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Bronchitis
Bronchitis refers to inflammation of the airways (bronchi) in the lungs. This is most often occurs secondary to a bacterial infection already present in the airways. Bronchitis differs from pneumonia, where the infection is deeper into the lung tissue. Bronchitis is a common infection seen in the smoking population who may also suffer simultaneously from chronic obstructive pulmonary disease (COPD). Smokers have difficulty clearing their secretions (mucus) and have diminished immunity against infection. Common symptoms include productive cough (in smokers, it may be occasionally blood streaked), fever, and chills. Shortness of breath is seen in more severe cases. Bronchitis is almost indistinguishable from pneumonia on the basis of symptomology alone. Long time smokers develop "wheezing" (asthma-like symptoms), where breathing OUT is more difficult than breathing IN. The act of breathing OUT may be accompanied by a musical wheeze.
Evaluation will include a medical history and physical examination in addition to a chest x-ray (to rule out pneumonia), blood tests (i.e. CBC, chemistry) and sputum cultures. Patients with shortness of breath may have an arterial blood gas performed to make sure their lung function is normal. In most cases, treatment is with oral antibiotics. Some cases with evidence for compromised lung function (long standing smokers with COPD) will require hospitalization. Those patients with "wheezing" will require bronchodilator (e.g. Alupent, Proventil) treatments. These are often administered as an aerosolized medication, inhaled by the patient. Inhalational treatments can be performed at home, but hospitalization will be required for patients who show a poor response to therapy. The majority of patients with bronchitis can be treated at home with close medical follow-up. A follow-up chest x-ray (several days later) will be performed in those patients not responding to eatment. The x-ray may reveal a developing pneumonia. Acetaminophen or aspirin should be used for fever control. The Internist or Pulmonologist is the experts in the treatment of this problem.
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