Acute bronchitis generally follows a viral respiratory infection, initially affecting your nose, sinuses, and throat and then spreading to the large bronchial airway passages. Sometimes, you may get what is called a secondary bacterial infection. This means that bacteria are infecting the airways, in addition to the virus. The already inflamed area is one in which bacteria like to grow.

You are at risk for acute bronchitis if you:

• Are at either end of the age spectrum; in other words, elderly, infants, and young children.
• Smoke
• Have underlying heart or lung disease.

Chronic bronchitis is a long-term condition of excessive bronchial mucus with a productive cough. This ongoing condition, from inflammation but not infection, blocks air flow in and out of the lungs. It causes serious damage and breathing difficulties over time.

Chronic bronchitis, like emphysema, is also known as chronic obstructive pulmonary disease. As these lung conditions progress over time, you become increasingly short of breath, have difficulty walking or exerting yourself physically, and may need oxygen on a regular basis.

Cigarette smoke is the chief cause of chronic bronchitis, including long-term exposure to second-hand smoke. Factors that make it worse include air pollution, certain occupations (like coal mining, textile manufacturing, or grain handling), infection, and allergies.

The severity of the disease often relates to how much and for how long you have smoked (or been exposed to smoke).

Chronic bronchitis, emphysema, and asthma as a group are the fourth-leading cause of death in the United States. Two to three out of 100 people have chronic bronchitis.

The symptoms of either type of bronchitis include:

• Cough that produces mucus (sputum); if yellow-green in color, you are more likely to have a bacterial infection; occasionally, the sputum is blood streaked, which must be evaluated by a doctor
• Shortness of breath worsened by exertion or mild activity
• Wheezing
• Fatigue
• Fever -- usually low-grade
• Chest discomfort

Even after acute bronchitis has cleared, you may have a dry, nagging cough that lingers for several weeks.

Additional symptoms of chronic bronchitis include:

• Frequent respiratory infections (such as colds or the flu)
• Ankle, feet, and leg swelling
• Blue-tinged lips from low levels of oxygen

• Rales (abnormal sounds in the lungs) or other abnormal breathing sounds may be heard by your doctor on lung examination with a stethoscope.
• Pulmonary (lung) function tests provide information useful for diagnosis and prognosis.
• Pulse oximetry is a device connected to your finger that tells the amount of oxygen in your blood.
• Arterial blood gas is a more exact (but more painful and invasive) measurement of oxygen and carbon dioxide levels.
• Chest x-ray.
• Sputum samples to check for evidence of inflammation or bacterial infection may be taken.

For acute bronchitis from a virus, you DO NOT need antibiotics. The infection will generally clear on its own within one week. Take the following measures for some relief:

• Take aspirin or acetaminophen (Tylenol) if you have a fever. Children MUST NOT take aspirin.
• Rest.
• Drink plenty of fluids.
• Use a humidifier or steam in the bathroom.
• DO NOT smoke.

If your symptoms are not improving, your doctor may prescribe an inhaler to open your airways. If your doctor thinks that you have a secondary bacterial infection, antibiotics will be prescribed.

For chronic bronchitis, the most important step you can take is to QUIT smoking. If caught early enough, you can reverse the damage to your lungs. Other important steps include:

• Limit your exposure to pollutants and other lung irritants.
• Get a flu vaccine each year and a pneumococcal (a common type of pneumonia) vaccine one time.
• Attend a respiratory training program that includes physical activity and breathing exercises. Your doctor can recommend a medically appropriate and well-supervised program. If it is early in your disease process, you can likely exercise on your own; talk to your doctor about safety.

Your doctor will usually prescribe inhaled medicines for chronic bronchitis. These drugs, which include bronchodilators like albuterol and ipratropium, open your constricted airways and aid in the clearance of mucus. An oral bronchodilator called theophylline and steroids (either inhaled or by mouth) are often necessary as well. If you have an active infection, your doctor will put you on antibiotics and sometimes recommend regular antibiotics to prevent infection.

If you have low oxygen levels, home oxygen will be used.

For acute bronchtitis, symptoms usually resolve within 7 to 10 days if you do not have an underlying lung disorder. However, a dry, hacking cough can linger for a number of months.

The chance for recovery is poor for advanced chronic bronchitis. Early recognition and treatment, combined with smoking cessation, improve the chance of a good outcome significantly.

Pneumonia can develop from either acute or chronic bronchitis. If you have chronic bronchitis, you are susceptible to recurrent upper respiratory infections. You may also develop:

• Right-sided heart failure or cor pulmonale
• Emphysema
• Pulmonary hypertension

Call your doctor if

• You are coughing up blood.
• You have a high fever or shaking chills.
• You have a low-grade fever for three or more days.
• You have thick, greenish mucus, especially if it has a bad smell.
• You feel short of breath or have chest pain.
• You have an underlying chronic illness, like heart or lung disease.
• You have a cough most days of the month or you have a frequently recurring cough.

• Wash your hands (and your children's hands) frequently to avoid spread of viruses and other infections.
• DO NOT smoke.
• Get an annual flu vaccine.
• Minimize exposure to air and other pollutants.