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Bronchitis: Patients
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Bronchitis can be either chronic or acute. Acute bronchitis is often the result of a cold or flu, in which case it is said the cold 'turned into bronchitis'. Acute bronchitis is most often caused by a virus, rather than bacteria, so taking antibiotics will probably not help, although doctors often prescribe them because their patients insist.
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To diagnose bronchitis, the doctor first takes the patient's health history and observes his or her symptoms. The doctor then listens to the patient's chest with a stethoscope. Certain sounds indicate narrowing of the airways. These sounds include moist rales, crackling, and wheezing. Moist rales is a bubbling sound caused when fluids are present in the bronchial tubes.
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Acute bronchitis is a lower respiratory tract infection that causes reversible bronchial inflammation. In up to 95 percent of cases, the cause is viral. While antibiotics are often prescribed for patients with acute bronchitis, little evidence shows that these agents provide significant symptomatic relief or shorten the course of the illness. In a few small studies, bronchodilators such as albuterol have been found to relieve some symptoms of acute bronchitis. Increased attention is being given to the role of Chlamydia species in acute bronchitis and adult-onset asthma. Studies in progress may help to clarify the importance of these organisms in acute bronchitis and to determine whether early treatment can prevent or ameliorate asthma.
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The long-term outcome time to relapse determined as the exacerbation-free interval (EFI) has been proposed as a standard measure for comparing the efficacy of antimicrobial therapies in acute exacerbation of chronic obstructive bronchitis (AECOB). In this 6-month, randomised, open-label study, the efficacy of 10 days of oral levofloxacin 500 mg once daily or cefuroxime 250 mg twice daily was evaluated in 689 well-defined patients experiencing AECOB episodes. In the clinically evaluable per-protocol (PPc) population and the modified intent-to-treat population, the clinical cure rates at test of cure were, respectively, 94.6% for levofloxacin versus 93.8% for cefuroxime (0.8% difference, 95% confidence interval (CI) -3.2 to 4.8) and 94.5% for levofloxacin versus 92.2% for cefuroxime (2.3% difference, 95% CI -1.8 to 6.2), whilst the probability that 25% of patients would relapse during follow-up was reached within 93 days for levofloxacin compared with 81 days for cefuroxime in the PPc population (P=0.756). A multivariate analysis revealed that only congestive heart failure and number of AECOB episodes in the previous 12 months were predictive of relapse. Safety was comparable in the two treatment groups, with possibly related treatment-emergent adverse events occurring in 5.0% and 2.9% of subjects in the levofloxacin and cefuroxime groups, respectively. In addition to demonstrating the non-inferiority of levofloxacin compared with cefuroxime in AECOB, the data from this study raise the question of whether EFI is a useful discriminative endpoint for comparing antimicrobial therapies.
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Chronic bronchitis is characterized by chronic or recurrent excess bronchial mucus secretion. About 12.5 million Americans are thought to suffer from chronic bronchitis, and the morbidity, mortality, and economic impact of this condition (and of emphysema) are immense. Chronic bronchial inflammation results in a persistent cough, which by definition occurs most days for at least three months of the year for at least two successive years. The cough is typically productive of varying amounts and appearance of phlegm (sputum). Other diseases that are associated with excessive mucus secretion, such as chronic sinusitis with post-nasal drip, asthma, lung cancer, tuberculosis, and bronchiectasis, must not be confused with chronic bronchitis. Patients with "simple chronic bronchitis" lack airflow obstruction on pulmonary function tests (spirometry), whereas those with "chronic obstructive bronchitis" have reduced air-flow rates.
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Acute bronchitis refers simply to inflammation of the tracheobronchial tree. The cause is usually infectious, but allergens and irritants can produce a similar clinical picture. Bronchitis typically occurs in the setting of an upper respiratory illness and is therefore observed more frequently in the winter months. Asthma can be mistakenly diagnosed as acute bronchitis if the patient has no prior history of asthma. In one study, one third of patients who had been determined to have recurrent bouts of acute bronchitis were eventually identified as having asthma. Chronic bronchitis and acute exacerbations of chronic bronchitis are ... discussed in this article.
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