bronchitis Bronchitis is an acute or chronic nonspecific inflammation of the bronchial mucosa and surrounding tissues caused by biological or non-biological factors, mainly including microbial infections, physical, or chemical irritants, characterized by symptoms such as cough and sputum production.

Bronchitis is an acute or chronic non-specific inflammation of the bronchial mucosa and surrounding tissues caused by biological or non-biological factors, primarily including microbial infections, physical or chemical irritants, etc., presenting as discomfort such as coughing and sputum production.

Acute Tracheobronchitis

Common causes include microbes, with viral infections being the most common, other microbial factors include bacteria, Mycoplasma pneumoniae, and Chlamydophila pneumoniae; inhalation of cold air, dust, irritating gases, or smoke can stimulate the tracheobronchial mucosa, causing acute injury and inflammatory response; common inhaled allergens, such as pollen, organic dust, fungal spores, animal fur excretions, and hypersensitivity to bacterial proteins, as well as migration of hookworm or roundworm larvae in the lungs, can cause acute tracheobronchial inflammatory reactions.

Chronic Bronchitis

The etiology is not completely clear and may be the result of the long-term interaction of various factors. Viral, bacterial, and mycoplasma infections are important causes of its occurrence and development. Inhaling harmful gases and particles, as well as immune, age, and climatic factors, are also important factors in the occurrence and development of chronic bronchitis.

Bronchiolitis

Mainly caused by viral infection of ciliated bronchial epithelial cells, with respiratory syncytial virus being the most common, accounting for more than 50%, and it is also the pathogen most likely to cause severe illness and outbreaks, posing significant hazards. Acute bronchiolitis is mainly seen in infants under 1 year of age, and factors such as living in crowded environments, tropical rainy seasons, lack of breastfeeding or breastfeeding for less than 1 month, age less than 12 weeks, bottle feeding, maternal smoking during pregnancy, preterm birth, and underlying heart and lung diseases or low resistance are all risk factors.

Obstructive Bronchiolitis

There are many possible causes, including rejection reactions after organ transplantation, connective tissue diseases, viral infections, Stevens-Johnson syndrome, Pneumocystis pneumonia, etc. Non-transplant-related obstructive bronchiolitis is less common. Sometimes, obstructive bronchiolitis specifically refers to severe childhood bronchiolitis caused by adenovirus infection.

Acute Tracheobronchitis

Coughing is the main manifestation of acute tracheobronchitis, initially dry, later accompanied by sputum production, and in the later stages, mucopurulent sputum may be present. Many acute bronchitis patients also have tracheitis, characterized by severe pain behind the sternum during breathing and coughing. Coughing usually lasts for 10 to 20 days, occasionally extending to 4 weeks or longer. If prolonged, it can evolve into chronic bronchitis.

Chronic Bronchitis

It has a slow onset and a long course. The main symptoms are coughing, sputum production, and sometimes wheezing. Morning coughing is predominant, with occasional bouts of coughing and sputum production during sleep. Sputum is generally white and mucous or foamy, occasionally tinged with blood. There is more sputum in the morning, and changing positions after waking up or moving can stimulate sputum production.

Bronchiolitis

Early presentation resembles symptoms of viral upper respiratory tract infections, with a rapid progression occurring 1-2 days later, manifesting as paroxysmal coughing, reaching its peak at 5-7 days.

Wheezing Bronchitis

Wheezing bronchitis, also known as asthmatic bronchitis, is mainly characterized by coughing, wheezing, dyspnea, and bilateral wheezing, often with recurrent episodes.

Obstructive Bronchiolitis

Symptoms and signs are often nonspecific. Most patients present with progressively worsening dyspnea, often accompanied by dry cough and wheezing.

Acute Tracheobronchitis

If there is severe dry cough or minimal sputum, antitussives such as codeine and dropropizine can be used. If there is sputum or difficulty in expectoration, ambroxol hydrochloride and thyme oil extract can be used to promote expectoration. In the presence of bronchospasm and airflow limitation, β2-agonists such as salbutamol or inhaled corticosteroids can be used for treatment.

