Bronchitis and Asthma

Asthma and bronchitis are common respiratory conditions characterized by inflammation of the airways (bronchi), but the connection doesn't stop there. If you have asthma, you are at an increased risk of bronchitis. When the two conditions occur together, symptoms such as coughing and shortness of breath can be compounded. Bronchitis can also prompt an asthma flare and make managing the condition especially challenging. And given the similarities of symptoms, it's possible to think you have chronic bronchitis when you actually have undiagnosed asthma.

The Connection

Asthma is a chronic condition, but bronchitis can be acute (a brief period of inflammation and swelling in the lungs) or chronic (bronchial tube inflammation causes a cough on most days of the month, at least three months of the year, and lasts for at least two years in a row).

Asthma is characterized by chronic lung inflammation and swollen and irritated airways. When you have asthma:

• A viral infection, such as the common cold or flu, puts you at a heightened risk of developing acute bronchitis because your lungs are already compromised.
• The inflammatory response to the infection can also act as a trigger for asthma symptoms and lead to an asthma attack.

While more research is needed, studies on childhood health may hold some answers about the relationship between infections, asthma, and bronchitis.

A history of viral respiratory infections at an early age is a risk factor for asthma. This may be due to lung damage or developmental lung changes caused by the infection.

Furthermore, the lung function impairment that occurs in childhood asthma may predispose to chronic bronchitis later in life.

Symptoms

Asthma and bronchitis have four overlapping symptoms:

• Coughing
• Wheezing
• Shortness of breath
• Chest tightness

Some aspects of these symptoms differ in each condition.

When acute cases of bronchitis occur following exposure to viral illnesses, additional symptoms can include:

• Sputum (mucus) that may be clear or colored
• 100.5 to 102 degrees F fever (anything higher would make a diagnosis of pneumonia, influenza, or COVID-19 more likely)
• Sore throat
• Pain associated with coughing
• Allergy and sinus congestion
• Chills or body aches

Many people refer to acute bronchitis as a “chest cold” and complain of a post-viral cough, sore throat, and congestion that resolves in a few days to a few weeks.

Asthma symptoms may also start or get worse with viral infections.

Causes

The causes of asthma are still unknown, but it is believed to be due to both genetic predisposition and environmental factors.

You are at an increased risk of developing asthma or experiencing worsened asthma symptoms if you have:

• A family history of asthma, especially a parent with asthma
• Allergies
• Viral respiratory infections and wheezing as a child
• Exposure to cigarette smoke
• Occupational exposure to chemical irritants or industrial dust
• Poor air quality from pollution (traffic pollution) or allergens (pollen, dust)
• Obesity

Symptoms of asthma occur or worsen with exposure to asthma triggers, including common allergens such as dust mites or pollen. Triggers vary from person to person.

Common triggers include:

• Animal dander
• Dust mites
• Cockroaches
• Mold
• Pollen
• Tobacco smoke
• Extreme weather
• Exercise
• Stress
• Some medications, such as aspirin, nonsteroidal anti-inflammatories (NSAIDs), and beta-blockers

In addition to virus infections, acute bronchitis can also be caused by bacteria or inhaling dust and fumes.

Chronic bronchitis leads to chronically irritated airways, decreased airflow, and scarring of the lungs. It is a type of chronic obstructive pulmonary disease (COPD), a chronic inflammatory disease of the lungs.

In addition to asthma, risk factors for acute or chronic bronchitis include:

• Smoking
• Exposure to secondhand smoke
• Exposure to environmental pollutants, such as industrial fumes
• COPD
• Family history of lung disease
• History of childhood respiratory diseases
• Gastroesophageal reflux disease (GERD)

Smoking cigarettes or heavy exposure to secondhand smoke is particularly problematic since it commonly causes chronic bronchitis and is a common trigger for asthma. Symptoms of both conditions can worsen while smoking.

Diagnosis

If you have symptoms of asthma or bronchitis, your healthcare provider will ask you about what you're experiencing, as well as your personal and family medical history. You will have a physical exam.

Testing possibilities include:

• Pulmonary function tests (PFTs), such as measuring forced exploratory volume in one second (FEV1) using spirometry. This involves blowing into a device that measures the air volume of your exhales to assess airway obstruction.
• Blood or sputum tests to look for signs of an infection
• Chest X-rays to rule out pneumonia

You might have PFTs before and after you use a bronchodilator medication. If your lung tests significantly improve after you use the medication, this is an indication that obstruction has resolved and you may be diagnosed with asthma. If airway obstruction persists after you use the medication, it could indicate that you have chronic bronchitis.

