Bronchitis may be suspected in patients with an acute respiratory infection with cough; however, because many more serious diseases of the lower respiratory tract cause cough, bronchitis must be considered a diagnosis of exclusion. Spirometry or lung function test forms the mainstay of diagnosis. Oxygen, bronchodilators, antitussives, expectorants/ antitussives form the main stay of treatment in bronchitis.

 

Tests and diagnosis

• Complete blood count – would indicate lung inflammation (raised WBC count, C- reactive protein)
• A sputum gram stain/culture showing neutrophil granulocytes (inflammatory white blood cells) and culture showing that has pathogenic microorganisms such as Streptococcus spp.
• A chest X-ray that reveals hyperinflation; collapse and consolidation of lung areas would support a diagnosis of pneumonia.
• Arterial blood gas (ABG) - a blood test that is used to evaluate the lungs' ability to provide blood with oxygen and remove carbon dioxide, and to measure the pH (acidity) of the blood.
• Obtain cultures of respiratory secretions/throat swab for influenza virus, M pneumoniae, and Bordetella pertussis when these organisms are suspected.
• Blood culture may sometimes be helpful if bacterial super infection is suspected.

• CT chest- reveals collapse, consolidation, and atelcetasis.

• Bronchoscopy may be needed to exclude foreign body aspiration, tuberculosis, tumors, and other chronic diseases of the tracheobronchial tree and lungs.

Pulmonary function test- Spirometry

• Diagnostic tests that help to measure the lungs' ability to exchange oxygen and carbon dioxide appropriately
• An FEV1/FVC ratio below 0.7 that is not fully reversible after bronchodilator therapy indicates the presence of COPD that requires more aggressive therapy and carries a more severe prognosis than simple chronic bronchitis.
• Residual volume and total lung capacity are normal. Vital capacity is reduced. 

Treatment

Preventive measures

• To quit smoking and exposure to secondhand smoke
• Avoid occupational exposure to chemical fumes and dust.
• Avoid strenuous exercises.
• Avoid cold weather (cold dry air).
• Use face masks around other people who are coughing and sneezing

Specific treatment for chronic bronchitis will be determined by the physician based on:

• your age, overall health, and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Specific treatment includes

Oxygen therapy

100% oxygen 5-6 lts per min by facial mask

Bronchodilators

In acute bronchitis and chronic bronchitis treatment with bronchodilators are useful in patients who have associated wheezing with cough and underlying lung disease.

• Beta2- agonist - Salbutamol, Salmetrol and others
• Methyl Xanthine- Deriphylline, Aminophylline, and others
• Anticholinergics- Ipratropium and Tiotropium bromide

Bronchodilators are given through inhalational, oral, and injectable routes

Antitussives/ expectorants

Antitussives – Dexmethorphan, Codeine sulphate, Diphenhydramine and others

Expectorants- Guaiphenasin, Ambroxyl, and Bromhexine

Steroids

Steroids are life saving medications in acute exacerbations

Available as oral, inhalational and injectable forms

Oral – methyl prednisolone

Inhalational- Budesenoid, Fluticosone, and Flunisolide

Injectable- Dexamethasone, Betamethasone, Hydrocortisone, and others

Antibiotics

For acute exacerbations antimicrobials have reasonable benefit.

Common antibiotics used are:

• Extended penicillin’s - Amoxicillin and clavulanate
• Macrolide antibiotics – Azithromycin and clarithromycin
• Third generation Cephalosporins- Ceftriaxone, Cefepodoxime, and others
• Fluroquinolones- Levofloxacin, Gatifloxacin, and others

Antiviral agents

• Influenza vaccinations offer greater protection for the appropriate populations because they offer coverage for influenza A and B.
• However, Amantadine and Rimantadine can be useful during epidemics of influenza A.
• Zanamivir and Oseltamivir are the newest agents and are effective for both influenza A and B.

Self care at home

• Acetaminophen (Tylenol) to reduce fever and muscle aches
• Avoid exposure to irritants such as tobacco smoke
• Cool mist vaporizer/humidifier to reduce bronchial irritation
• Steam inhalation Clear your airways by gentle coughing/ drinking plenty of water
• Breathe through nose instead of your mouth when you ate outside
• Eat healthy foods
• Proper breathing exercises