Bronchitis is inflammation of the bronchioles. Chronic bronchitis is defined as cough with sputum production for at least three months a year for two consecutive years. It is common worldwide and is caused by respiratory viruses, bacteria, and smoking. Symptoms include cough, sputum production, wheezing, and shortness of breath. Treatment focuses on relieving symptoms with medications to open airways and thin mucus. Antibiotics are usually not needed unless complications are present.

2. Introduction
 Bronchitis is characterised by inflamation of the
bronchiole tubes
 Chronic bronchitis is defined clinically as cough with
sputum expectoration for at least 3 months a year
during a period of 2 consecutive years.

3. Epidemology
 Common throughout the world & is one of the top 5
reasons for seeking medical care in countries that
collect such data
 No difference in racial distribution
 In terms of gender specific incidence bronchitis
affects males more than female.

4. ETIOLOGY
 Respiratory viruses are the most common cause
- Influenza A & B, Parainfluenza, Respiratory syncitial
virus & corona virus
 Mycoplasma species, chlamydia pneumoniae,
Streptococcus pneumoniae, Morexella catarrhalis &
Haemophius influenzae
 Bordetella pertussis should be considered in children
who are incompletely vaccinated.

5. Etiology contd…….
 Smoking mostly causative of chronic bronchitis
 Air pollutants & dust

6. Pathophysiology
 During an episode of acute bronchitis the cells of the
bronchial lining tissue are irritated & the mucous
membrane becomes hyperemic & edematous,
diminishing bronchial mucocillary function.
 Air passages become clogged by debris & irritation
increases
 In response copious secretion of mucus develops
which causes characterstic cough of bronchitis

7. History
 Obtain a complete history including information on exposure to
toxic substances & smoking.
 Cough is the most commonly observed symptom
- lasting greater than 5 days may suggest ac. Bronchitis
- Purulent sputum is reported in 50% of persons with bronchitis
-Changes in sputum color are due to peroxidase released by
leucocytes
 Fever suggests influenzae or pneumonia
 Dyspnea & cyanosis unless has underlying COPD or other
conditions that impairs lung function.

8. Other symptoms
 Sore throat
 Runny or stuffy nose
 Headache
 Muscle aches
 Extreme fatigue

9. Physical examination
 Varies from normal-to-pharyngeal erythema,localised
lymphadenopathy
 Rhinorrhea to coarse rhonchi & wheezes that change
in location & intensity after deep & productive cough.
 Sustained heave along the left sternal border indicates
right ventricular hypertrophy secondary to chronic
bronchitis.
 Bullous myringitits may suggest mycoplasma
pneumoniae
 Conjuctivitis, adenopathy & rhinorrhoea suggest
adenovirus infection.

10. Differential diagnosis
 Asthma
 Broncheictasis
 Broncholitis
 Chronic bronchitis
 COPD
 Gastroesophageal reflux disease
 Influenzae
 Pharyngitis
 Sinusitis
 Streptoccocus Group A infections

11. Work up
 Complete blood count
 Cultures & stainings
- throat swab & sputum
- Blood culture
 Prolactin levels  useful to distinguish bacterial from non
bacterial infections
 Chest radiography if suggestive of pneumonia
 Bronchoscopy To exclude foreign body aspiration,
tuberculosis,tumors,& other chronic disease of
tracheobronchial tree & lungs.
 Spirometery

12. Work up contd…..
 Laryngoscopy to exclude epiglottis

13. Medical care
 Therapy generally focussed on allevation of symptoms
 Prescribe medications that open obstructed bronchial
airways & thin obstructive mucus so that can be
coughed up more easily
 Should ensure that patient is oxygenating adequately
 Bed rest is recommended.
 Avoidance of environmental irritants

14. Antibiotic therapy
 Not recommended unless a risk of serious
complications exist because of comorbid conditions.
 Can be used if secondary infection & suspicion of
pertussis infection

15. Long term monitoring
 If symptoms worsen consider alternative diagnosis
 If symptoms recur 3/yr requires other investigations
 If symptoms persist for more than 1 month consider
the otheer causes of chronic cough

16. Influenzae vaccinations
 Reduce incidence of upper respiratory tract infections
 Subsequently reduce the incidence of acute bacterial
bronchitis

17. Symptomatic treatment
 Beta 2 agonist bronchodilators
 NSAIDs for mild to moderate pain
 Albute3rol & guaifenesin products treat cough,dyspnea
& wheezing

18. QUERIS?