Bronchitis Clinical Presentation

  • Author: Jazeela Fayyaz, DO; Chief Editor: Zab Mosenifar, MD   more...
 
Updated: Mar 29, 2011
 

History

Obtain a complete history, including information on exposure to toxic substances and smoking. Patients with chronic bronchitis are often overweight and cyanotic. Initially, cough is present in the winter months. Over the years, the cough progresses from hibernal to perennial, and mucopurulent relapses increase in frequency, the duration and severity of which increase to the point of exertional dyspnea.

Cough is the most commonly observed symptom. It begins early in the course of many acute respiratory tract infections and becomes more prominent as the disease progresses. Acute bronchitis may be indistinguishable from an upper respiratory tract infection during the first few days, though cough lasting greater than 5 days may suggest acute bronchitis.[6]

In patients with acute bronchitis, cough generally lasts from 10-20 days. Sputum production is reported in approximately half the patients in whom cough occurred. Sputum may be clear, yellow, green, or even blood-tinged. Purulent sputum is reported in 50% of persons with acute bronchitis. Changes in sputum color are due to peroxidase released by leukocytes in sputum; therefore, color alone cannot be considered indicative of bacterial infection.

Fever is a relatively unusual sign and, when accompanied by cough, suggests either influenza or pneumonia. Nausea, vomiting, and diarrhea are rare. Severe cases may cause general malaise and chest pain. With severe tracheal involvement, symptoms include burning, substernal chest pain associated with respiration, and coughing.

Dyspnea and cyanosis are not observed in adults unless the patient has underlying chronic obstructive pulmonary disease or another condition that impairs lung function.

Other symptoms of acute bronchitis include the following:

  • Sore throat
  • Runny or stuffy nose
  • Headache
  • Muscle aches
  • Extreme fatigue
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Physical Examination

The physical examination findings in acute bronchitis can vary from normal-to-pharyngeal erythema, localized lymphadenopathy, and rhinorrhea to coarse rhonchi and wheezes that change in location and intensity after a deep and productive cough.

Diffuse wheezes, high-pitched continuous sounds, and the use of accessory muscles can be observed in severe cases. Occasionally, diffuse diminution of air intake or inspiratory stridor occurs; these findings indicate obstruction of a major bronchi or the trachea, which requires sequentially vigorous coughing, suctioning, and, possibly, intubation or even tracheostomy.

Sustained heave along the left sternal border indicates right ventricular hypertrophy secondary to chronic bronchitis. Clubbing on the digits and peripheral cyanosis indicate cystic fibrosis. Bullous myringitis may suggest mycoplasmal pneumonia. Conjunctivitis, adenopathy, and rhinorrhea suggest adenovirus infection.

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Contributor Information and Disclosures
Author

Jazeela Fayyaz, DO  Senior Fellow, Department of Pulmonology, Lenox Hill Hospital

Jazeela Fayyaz, DO is a member of the following medical societies: American College of Physicians and American Thoracic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Klaus-Dieter Lessnau, MD, FCCP  Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Sepracor None None

Jeffrey Nascimento, DO, MS  Fellow, Department of Pulmonary Medicine, Lenox Hill Hospital

Jeffrey Nascimento, DO, MS is a member of the following medical societies: American College of Chest Physicians, American Medical Association, American Osteopathic Association, American Thoracic Society, New York County Medical Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Roger B Olade, MD, MPH  Medical Director, Providence Health Group

Roger B Olade, MD, MPH is a member of the following medical societies: American College of Occupational and Environmental Medicine and American College of Physicians

Disclosure: Nothing to disclose.

Samuel Ong, MD  Visiting Assistant Professor, Department of Emergency Medicine, Olive View-UCLA Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

David FM Brown, MD  Associate Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital

David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Paul Blackburn, DO, FACOEP, FACEP  Program Director, Department of Emergency Medicine, Maricopa Medical Center; Assistant Professor, Department of Surgery, University of Arizona College of Medicine

Paul Blackburn, DO, FACOEP, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American Medical Association, and Arizona Medical Association

Disclosure: Nothing to disclose.

Robert E O'Connor, MD, MPH  Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD  Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Professor and Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society

Disclosure: Nothing to disclose.

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