchitis, these days, most doctors avoid writing prescriptions for what its typically a condition caused by a virus. “I remember when I was a kid, what would always happen, the doctor would write illegibly on this pad some sort of prescription that made you feel like it was worthwhile to come in to see the doctor,” Turowski says. “But what we’ve learned is that bronchitis itself is just inflammation of the airways, and the airways have a natural balance of mucus and cell types that are there to modulate and maintain the airway and keep it clean.” When a virus invades, “the body doesn’t have a specific way of dealing with viruses. It generally just launches all-out warfare against them. And so the body tends to over-secrete things like mucus and white blood cells,” which forms the “mucus that we cough up. It’s white blood cells, mucus, saliva and things that are lining the airways. It very rarely requires antibiotics,” and so for the vast majority of cases of bronchitis, no antibiotics are needed.
That said, there are some times when an antibiotic might be needed. The CHEST Foundation reports that bacteria cause bronchitis in less than 10 percent of cases, and when it does, antibiotics may be appropriate to treat these infections. But for the vast majority of people with bronchitis, a virus has triggered it, and antibiotics aren’t appropriate. In these instances, there’s not a whole lot the doctor can do for you, and your grandma’s remedies might be best.
“One of the big initiatives across the world, from the World Health Organization to our own country is to get people to stop writing prescriptions for antibiotics for acute bronchitis,” Simonelli says, “because it’s one of the most frequent reasons that antibiotics are used incorrectly. You don’t want to do that because they have side effects and then you worry about getting resistant bugs,” meaning that overuse of antibiotics can lead to the development of more virulent and harder-to-kill strains of bacteria.
Plus, he adds, “using an antibiotic when you don’t need it sets the stage for getting sicker later on. There are a lot of reasons not to use an antibiotic, and so we try to get people to stop doing that.” Instead, time is the best curative, and easing symptoms with “good, old-fashioned remedies like cough drops, over-the-counter medicines, tea with honey and the usual things that your grandmother might have used — those are the right things to do.”
For many people, this means reaching for an over-the-counter medication, though Turowski says “I don’t recommend people overdo it on things like that.” But medications like “Robitussin and Mucinex that have antitussin (ingredients that thin mucus and make it easier to clear from the body) or anti-cough ingredients” may help. “They’ve never been proven to help, but they’ve never been proven to harm either,” he says.
In addition, “try to remain hydrated, get adequate sleep and make sure your vaccinations are up to date,” including your annual flu shot and pneumonia vaccine if your doctor recommends that you have that vaccination. And lastly, “if you’re a smoker, stop smoking. That can make the cough worse while you’re sick,” Turowski says.
Time remains the best healer for cases of acute bronchitis. “It will get better. It just takes time,” Simonelli says.
Is It Bronchitis, or Something Else?
However, if you have frequent bouts of bronchitis or a case that just doesn’t seem to go away, something else may be going on with your lungs. While doctors worry that cases of acute bronchitis will progress to pneumonia, it can also turn into chronic bronchitis, which is one of two conditions that fall under the heading of chronic obstructive pulmonary disease.
COPD is an umbrella term referring to emphysema and chronic bronchitis. The primary risk factor for COPD is cigarette smoking, but not everyone who has COPD was or is a smoker. COPD is a degenerative disease that gets worse with time, and some of the hallmark symptoms are wheezing, chest tightness, coughing up phlegm and mucus, frequent colds and respiratory infections, unintended weight loss, lower extremity swelling, loss of energy and fatigue. COPD can be diagnosed using a mix of testing, including spirometry, which measures how much air you can push out of your lungs and walking tests to measure your exercise capacity.
In addition, cases of persistent cough and chest tightness might not be bronchitis at all, but rather a form of asthma that causes you to cough a lot. Asthma and bronchitis have similar symptoms and it can be challenging to differentiate between the two conditions sometimes. “You’ll often hear a story about someone who gets bronchitis at the same time every year or a couple times a year,” Simonelli says. It’s entirely possible that you could be dealing with repeat cases of acute bronchitis, but it could also be a form of asthma. ” Asthma has very similar symptoms to bronchitis, with coughing that could be with or without phlegm. Wheezing could be part of it, and they may even get a little short of breath,” so bronchitis can look like asthma. Asthma is managed through the use of inhalers that open up the airways.
If you’re having frequent bouts of bronchitis or find that you have chest tightness, wheezing or other symptoms that might indicate a more severe problem, you may want to consider seeking the assistance of a pulmonologist.
Who’s at the Highest Risk of Getting Acute Bronchitis?
While anyone can get bronchitis at any age, Turowski says “certain populations are more prone to getting it.” Asthmatics — people who have asthma — “have an underlying hyper-reactivity of small airways, so they’re at a greater risk if a virus gets inside the body,” that the body will overreact and a case of acute bronchitis will be triggered. Asthmatics and people with COPD are also more prone to contracting bacterial bronchitis because of the underlying lung problems. And people whose immune systems aren’t functioning at 100 percent capacity, which can be common in very young children whose immune systems are still developing and older adults whose immune systems may be compromised by age and other ailments, are at higher risk as well.