Bronchitis
Bronchitis is characterised by inflammation of the large bronchi mucosa that leads to symptoms of cough and sputum production. The inflammation is usually caused by a viral infection, with symptoms lasting 1–3 weeks.
Expand all
Collapse all
Definition
Bronchitis is characterised by inflammation of the large bronchi mucosa that leads to symptoms of cough and sputum production. Nowicki and Murray (2020) defined bronchitis as inflammation of the mucous membranes that line the bronchi in the airways. The inflammation is usually caused by a viral infection, with symptoms lasting 1–3 weeks (Ebell et al, 2013). The cardinal signs are persistent cough and mucus production, usually lasting 5 days to 2 weeks (Kızılırmak and Yorgancıoğlu, 2023).
Kradin (2016) described chronic bronchitis as symptoms of chronic cough and increased sputum production. Chronic bronchitis can be caused by inhalation of chemicals from the environment. It is characterised by cough and hypersecretion of mucus, similar to acute bronchitis, but is also associated with chronic inflammation in the airways. Patients often experience exacerbations of the condition, as well as:
- airflow obstruction
- progressive lung function decline
- increased morbidity (Kradin, 2016; Boucher, 2019)
A patient can
To view the rest of this content login below; or read sample articles.
Symptoms
The main symptom that occurs in both acute and chronic bronchitis is a cough. Cough is a mechanism to clear mucus when the mucociliary escalator is ineffective (Boucher, 2019).
Other symptoms include:
- increased sputum
- dyspnoea (severe shortness of breath or difficulty breathing)
- wheeze
Patients with chronic bronchitis generally present with chronic productive cough, malaise and a decline in their lung function (Widysanto and Mathew, 2023).
To view the rest of this content login below; or read sample articles.
Aetiology
Acute bronchitis
Acute bronchitis is usually caused by a viral infection, such as:
- rhinovirus
- enterovirus
- influenza A and B
- parainfluenza
- coronavirus
- human metapneumovirus
- respiratory syncytial virus (Woodhead et al, 2011)
Respiratory viruses, such as respiratory syncytial virus and human metapneumovirus, are common causes of bronchiolitis and bronchitis in children (Douros and Everard, 2020). These viruses are transmitted by respiratory droplets. Bacterial infections can also cause a small percentage of bronchitis cases (Singh et al, 2024). These include atypical bacteria, such as Mycoplasma pneumoniae, Chlamydophila pneumoniae and Bordetella pertussis (Park et al, 2016).
Children are also at risk of developing bronchitis if they are exposed to environmental tobacco smoke (Wark, 2015). Risk factors for acute bronchitis in adults include:
- history of smoking
- environmental factors, such as living in polluted areas or crowded living conditions
- history of asthma (Singh et al, 2024)
Allergens, such as pollen or perfume, can increase
To view the rest of this content login below; or read sample articles.
Diagnosis
Acute bronchitis
Acute bronchitis is characterised by a cough, which can be productive (wet cough that brings up mucus or phlegm) or unproductive (dry cough that does not bring up mucus or phlegm). Other symptoms or clinical signs that may suggest lower respiratory tract infection with no alternative explanation should also be considered (European Respiratory Society, 2023). The processes of history taking and physical examination are sufficient to determine the differential diagnosis (European Respiratory Society, 2023). Differential diagnoses to consider when a patient presents with cough and excessive mucus production are:
- exacerbation of asthma
- exacerbation of chronic obstructive pulmonary disease
- COVID-19
- lung cancer
- heart failure
- pneumonia (European Respiratory Society, 2023)
There are no specific diagnostic criteria for bronchitis, so diagnosis is made on clinical presentation, history and exclusion of differential diagnoses (Duncan and McCartney, 2023). Patients with acute bronchitis also present with:
- dyspnoea
- nasal congestion
- headache
- fever
The
To view the rest of this content login below; or read sample articles.
Treatment
Acute bronchitis
Patients often seek advice as the cough is irritating and slow to resolve, underestimating the time it takes to recover from acute bronchitis (Ebell et al, 2013). They often attend healthcare services requesting antibiotics to treat their condition, but these should not be prescribed if the patient is not systemically very unwell or at higher risk of complications (National Institute for Health and Care Excellence, 2024). Smith et al’s (2014) Cochrane review showed that there was limited evidence to support the use of antibiotics in acute bronchitis. The participants who were given antibiotics were less likely to have a daytime cough in four of the studies, but still had a night-time cough. There was also an increase in adverse effects in patients who received antibiotics, including allergic reactions, nausea and vomiting and Clostridium difficile infection (Smith et al, 2014).
The management of acute bronchitis focuses on
To view the rest of this content login below; or read sample articles.
NMC proficiencies
Nursing and Midwifery Council: standards of proficiency for registered nurses
Part 1: Procedures for assessing people’s needs for person-centred care
1. Use evidence-based, best practice approaches to take a history, observe, recognise and accurately assess people of all ages
Part 2: Procedures for the planning, provision and management of person-centred nursing care
4. Use evidence-based, best practice approaches for meeting the needs for care and support with hygiene and the maintenance of skin integrity, accurately assessing the person’s capacity for independence and self-care and initiating appropriate interventions
9. Use evidence-based, best practice approaches for meeting needs for care and support with the prevention and management of infection, accurately assessing the person’s capacity for independence and self-care and initiating appropriate interventions
To view the rest of this content login below; or read sample articles.
Resources
Altiner A, Wilm S, Däubener W et al. Sputum colour for diagnosis of a bacterial infection in patients with acute cough. Scand J Prim Health Care. 2009;27(2):70–73. https://doi.org/10.1080/02813430902759663
Boucher RC. Muco-obstructive lung diseases. N Engl J Med. 2019;380(20):1941–1953. https://doi.org/10.1056/NEJMra1813799
Braymiller JL, Barrington-Trimis JL, Leventhal AM et al. Assessment of nicotine and cannabis vaping and respiratory symptoms in young adults. JAMA Netw Open. 2020;3(12):e2030189. https://doi.org/10.1001/jamanetworkopen.2020.30189
de Oca MM, Halbert RJ, Lopez MV et al. The chronic bronchitis phenotype in subjects with and without COPD: the PLATINO study. Eur Respir J. 2012;40(1):28–36. https://doi.org/10.1183/09031936.00141611
Douros K, Everard ML. Time to say goodbye to bronchiolitis, viral wheeze, reactive airways disease, wheeze bronchitis and all that. Front Pediatr. 2020;8:218. https://doi.org/10.3389/fped.2020.00218
Duncan D, McCartney C. What is bronchitis and how is it managed? Journal of Prescribing Practice. 2023;5(4):148–150. https://doi.org/10.12968/jprp.2023.5.4.148
Ebell MH, Lundgren J, Youngpairoj S. How long does a cough last? Comparing patients’ expectations with data from a systematic review of the literature. Ann Fam Med. 2013;11(1):5–13.
To view the rest of this content login below; or read sample articles.