Most patients with acute bronchitis do not need antibiotic treatment, especially for those with unidentified pathogens, and antibiotics should not be used routinely. Penicillins can be used in the presence of evidence of bacterial infection, and cephalosporins or quinolones can also be considered. Azithromycin is recommended for infections with Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Bordetella pertussis. Influenza virus infection can be treated with oseltamivir. Patients with systemic malaise and fever as the main symptoms should rest in bed, drink plenty of water, and take antipyretics such as acetaminophen.

Acute exacerbation of chronic bronchitis

The acute exacerbation phase mainly focuses on controlling infection, antitussive and expectorant therapy, and asthma management. Antibiotics such as β-lactams, quinolones, and macrolides can be used. Antitussive and expectorant agents such as compound licorice preparations and compound ammonium chloride preparations can be used. Asthma can be managed with aminophylline or sustained-release theophylline, β2-agonists plus inhaled corticosteroids, etc.

Bronchiolitis

Most children present with mild clinical symptoms. For moderate to severe cases, close monitoring and assessment of the condition are necessary. Low-concentration oxygen therapy can be given when the blood oxygen saturation is below 90%. During the acute phase, bronchodilators (β2-agonists), corticosteroids, and 3% hypertonic saline can be administered based on the condition. Routine use of antiviral drug ribavirin is not recommended.

Wheezing Bronchitis

Treatment focuses on rapidly relieving symptoms, improving ventilation, effectively reducing airway inflammation and hyperresponsiveness, and preventing complications. During acute attacks, β2-agonists and M receptor antagonists can be used to relieve bronchospasm and dilate the airways.

Psychological Care

During the care process, carefully explain the pathogenesis, causes of the disease, and especially emphasize that the disease has a long course and a long treatment period. Encourage patients to build confidence in overcoming the disease and to overcome short-term behavior and "impatience for quick success."

Environmental Care

Avoid harmful and irritating gases, and it is best to install a range hood in the kitchen. The room temperature where the patient lives should be relatively stable, at 18-20°C. In the dry winter air, the room's humidity should be increased appropriately, with a relative humidity of 50%-60%. Regular ventilation should be carried out to reduce the density of pathogenic microorganisms in the air.

Medication Care

The treatment of bronchitis is a long-term process. During the acute phase, patients should be given medications for controlling infection, expectorant, and antitussive drugs. In the recovery phase, the treatment should focus on strengthening the body, improving resistance, and preventing recurrence.

Oxygen Therapy Care

Patients with chronic bronchitis require long-term oxygen therapy. During oxygen therapy, attention should be paid to the oxygen flow rate, and the daily oxygen inhalation time should not be less than 15 hours.

Expectoration Care

For patients with thick and difficult-to-expectorate sputum, various methods should be used to help with expectoration. Change positions regularly, teach patients how to clear their throat, and have family members assist with back tapping to facilitate sputum clearance.

Moderate Exercise

Engage in appropriate exercise based on the individual's condition. During exercise, try to use pursed-lip breathing or diaphragmatic breathing, and when experiencing difficulty breathing, perform 1-2 diaphragmatic breaths during each exercise. Exercise methods for bronchitis patients include relaxation training, thoracic relaxation training, walking training, and limb/trunk muscle strength training.

Smoking Cessation

Caregivers should explain the dangers of smoking to patients and encourage them to quit smoking. At the same time, family members should create a smoke-free environment for the patient.

Dietary Care

Strengthen nutrition and have a balanced diet. Honey, yams, ginkgo nuts, walnuts, pears, and loquats all have certain effects on bronchitis patients and can be consumed appropriately.

Patients should avoid consuming raw, cold, greasy, or spicy foods, and should control their salt intake.

Patients with bronchitis have poor resistance to cold, and exposure to cold stimuli can easily cause upper respiratory tract infections. Upper respiratory tract infections are the main cause of disease recurrence or acute exacerbation, so family members should remind patients to keep warm and add clothing in a timely manner to prevent colds.

During the flu season, patients can receive flu vaccination under the guidance of a doctor.