Diagnosis using PFTs can be complicated and diagnostic confusion sometimes occurs.

For example:

• If your lung tests improve, yet you also have a chronic cough that produces phlegm, you may be diagnosed with both asthma and chronic bronchitis.
• If you've already been diagnosed with asthma and start to develop a worsening cough with excess mucus, you may get an additional diagnosis of co-occurring bronchitis.
• Some people with asthma can develop a more fixed airway obstruction that will only improve slightly with medications, making it hard to distinguish from chronic bronchitis.

When it's hard to determine if someone has asthma, bronchitis, or both, additional testing—such as computed tomography (CT) of the chest and lung volumes with diffusion capacity of carbon monoxide may be able to differentiate the two, as well as a history of allergies or a childhood history of respiratory issues (which suggests asthma).

Treatment

Most cases of acute bronchitis resolve on their own. Acute bronchitis treatment generally focuses on symptom relief.

Your healthcare provider may recommend some of the following medications and remedies if you have acute bronchitis:

• Over-the-counter (OTC) cold medications, such as cough suppressants or mucolytics (drugs that break up and thin mucus)
• OTC pain relievers, such as ibuprofen
• Teaspoons of honey to ease throat irritation from coughing
• Using a humidifier or steam treatment
• Drinking lots of water
• Rest

If your acute bronchitis is caused by bacteria, you'll be prescribed antibiotics. Prompt treatment of bacterial bronchitis is important as it may help lower the risk of an asthma attack while you are recovering.

The overall treatment plan for asthma depends on asthma severity and symptom triggers, but the most commonly prescribed medications include:

• Short-acting beta-agonists (SABAs), known as rescue medications that are taken via inhaler and can address acute symptoms by quickly widening airways
• Inhaled corticosteroids, long-term controller medications taken regularly (most often, daily) to reduce inflammation and prevent symptoms over time—especially in those with persistent asthma that happens several times a week to multiple times a day

A rescue inhaler may be all that's needed for the treatment of mild intermittent asthma or exercise-induced asthma that only happens during physical activity. 

Additional medications or multi-faceted environmental interventions, such as mold remediation or pest control, may also be recommended if asthma is triggered by allergens.

Your healthcare provider will also help you develop an asthma action plan for recognizing asthma triggers and knowing what steps to take based on symptoms.

If you have asthma and bronchitis, diligently adhering to recommendations for one condition can impact your experience with the other.

Seek medical care if you experience any of the following:

• Parameters outlined in your asthma action plan
• Fever
• Cough does not improve despite following your action plan or lasts more than 10 days
• Barking cough that makes it hard to speak or breathe
• Coughing up blood
• Weight loss

In general, when asthma is well controlled and you are not experiencing symptoms, your lung function will return to near normal.

If you have chronic bronchitis, your lung function will not return to normal because the lungs have been damaged. Still, symptoms can sometimes improve with a combination of treatments, including medications and lifestyle interventions, especially quitting smoking and/or avoiding smoke and pollutants whenever possible.

Treatments for chronic bronchitis include:

• Cough medications, such as cough suppressants or mucolytics
• Bronchodilator medications to help manage acute symptoms
• Inhaled or oral corticosteroids to decrease inflammation
• Pulmonary rehabilitation, which involves involves working with a therapist to optimize control of your breathing and coughing and may include exercises
• Postural drainage and chest physiotherapy, which involves moving into positions that allows the mucus to drain
• Phosphodiesterase 4 inhibitors (PDE4 inhibitors) to decrease inflammation
• Oxygen therapy, which involves portable units that deliver supplemental oxygen you inhale
• Lung transplant surgery in the most severe cases

Smoking cessation medications, such as prescription Chantix (varenicline) or OTC nicotine replacement therapy, may help you quit smoking. They don't directly treat your asthma or bronchitis but can help you quit so that smoking isn't triggering symptoms and lung damage.

A Word From Verywell

If you're experiencing a chronic cough or shortness of breath, it's important to contact your healthcare provider who can help evaluate whether it might be asthma, bronchitis, or something else.

If you've already been diagnosed with asthma, chronic bronchitis, or both, stick to your treatment plan and notify your healthcare provider if you experience any changes or worsening of symptoms.

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