All about bronchitis

Bronchitis is usually caused by an infection. In otherwise healthy people, this is usually a virus, while in people with COPD, bacterial infection is much more often to blame. Read on to find out more.

As a doctor, I see a lot of inflammation - ears, appendixes, skins, you name it. In medical jargon, '-itis' tagged on the end of a body part simply means inflammation of that part (think tonsillitis). Inflammation is often caused by infection by viruses or bacteria - but inflammation caused by allergy or irritation (like the common skin condition dermatitis) is also an '-itis'. In winter, coughs and colds abound, so it's hardly surprising the big airways, called the bronchi, are commonly affected at that time of year. Bronchitis is inflammation of these big airways. It's usually caused by infection, but the type of infection depends on whether you already have lung problems.

Bronchitis - chronic or acute?

I've trained other doctors working towards becoming GPs for years. I never cease to be amused at how confused they get when their patients use expressions to describe something completely different to the medical meaning, and acute and chronic are no exception. For instance, my patients will often tell me they have 'chronic diarrhoea' to emphasise how bad it is - even if it's only lasted for a day or two. To a doctor, chronic means something that lasts a long time, rather than something that's severe. Acute means something that's come on suddenly. So acute bronchitis is an inflammation of otherwise healthy airways.

Chronic bronchitis - what's in a name?

Chronic obstructive pulmonary (lung) disease (COPD) affects about three million people in the UK. It used to be called chronic bronchitis or emphysema. Doctors now talk about COPD because most people who suffer from it have both inflammation of their large airways (bronchitis) and damage to the small airways (emphysema). In the UK, smoking is almost always the cause. An inherited condition called alpha-1 antitrypsin deficiency can also cause symptoms of chronic bronchitis even in people who don't smoke. The mainstay of treatment for COPD is inhalers, which deposit medicine to open up your airways straight to where it's needed.

Bronchitis - what are the symptoms?

Bronchitis is usually caused by an infection. In otherwise healthy people, this is usually a virus, while in people with COPD, bacterial infection is much more often to blame. Symptoms include cough, producing more phlegm, runny nose, fever and aches and pains.

What are the warning signs?

If you're otherwise healthy, you may not get any other symptoms if you get acute bronchitis. The symptoms should start to subside within a week or so. However, you can still have a cough for several weeks, because of the inflammation left in your airways after your body has fought off the infection. However, if you have COPD, an infection will commonly make your existing symptoms (especially shortness of breath) worse.

If you don't have existing lung disease but your cough lasts for more than three or four weeks; is accompanied by feeling short of breath or wheezy; coughing up blood or rust-coloured sputum; sharp chest pains when you breathe (rather than an aching chest after you cough); drowsiness or confusion, you should see a doctor.

What's the treatment?

Acute bronchitis is often caused by a viral infection, which can't be cured with antibiotics. Take regular paracetamol or ibuprofen; keep up your fluid intake (you're prone to dehydration when you have a fever); and rest up. There's no need to see a doctor unless you have any of the warning signs.

If you have COPD it's an entirely different story. Flare-ups of COPD caused by infection are one of the most common reasons for hospital admissions in the UK. If you have COPD, you'll probably have a cough most days. But as soon as you start coughing more, or if the amount of sputum you produce increases or changes colour, you need to start antibiotics. If you become more short of breath, your first step is to increase the dose of your inhalers. If this doesn't work, you'll probably need a course of steroid tablets.

Getting treatment early for COPD can make all the difference between getting back on your feet or ending up in hospital. Most GPs now give 'rescue packs' of medication (antibiotics and steroid tablets) that you can keep at home and start at the first sign of a flare-up. Speak to your doctor about keeping treatment to hand.

With thanks to 'My Weekly' magazine where this article was originally published.

Dr Sarah is unable to provide medical advice or respond directly to questions concerning your health. If you have health concerns we recommend contacting your GP.