Bronchitis and Asthma

Asthma and bronchitis are common respiratory conditions that involve inflammation of the airways. While they can occur independently, their connections and differences are important to know more about.

People with asthma are at greater risk for bronchitis, and some symptoms of bronchitis also occur with asthma, leading to a compounding of issues like coughing and shortness of breath when the two occur together. Bronchitis can also prompt an asthma flare and challenge overall management.

And given these symptom simlarities, it's possible that you may think you have chronic bronchitis when you actually have undiagnosed asthma.

The Connection

Asthma is a chronic condition, but bronchitis can be acute (there is inflammation and swelling in the lungs in a short period of time) or chronic (in which inflammation of the bronchial tubes produces 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).

People with asthma have chronic inflammation of the lungs and swollen and irritated airways. If someone with asthma gets a viral infection, such as the common cold or flu, they are at a heightened risk of developing acute bronchitis because their 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.

A diagnosis of chronic bronchitis can occur in those with poorly controlled asthma. Given the similarities in how the two present, it is not uncommon for patients who are diagnosed with asthma later in life to be initially diagnosed with bronchitis.

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

Namely, having viral respiratory infections in one's early years is a risk factor for asthma. This may have to do with damage to the lungs or an abnormal development of the lungs.

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

Symptoms

Asthma and bronchitis have four overlapping symptoms:

• Coughing
• Wheezing
• Shortness of breath
• Chest tightness

The nature of these symptoms, however, differs.

Because acute cases of bronchitis commonly 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 patients 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 having asthma symptoms worsen 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 dusts
• 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. While triggers vary from person to person, common ones 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

While acute bronchitis is most commonly caused by viruses, it 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 often part 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 doctor will ask you about what you're experiencing, as well as your personal and family medical history. A physical exam will be performed.

Testing possibilities include:

• Pulmonary function tests (PFTs), such as measuring forced exploratory volume (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 infections
• Chest X-rays to rule out pneumonia

Pulmonary function tests are often performed before and after giving you a bronchodilator medication. If your lung tests significantly improve and indicate that airway obstruction resolved after being given the medication, you may be diagnosed with asthma. If airway obstruction mostly persists after being given the medication, chronic bronchitis may be suspected.

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.

Unfortunately, diagnostic confusion sometimes occurs. For example, diagnosis using PFTs can be complicated because 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 blood tests to check for inflammatory cells in asthma and a bronchial biopsy (sample of bronchial tissue)—may be done to reach a diagnosis.

Treatment

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

Your doctor 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 bronchitis due to bacteria 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 inhalers, which can address acute symptoms by widening airways quickly
• Inhaled corticosteroids, long-term controller medications taken 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 mild asthma or exercise-induced asthma that only happens during physical activity. 

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

Your physician 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 experience an episode of bronchitis, you'll need to follow your asthma action plan and adjust treatment accordingly. Remember that 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 and COPD, on the other hand, 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 also be used to 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 doctor if you experience any changes or worsening of symptoms.

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