Bronchitis is an inflammation of the air passages between the nose and the lungs, including the windpipe or trachea and the larger air tubes of the lung that bring air in from the trachea (bronchi). Bronchitis can either be of brief duration (acute) or have a long course (chronic). Acute bronchitis is usually caused by a viral infection but can also be caused by a bacterial infection and can heal without complications. Chronic bronchitis is a sign of serious lung disease that may be slowed but cannot be cured. This form is found almost exclusively in adult smokers. Bronchitis in children is often misdiagnosed as asthma .
Acute bronchitis is most prevalent in winter. It is most often caused by a viral infection and may be accompanied by a secondary bacterial infection. Acute bronchitis resolves within two weeks, although the cough may persist longer. Acute bronchitis, like any upper airway inflammatory process, can increase a child's likelihood of developing pneumonia .
Acute bronchitis is one of the more common illnesses affecting preschool and school-age children. It is more commonly diagnosed among children under age five than any other age group. It occurs more often in young males. It can occur anytime but is more frequent during the winter months. In otherwise healthy children complications are few.
Causes and symptoms
Acute bronchitis usually begins with the symptoms of a cold, such as a runny nose, sneezing, and dry cough. However, the cough soon becomes deep and painful. Coughing brings up a greenish yellow phlegm or sputum. These symptoms may be accompanied by a fever of up to 102°F (38.8°C). Wheezing after coughing is common.
In uncomplicated acute bronchitis, the fever and most other symptoms, except the cough, disappear after three to five days. Coughing may continue for several weeks. Acute bronchitis is often complicated by a bacterial infection, in which case the fever and a general feeling of illness persist. To be cured, the bacterial infection should be treated with antibiotics . A cough that does not go away may be a sign of another problem such as asthma or pneumonia.
Physical findings of acute bronchitis vary with the age of the child, and the stage of the disease, but may include the following:
- runny nose
- dry, hacking unproductive cough that may change to a loose cough with increased mucus
- sore throat
- back and other muscle pains
- chills and low grade fever
- headache and general malaise (feeling unwell)
Initial diagnosis of bronchitis is based on observing the child's symptoms and health history. The physician will listen to the child's chest with a stethoscope for specific sounds that indicate lung inflammation, such as moist rales and crackling, and wheezing, that indicate airway narrowing. Moist rales is a bubbling sound heard
A sputum culture may be performed, particularly if the sputum is green or has blood in it, to determine whether a bacterial infection is present and to identify the disease-causing organism so that an appropriate antibiotic can be selected. Normally, the patient will be asked to cough deeply then spit the material that comes up from the lungs (sputum) into a cup. This sample is then grown in the laboratory to determine which organisms are present. The results are available in two to three days.
Occasionally, in diagnosing a chronic lung disorder, the sample of sputum is collected using a procedure called a bronchoscopy. In this procedure, the patient is given a local anesthetic, and a tube is passed into the airways to collect a sputum sample.
To better determine what type of obstructive lung disease a patient has, the doctor may do a chest x ray and order blood tests. Other tests may be used to measure how effectively oxygen and carbon dioxide are exchanged in the lungs.
When no secondary infection is present, acute bronchitis is treated in the same way as the common cold . Home care includes drinking plenty of fluids, resting, not smoking , increasing moisture in the air with a cool mist humidifier, and taking acetaminophen (Datril, Tylenol, Panadol) for fever and pain . Aspirin should not be given to children because of its association with the serious illness Reye's syndrome .
Cough suppressants are used only when the cough is dry and produces no sputum. If the patient is coughing up phlegm, the cough should be allowed to continue. The purpose of the cough is to bring up extra mucus and irritants from the lungs. When coughing is suppressed, the mucus accumulates in the plugged airways and can become a breeding ground for pneumonia bacteria.
Expectorant cough medicines, unlike cough suppressants, do not stop the cough. Instead they are used to thin the mucus in the lungs, making it easier to cough up. This type of cough medicine may be helpful to individuals suffering from bronchitis. People who are unsure about what type of medications are in over-the-counter cough syrups should ask their pharmacist for an explanation.
If a secondary bacterial infection is present, the infection is treated with an antibiotic. Patients need to take the entire amount of antibiotic prescribed. Stopping the antibiotic early can lead to a return of the infection. Tetracycline or ampicillin is often used to treat adults. Other possibilities include trimethoprim/sulfamethoxazole (Bactrim or Septra) and the newer erythromycin-like drugs, such as azithromycin (Zithromax) and clarithromycin (Biaxin). Children under age eight are usually given amoxicillin (Amoxil, Pentamox, Sumox, Trimox) because tetracycline discolors permanent teeth that have not yet come in.
For some children with acute bronchitis, doctors may prescribe medicines often used to treat asthma. These medicines can help open the bronchial tubes and clear out mucus. Bronchial dilators are usually given with an inhaler. An inhaler sprays the medicine right into the bronchial tree.
When treated, acute bronchitis normally resolves in one to two weeks without complications, although a cough may continue for several more weeks. The progression of chronic bronchitis, on the other hand, may be slowed, but an initial improvement in symptoms may be achieved.
Parents should make sure their children are getting adequate nutrition and rest to boost their immunity during cold and flu season. Children should be taught to wash their hands regularly to avoid spreading bacteria and viruses. Other preventative steps include avoiding chemical and environmental irritants, such as air pollution. Immunizations against certain types of pneumonia (as well as influenza ) are an important preventative measure for the very young or those children with chronic diseases.
Parents should encourage fluids by frequent offers of small amounts of the child's favorite liquids. Humidifiers should produce moist air to keep mucus from drying and to make it easier for the child to breathe. The child should be checked for signs of dehydration , including daily weights. Acetaminophen is given for temperatures over 101°F (38.3°C). Quiet activity provides a diversion for the sick child.
In caring for a child with acute bronchitis, parents should make the following observations:
- Is there a decrease in coughing and mucus production?
- Does the child have periods of rest and sleep?
- Is the child's intake enough for his or her age?
- Has the child kept a normal body temperature for 24 hours?
Parents should be aware that there is a significant association between high levels of air pollution, smoking, and increased incidence of chronic bronchitis. Air pollutants aggravate chronic pulmonary disease in children and cause decreased pulmonary performance in exercising children and teenagers. Teenagers should be questioned and taught about the ill effects of smoking either tobacco or marijuana. Teenagers should also be questioned about industrial fumes or automobile exhaust exposure at school or work.
Acute —Refers to a disease or symptom that has a sudden onset and lasts a relatively short period of time.
Bronchi —Singular, bronchus; the large tubular passages that carry air to the lung and allow air to be expelled from the lungs.
Chronic —Refers to a disease or condition that progresses slowly but persists or recurs over time.
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American Lung Association. 1740 Broadway, New York, NY 10019. Web site: http://www.lungusa.org.
National Heart, Lung, and Blood Institute. PO Box 30105, Bethesda, MD 20824–0105. Web site: http://www.nhlbi.nih.gov.
National Jewish Center for Immunology and Respiratory Medicine. 1400 Jackson St., Denver, CO 80206. Web site: http://www.nationaljewish.org/main.html.
"Bronchitis." MedlinePlus. Available online at http://www.nlm.nih.gov/medlineplus/bronchitis.html (accessed December 17, 2004).
Aliene Linwood, RN, DPA, FACHE
Tish Davidson, AM