Bronchitis

What is Bronchitis?
Bronchitis is an inflammation of the air passages that extend from windpipe into the lungs. This may be caused by
a virus, bacteria, smoking or the inhalation of chemical pollutants or dust. When the cells of the bronchial-lining
tissue are irritated beyond a certain point, the tiny hairs (cilia within them, which normally trap and eliminate
pollutants stop functioning. !s a result, they become clogged by debris and the irritation increases. "n response,
secretion of mucus is increased resulting in cough and if severe enough shortness of breath.
Bronchitis comes in two forms# acute (less than $ weeks or chronic (recurring fre%uently for more than two
years#
Acute Bronchitis:
Chest x-ray of a patient with pneumonia of the right lung
This is responsible for the hacking cough and phlegm production that accompany an upper respiratory tract
infection. "n most cases, it is viral in origin, sometimes it is caused by bacteria. The mucosal area will return to
normal after several days unless there is an underlying lung problem. The presence of fever, chills, muscle ache
and chest pain suggest a more serious infection like pneumonia. &hest x-ray should be ordered.
Chronic Bronchitis
&hronic bronchitis is defined as excessive mucus secretion in the bronchi presenting with a chronic or recurrent
mucus-producing cough that lasts three or more months and recurs year after year. &hronic bronchitis may result
from a series of attacks of acute bronchitis, or it may evolve gradually because of heavy smoking or inhalation of
polluted air. When the mucus producing layer of the bronchial lining has thickened, narrowing the airways to the
point where breathing becomes increasingly more difficult. When the cilia cannot sweep the air clean of foreign
irritants, the air passages become more vulnerable to infection. This results in further tissue damage. 'nlike acute
bronchitis, chronic bronchitis is an ongoing, serious disease.
Diagnosis
Symptoms
o (ersistent cough
o (roductive cough
o )hortness of breath
o Whee*ing
o +ever
Investigations
o &hest x-ray
o Blood test example blood count
o )putum test
o ,ung +unction test
The doctor will decide on above tests if indicated and necessary.
Treatment
o (lenty of rest
o !de%uate fluid intake
o !void smoke and fumes
o )top smoking in chronic bronchitis
o &ough syrup
o Bronchodilator
o "nhaled or oral steroid if severe
o -xygen therapy if severe
o !ntibiotic if indicated
"f you have chronic bronchitis, it is advisable to stop smoking and have an annual flu vaccination.
Bronchiectasis
What is bronchiectasis
Bronchiectasis the condition when the airways in the lung are larger that seen in the normal person. The airways
are usually described as dilated and can be seen on the x-ray or &T scan to extend much further into the lung than
is normal.
Do I have bronchiectasis?
Bronchiectasis is one of the causes of chronic cough. The most common presentation is that of coughing with
copious amounts of phlegm production on a daily basis. Besides this, patients may occasionally cough out blood.
!nother common occurrence is that of fre%uent chest infections and visits to the doctor that re%uire antibiotics.
How did I get bronchiectasis?
Bronchiectasis is scarring of the lung that usually occurs after a bacterial infection. The se%uelae of the infection
usually involves scarring of the lungs that will lead to dilatation of the airways ( bronchiectasis. )ome people may
recall a childhood infection that may have been severe enough to have been hospitali*ed while some others may
have no recollection at all. (eople who have had tuberculosis in the distant past that has resulted in lung damage or
scarring can also have bronchiectasis.
-ther conditions such as measles in childhood, influen*a and non-tuberculous mycobacteria may cause
bronchiectasis. -bstruction of the airway by foreign bodies, inborn abnormalities of the airway as well as
abnormal swallowing mechanisms can all predispose towards bronchiectasis.
)ome rare conditions may predispose to bronchiectasis because they make the sufferer more prone to bacterial
infections. These include inborn deficiencies in the immune system such as hypogammaglobulinemias and cystic
fibrosis.
Can it be cured? I not! what can I e"pect in the uture?
Chest x-ray of a patient with severe pneumonia
-nce the lung is scarred up, it cannot revert to its original architecture. Bronchiectasis is a permanent condition
and cannot be cured per se. The result is a part of the lung that has abnormal pooling of airway secretions and this
results in increases phlem production. )ome patients complain of coughing out phlegm as they change the position
of the body ( ie on lying down or turning because the pooled phlegm drains in certain postures.
!nother se%uelae is recurrent infections. this usually is signalled by an increase in the phlegm over the usual
amounts as well as a change in colour or smell from the usual pattern. These infections need to be treated with
appropriate antibiotics to prevent a more serious outcome.
! feared outcome from bronchiectasis is coloni*ation with (seudomonas aeruginosa. This organism is fastidious
and predisposes to recurrent pneumonia which can hospitali*e a patient.
What can I do to prevent prob#ems rom bronchiectasis?
(atients with a history of bronchiectasis should be seen by a chest specialist. The condition is chronic and episodic
worsening of the condition by bacterial infections are prone to occur. .our specialist may refer you to a
physiotherapist who will teach you how to clear the affected parts of the lung of phlegm and this may reduce the
incidence of infections. )ome patients may benefit from long term antibiotics. )urveillance to assess for infections
by opportunistic organisms is also part of the management of this condition.
What i I cough out b#ood?
Bronchiectasis patients are prone to cough out blood. This is because of the increased blood flow in the affected
areas that may lead to formation of new blood vessels which are more fragile. The bleeds often occur during an
infective episode.
.ou should always see your doctor in the event of a new episode of bleeding. This may sometimes be due to an
unrelated event such as lung cancer or TB. -ften, it is due to a bacterial infection that is amenable to treatment
with antibiotics.
"f the amount of blood is small ( blood streaked sputum and you do not have any other symptoms such as
breathlessness, chest discomfort etc., you may wait till the next day to see your doctor. /owever, in cases when the
bleeding produces fresh blood in larger amounts or if you are breathless even if the amount is small, you should
immediately go to the nearest hospital.