Complications of Bronchitis

Bronchitis is a common respiratory infection that many people experience at one time or another. It’s characterized by upper respiratory symptoms and a cough. While most often the condition resolves on its own, in some cases it can lead to further complications.

Learn about the potential complications associated with both acute and chronic bronchitis.

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Acute vs. Chronic Bronchitis

Before discussing the complications of bronchitis, it’s important to distinguish the two different kinds, as both the symptoms and impact can vary significantly.

  • Acute bronchitis often occurs at the tail end of a cold or the flu. Instead of improving, a person may develop a low-grade fever and a bothersome cough. Roughly 90% of the time, acute bronchitis is viral in origin, so antibiotics are not helpful. Home remedies may ease the symptoms until they resolve on their own, though a cough may persist for several weeks.
  • Chronic bronchitis is considered by many to be a form of chronic obstructive pulmonary disease (COPD). It is characterized by a daily cough (often productive of large amounts of phlegm) that lasts for at least three months. In addition to coughing, symptoms such as shortness of breath (dyspnea), chest pain, and weight loss may occur.

Acute Bronchitis Complications

While acute bronchitis usually runs its course, complications such as secondary bacterial infection (“superinfection”) may occur in 5% to 10% of people.

Can Acute Bronchitis Become Chronic Bronchitis?

It’s important to note that, in addition to these complications, repeated episodes of acute bronchitis (especially in people who smoke or who are exposed to dust at work) can eventually lead to chronic bronchitis.

This progression from acute bronchitis to chronic bronchitis is an important reason to talk to your doctor if you are experiencing repeated symptoms and to eliminate potential causes, such as smoking.

Secondary Infections

Secondary bacterial infections or “superinfections” are not uncommon following an episode of acute viral bronchitis and can both lengthen and worsen the illness.

Viral infections affect the body in a few ways that predispose to these infections:

  • Damage to the airways (the cilia that catch debris and bacteria) can make it easier for these foreign invaders to gain access to areas such as the sinuses or lungs.
  • Viral infections can also affect the immune system (for example, by reducing the number of macrophages that “eat” bacteria) such that bacteria are allowed to grow and multiply.
  • Viruses such as influenza may disrupt the normally tight junctions between the cells lining the airways such that bacteria can more easily attach to and penetrate these normal barriers. The buildup of bacteria in the airways that may occur with viral infections is referred to by scientists as “bacterial colonization.”

Bacteria that are commonly responsible for superinfections (and are often present on the skin and in the environment) include Streptococcus pneumoniae (the bacteria that causes pneumococcal pneumonia), Haemophilis Influenzae, and Staphylococcus aureus.

Some potential secondary infections include:

  • Middle ear infections (otitis media), especially in children
  • Sinus infections (sinusitis)
  • Pneumonia (discussed next)
  • Sepsis (occurs when bacteria multiply in the bloodstream causing a body side and often very serious infection)

Pneumonia

Pneumonia is the most common complication of viral acute bronchitis, occurring in roughly 5% of people. Among children aged 5 and over, as well as adults, the most common cause is Streptococcus pneumonia.

This is the reason why the pneumonia vaccine is recommended for children and for adults over the age of 65, as well as for people with lung conditions—such as COPD or asthma—or who are immunosuppressed for some reason.

In children under the age of 5, the most common cause of pneumonia is respiratory syncytial virus (RSV), which may be responsible for initial bronchitis as well as a secondary viral infection.

Chronic Bronchitis Complications

Unlike acute bronchitis, complications are fairly common with chronic bronchitis, especially worsening of the condition (acute exacerbations).

Knowing Your Baseline With Chronic Bronchitis

For people living with chronic bronchitis, it’s very important to know your “baseline,” or how you usually feel, as the symptoms that might suggest a complication (e.g., shortness of breath) may already be present to some degree.

In order to objectively measure symptoms, some people use numbers to guide them. For example, if on a scale of 1 to 10 (with 1 being barely a problem and 10 being severe), a change from a 3 in your level of shortness of breath to a 5 could be a problem.

Daily home spirometry is another way to know if your lung function is worsening. The most important point, however, is to know and listen to your own body. If you feel concerned about your health for any reason, talk to your doctor.

