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Bronchitis Main page

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Acute bronchitis
Chronic bronchitis

Differential Diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]
Synonyms and keywords: Inflammation of bronchus


Bronchitis is an inflammation of the bronchi (medium and large size airways).[1] Acute bronchitis is a self-limiting disease usually caused by viruses or bacteria. Chronic bronchitis is a subtype of the chronic obstructive pulmonary disease (COPD), and it is defined as a chronic productive cough for at least three months in two consecutive years, after excluding other causes of chronic cough. The inflammatory response of the bronchial epithelium to infections or irritants that involve the medium and large-sized airways results in thickening of the bronchial and tracheal mucosa. Hallmark features of the pathophysiology of chronic bronchitis include hyperplasia and hypertrophy of the goblet cells of the airway, resulting in an increased mucus secretion, which contributes to the airway obstruction. Microscopically, there is infiltration of the walls of the airway with inflammatory cells, particularly neutrophils. Inflammation is followed by scarring and remodeling that thickens the walls, resulting in narrowing of the small airway. Further progression leads to metaplasia and fibrosis of the lower airway. The consequence of these changes is a limitation of airflow.[2][3][4] Acute bronchitis affects young children and old people. Its overall incidence is approximately 5% in the U.S. There is no racial or gender predilection for this disease.[5][6][7]Although chronic bronchitis is common among geriatric patients, it occurs more commonly among caucasian individuals compared to other races, and there is no sexual predilection.[8] Age, season of the year and the immunization status are the main determining risk factors for acquiring acute bronchitis.[9][6][10] The most potent risk factor in the development of chronic bronchitis is cigarette smoking.[11] Other risk factors are occupational pollutants such as cadmium and silica, air pollutants, and genetic factors such as alpha 1 antitrypsin deficiency[12] Acute bronchitis is a self limiting lower respiratory tract infection that usually presents with cough that lasts for up to 3 weeks.[9][13] Chronic bronchitis gradually worsens over time and can result in death. The rate of deterioration varies between individuals and depends on the level of airflow obstruction. The prognosis is dependent on early recognition and smoking cessation, which improves the outcome significantly. Smoking cessation, good hand hygiene, vaccination, and a reduction in occupational exposure to known risk factors, are important to ensure decreased severity and risk of bronchitis.[10][14]


  • Acute Bronchitis: may be caused by either viruses, bacteria or environmental factors.
Viruses: Influenza virus, parainfluenza virus, respiratory syncytial virus, coronavirus, adenovirus, enterovirus, rhinovirus, coxsackievirus, and human metapneumovirus[15][16][17]
Bacteria: Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Bordetella pertussis[6]
Environmental factors: Toxic fume inhalation, tobacco, dust, and aerosols[18]
  • Chronic Bronchitis: may be caused by smoking, air pollutants and occupational exposures in a genetically susceptible person.


Bronchitis is classified into two major categories based on symptom chronicity:

Differential diagnosis

Organ System Disease Symptoms Signs Laboratory findings Diagnostic modality Management
Cardiac HFpEF Exertional dyspnea, reduced exercise tolerance, orthopnea, paroxysmal nocturnal dyspnea, edema Elevated JVP, fine crackles, edema Increased BNP Echocardiography (normal EF) Control of volume overload and hypertension,

treatment of underlying condition (obesity, AF, coronary artery disease, anemia)

HFrEF Exertional dyspnea, reduced exercise tolerance, orthopnea, paroxysmal nocturnal dyspnea, edema Elevated JVP, fine crackles, edema Increased BNP Echocardiography (reduced EF) Diuretics, ACE inhibitors, ARBs, beta blockers, nitrates
Pericardial disease Exercise intolerance, dyspnea, fatigue Elevated JVP, pericardial knock, kussmaul's sign, pulsus paradoxus - Echocardiography, ECG Diuretics, pericardiectomy
Hypertrophic cardiomyopathy Dyspnea, chest pain, palpitation, lightheadedness Systolic murmur - Echocardiography, ECG Beta blockers, verapamil
Valvular disease

(MR, TR)

Edema, fatigue, exercise intolerance, dyspnea, lightheadedness Cardiac murmur - Echocardiography, ECG Valve repair or replacement, diuretics, beta blockers
Pulmonary Chronic airway disease Cough, dyspnea, chest pain, exercise intolerance Tachypnea, respiratory distress, cyanosis, edema, rhonchi and crackles Hypoxemia, hypercapnea, polycythemia, PFT, chest imaging Bronchodilators, corticosteroids, anticholinergics
Interstitial lung diseaee Exercise intolerance, cough Crackles, clubbing, cyanosis Hypoxemia PFT, Chest imaging, lung biopsy Corticosteroids, bronchodilators
Pulmonary hypertension Dyspnea, fatigue, chest pain, syncope, palpitation Edema, clubbing, elevated JVP, TR murmur Elevated BNP, elevated d-dimer Echocardiography, cardiac cathaterization Diuretics, calcium channel blockers, endothelin receptor antagonist, phosphodiesterase 5 inhibitor
Sleep apnea Snoring, somnolence, headache, fatigue, irritability Tachypnea, hypertension, tachycardia Hypoxemia, polycythemia Polysomnography Weight reduction, CPAP
Asthma Dry cough, dyspnea, wheezing Wheezing, tachypnea Hypoxemia PFT Bronchodilators, corticosteroids, anticholinergics


