Depending on the duration of the disease, bronchitis can be divided into acute (<3 weeks), subacute (3–8 weeks) or chronic (> 8 weeks). Acute bronchitis is most often caused bya viral infection. Subacute inflammation may be the result ofbronchial hyperreactivityafter infection orpertussisinfection , while chronic inflammation is the result of harmful environmental factors, most oftensmoking.

Acute bronchitis

Acute bronchitis is an acute respiratory infection with acoughlasting <3 weeks and is diagnosed whenpneumoniais excluded .

How common is bronchitis

It is a common disease. Most of us have had more than one episode of acute bronchitis in their lifetime. The disease is the most common diagnosis in patients who report to a doctor because of an acute cough.

The causes of bronchitis

Dig. 1.The RSV

Public Health Image Library virus

Fig. 2.AdenovirusPublic Health Image Library

The most common causes are viruses that causecoldsandflu. These are among others:

• influenza A virus, influenza B, parainfluenza, RSV, coronaviruses, adenoviruses and rhinoviruses. These viruses most often cause a cold, but sometimes the symptoms also extend to the respiratory tract and bronchitis develops.
• The disease is rarely caused by bacteria (estimated to be less than 10% of cases). They are often so-called bacteria. atypical (Mycoplasma pneumoniaeandChlamydophila pneumoniae), which are common causes of pneumonia and bronchitis, andBordetella pertussis, a bacterium that causeswhooping cough.B. pertussiscan cause acute bronchitis also in people vaccinated against whooping cough, but the disease is milder in them.

In most patients, there are no indications for microbiological diagnostics, i.e. there is no need to identify which virus or bacterium is causing the disease, as it does not affect the treatment.

Symptoms of bronchitis

The most common symptoms are:

• cough, most often accompanied by expectoration of mucous (whitish) or purulent (yellow, less often greenish)
• sputum
• fever
• bad mood
• muscle pain sometimes
• lesswheezing

Systemic symptoms (fever, “crash”, muscle pain) are common with influenza and parainfluenza but rare when the acute bronchitis is caused by other viruses.

Symptoms do not allow the doctor to reliably distinguish the causes of bronchitis. The symptoms gradually disappear, usually lasting up to 6-7 days. Sometimes the cough may last up to 2-3 weeks.

When should you see a doctor with bronchitis?

• if you experience wheezing andshortnessof breath, or severepain in the chestwhich increases when you breathe in
• if fever (> 38^oC) lasts for more than a few days
• if symptoms persist for more than 7 days.

Tests performed during a medical visit to diagnose bronchitis

Usually, apart from a thorough physical examination, no additional tests are needed. In some patients it is necessary to perform a chest radiograph, most often in order to exclude pneumonia, the symptoms of which are sometimes similar (in the case of pneumonia, fever and cough are usually more severe, dyspnoea is often present, and the doctor finds changes during auscultation of the chest).

Correct removal of the chest cavity excludes pneumonia. Microbiological testing (to find out what viruses or bacteria are responsible for the symptoms) is usually not necessary.

Treatment of bronchitis

• home rest
• in case of fever, drinking plenty of non-carbonated fluids, taking paracetamol on an ad hoc basis (if it is not effective, you can use ibuprofen or aspirin, but these drugs are harmful to the gastric mucosa).
• If you are coughing up mucus, your doctor may advise you to use drugs to help you cough up. The most commonly used are ambroxol, acetylcysteine ​​and carbocysteine. These drugs reduce the viscosity of the secretion and make it easier to expectorate. In order to facilitate expectoration of secretions, guaifenesin is also used, which acts as an expectorant. For dry cough (without bronchial secretions), antitussive drugs such as levodropropizin and butamirate or dextromethorphan are used.
• antibiotics do not improve acute bronchitis and should not be used. The presence of yellow (purulent) sputum does not constitute a bacterial etiology of bronchitis and is not an indication for taking an antibiotic. The unnecessary use of antibiotics, in addition to the risk of side effects for the patient, is associated with the selection of resistant strains – simplifying a bit, only bacteria that are most resistant to treatment and resistant to antibiotics survive. The result is that when antibiotic treatment is really necessary, bacteria can become resistant to them.
• in patients with dyspnoea and / or severe cough, the doctor may administer bronchodilators. The most commonly used drugs are long-acting drugs, such as fenoterol or salmeterol. They relax the muscles of the bronchial wall and cause the bronchial tubes to dilate. Their use makes sense only in patients whose increased inflammation in the course of bronchitis has led to bronchial obstruction, i.e. their narrowing. Bronchial obstruction may manifest itself as shortness of breath and wheezing, and is detected by a doctor during auscultation of the lungs. An objective test to assess the presence and severity of bronchial obstruction isspirometry, but it is usually not used in the acute period of the disease. There is no point in using bronchodilators in people without symptoms of bronchial obstruction.

Antimicrobial drugs are used exceptionally, in those rare cases of bronchitis where the etiology is established (most often this happens with whooping cough or influenza.