Physicians often use something known as the BODE Index to assess severity in people with COPD such as chronic bronchitis. In addition to measuring the degree of shortness of breath, the index includes measures of exercise tolerance, airway obstruction (FEV1), and body mass index (weight) to assess both severity and potential worsening of the condition.

Dyspnea

Dyspnea, the medical term that refers to the sensation of shortness of breath, is common with chronic bronchitis. Not only can dyspnea be uncomfortable and cause significant anxiety, but it has been found to greatly interfere with the overall quality of life. That said, appropriate management can be very helpful,

Managing dyspnea requires a combination of several approaches:

Acute Exacerbation

Acute exacerbations of chronic bronchitis are common, yet of concern, in that they can be both uncomfortable (and sometimes dangerous) and may hasten the progression of the disease.

While there are a number of factors that can result in an exacerbation of chronic bronchitis, viral infections—such as acute viral bronchitis superimposed on chronic bronchitis—are a very common cause.

Symptoms of an acute exacerbation may include:

  • Increased cough
  • Change in sputum (either color or amount)
  • Change in wheezing
  • Change in chest tightness
  • Fever
  • Increased respiratory rate (tachypnea)
  • Fever (usually low grade)
  • Anxiety
  • Lightheadedness and tingling (if oxygen levels are low)

Depending on the severity of an exacerbation, hospitalization may be required. If a bacterial infection is responsible for the exacerbation (such as pneumonia), antibiotics will be needed. For people who have more than one exacerbation each year, inhaled corticosteroids are usually recommended.

Respiratory Failure

Respiratory failure is, unfortunately, a complication of chronic bronchitis. It occurs when the lungs fail to bring in enough oxygen to supply the tissues of the body (hypoxia). Without enough oxygen available, a number of bodily systems experience damage. It can also result in the buildup of carbon dioxide in the bloodstream.

A number of symptoms may suggest that respiratory failure is occurring, though the symptoms often vary depending on whether respiratory failure has come on slowly or rapidly.

With the sudden onset of severe respiratory failure, a person may develop severe cyanosis (a bluish tinge to the fingers and lips) or become unconscious.

More commonly, respiratory failure begins more gradually. Symptoms may include:

  • Shortness of breath (dyspnea)
  • A rapid respiratory rate (tachypnea)
  • A rapid heart rate (tachycardia)
  • Cyanosis
  • Lack of coordination
  • Impaired judgment
  • Feelings of well-being and sometimes euphoria
  • Tingling and warm sensations
  • Tunnel vision

When respiratory failure develops very slowly, symptoms may include primarily severe fatigue, apathy, and a disinterest in activities that would normally be of interest.

Respiratory failure is a medical emergency, especially if it develops rapidly. Treatment usually requires a number of medications (including those that dilate the airways, corticosteroids, etc.) as well as breathing support. This may include oxygen, non-invasive ventilatory support, or mechanical ventilation when severe.

Cor Pulmonale

Cor pulmonale or right-sided heart failure, can occur with long-term chronic bronchitis.

The left side of the heart has to be strong and thick to pump blood throughout the body. In contrast, the right side of the heart (right atrium and right ventricle) are thinner, as they only need to pump deoxygenated blood to the lungs (via the pulmonary artery, the only artery in the body that carries deoxygenated blood).

Symptoms of cor pulmonale are similar to those of left-side heart failure, which is most common but is often more severe. These may include:

  • A cough
  • Shortness of breath, which may occur at rest as well as with activity
  • Fluid retention (edema) of the extremities
  • Fatigue (which can be severe)
  • Dilated blood vessels in the neck
  • Swelling of the abdomen (ascites)
  • A rapid respiratory rate
  • A rapid pulse
  • Cyanosis
  • Chest pain
  • Fainting (syncope)

Cor pulmonale can rapidly become life threatening and is a medical emergency. Treatment includes medications to reduce pressure in the pulmonary arteries, management of the underlying lung disease, diuretics (for fluid retention), blood thinners, and oxygen.

When very severe, and the above treatments cannot successfully manage the condition, a ventricular assist device to help the heartbeat may be needed.