  1. Bronchitis (Chest Cold) - Get Smart: Know When Antibiotics Work. Centers for Disease Control and Prevention (2015). Accessed on July 28, 2016
  2. Cosio MG, Saetta M, Agusti A (2009). "Immunologic aspects of chronic obstructive pulmonary disease". N. Engl. J. Med. 360 (23): 2445–54. doi:10.1056/NEJMra0804752. PMID 19494220.
  3. Kumar P, Clark M (2005). Clinical Medicine, 6ed. Elsevier Saunders. pp 900-901. ISBN 0702027634.
  4. McDonough JE, Yuan R, Suzuki M, Seyednejad N, Elliott WM, Sanchez PG, Wright AC, Gefter WB, Litzky L, Coxson HO, Paré PD, Sin DD, Pierce RA, Woods JC, McWilliams AM, Mayo JR, Lam SC, Cooper JD, Hogg JC (2011). "Small-airway obstruction and emphysema in chronic obstructive pulmonary disease". N. Engl. J. Med. 365 (17): 1567–75. doi:10.1056/NEJMoa1106955. PMC 3238466. PMID 22029978.
  5. Macfarlane J, Holmes W, Gard P, Macfarlane R, Rose D, Weston V, Leinonen M, Saikku P, Myint S (2001). "Prospective study of the incidence, aetiology and outcome of adult lower respiratory tract illness in the community". Thorax. 56 (2): 109–14. PMC 1746009. PMID 11209098.
  6. 6.0 6.1 6.2 Wenzel RP, Fowler AA (2006). "Clinical practice. Acute bronchitis". N. Engl. J. Med. 355 (20): 2125–30. doi:10.1056/NEJMcp061493. PMID 17108344.
  7. Ferri FF. Ferri's Clinical Advisor 2016, 5 Books in 1. Elsevier Health Sciences; 2015.
  8. > Prevalence and Incidence of COPD Retrieved on Mars 14, 2010
  9. 9.0 9.1 Gonzales R, Sande MA (2000). "Uncomplicated acute bronchitis". Ann. Intern. Med. 133 (12): 981–91. PMID 11119400.
  10. 10.0 10.1 Albert RH (2010). "Diagnosis and treatment of acute bronchitis". Am Fam Physician. 82 (11): 1345–50. PMID 21121518.
  11. - COPD causes
  12. MedlinePlus Medical Encyclopedia
  13. Landau LI (2006). "Acute and chronic cough". Paediatr Respir Rev. 7 Suppl 1: S64–7. doi:10.1016/j.prrv.2006.04.172. PMID 16798599.
  14. Braman SS (2006). "Chronic cough due to acute bronchitis: ACCP evidence-based clinical practice guidelines". Chest. 129 (1 Suppl): 95S–103S. doi:10.1378/chest.129.1_suppl.95S. PMID 16428698.
  15. Jonsson JS, Sigurdsson JA, Kristinsson KG, Guthnadóttir M, Magnusson S (1997). "Acute bronchitis in adults. How close do we come to its aetiology in general practice?". Scand J Prim Health Care. 15 (3): 156–60. PMID 9323784.
  16. Boivin G, Abed Y, Pelletier G, Ruel L, Moisan D, Côté S, Peret TC, Erdman DD, Anderson LJ (2002). "Virological features and clinical manifestations associated with human metapneumovirus: a new paramyxovirus responsible for acute respiratory-tract infections in all age groups". J. Infect. Dis. 186 (9): 1330–4. doi:10.1086/344319. PMID 12402203.
  17. Louie JK, Hacker JK, Gonzales R, Mark J, Maselli JH, Yagi S, Drew WL (2005). "Characterization of viral agents causing acute respiratory infection in a San Francisco University Medical Center Clinic during the influenza season". Clin. Infect. Dis. 41 (6): 822–8. doi:10.1086/432800. PMID 16107980.
  18. Irwin RS, Madison JM (2000). "The diagnosis and treatment of cough". N. Engl. J. Med. 343 (23): 1715–21. doi:10.1056/NEJM200012073432308. PMID 11106722.