Pneumothorax

A pneumothorax, or “collapsed lung,” is another potential complication of chronic bronchitis, especially in those who also have emphysematous changes in their lungs. With a pneumothorax, a “hole” in the lungs allows air to leak into the space (pleural cavity) between the two pleural membranes (pleura) that surround the lungs.

A pneumothorax can either be primary, occurring in a person with no underlying lung disease, or secondary, when underlying lung disease is present. In this case, a pneumothorax would be considered secondary due to chronic bronchitis/COPD.

Symptoms of a pneumothorax can vary from very mild to life threatening and may include:

  • Chest pain on one side of the body that can be mild to severe (present for most people with the complication)—The pain is often sharp, and worsens with a deep breath or with coughing. The pain may also radiate to the arm or shoulder, causing some people to be concerned they are having a heart attack.
  • Shortness of breath
  • An elevated heart rate
  • A rapid pulse
  • Cyanosis
  • Lightheadedness
  • Sometimes (if the air leaks into surrounding tissue), people may note a sensation under the skin of their chest or neck that has been likened to bubble wrap (subcutaneous emphysema)

It’s important to note that when non-life-threatening, symptoms of a pneumothorax often improve (and sometimes resolve) over the next 24 hours. For this reason, it’s important for people to contact their doctor even if their symptoms appear to be improving.

Polycythemia

Polycythemia refers to a high red blood cell count and can have many causes. It is further divided into primary polycythemia and secondary polycythemia, with secondary polycythemia occurring as a compensatory process related to another medical condition.

With chronic bronchitis, the body may respond to low levels of oxygen in the body (hypoxia) by producing more red blood cells to carry oxygen (secondary polycythemia). In this case, the polycythemia is considered “appropriate” as it is the body’s attempt to maintain oxygen levels in the tissues. Smoking can also cause secondary polycythemia.

Symptoms of polycythemia are related primarily to the increased thickness (viscosity) of the blood. This increased viscosity may result in decreased blood flow to the brain (when the red blood cell count is very high) or in the formation of blood clots (thromboses).

Symptoms may include:

  • Fatigue
  • Headache
  • Dizziness (vertigo)
  • Visual disturbances
  • Ringing in the ears (tinnitus)
  • A ruddy appearance
  • Easy bruising
  • High blood pressure
  • Decreased mental acuity/confusion
  • Clubbing (a condition in which the fingernails and sometimes toes take on the appearance of upside-down spoons) and cyanosis due to relatively long-term hypoxia

Reactive Airway Disease

Reactive airway disease (RAD) describes a condition in which the airways respond to an irritant (smoke, infection, etc.) by narrowing. There has been debate over what constitutes reactive airway disease, but in general, RAD refers to a narrowing of the airways that is reversible in nature and unknown with respect to diagnosis.

Emphysema and COPD

Both chronic bronchitis and emphysema are types of COPD, and since they have similar risk factors (such as smoking, exposure to airway irritants, etc.), they often occur together. Overall, roughly half of people diagnosed with COPD have bronchitis and half emphysema, with a much smaller number having bronchiectasis.

Emphysema is not necessarily a complication of chronic bronchitis, but needs to be considered with any of the complications discussed above as well as with the management of the disease, as potential treatments may vary. Fortunately, actions to prevent the worsening of both (avoiding smoking, fume exposure, viral infections, etc.) can reduce complications and worsening of both conditions.

Hemoptysis

Hemoptysis, or coughing up blood, may occur with acute bronchitis and chronic bronchitis, or it could signal another condition altogether. When talking about coughing up blood, most people note only a tinge of blood on a tissue—an amount so small that you may question whether or not it is really blood. But coughing up even a small amount of blood, say a teaspoon, is a medical emergency.

If you’ve coughed up blood, see your doctor right away, even if you feel there is an obvious cause (such as throat irritation). In many cases, treatment of the underlying problem will resolve the hemoptysis. When severe, however, treatments such as bronchial artery embolization can quickly stop a bleed that could otherwise have a poor outcome.

Summary

While bronchitis most often resolves on its own, in some cases it can lead to further complications.

A Word From Verywell

It can be frightening to hear about all of the potential complications that may accompany a diagnosis of acute bronchitis, yet being aware of these possibilities may help you catch a secondary condition before it can take hold.

Fortunately, there are ways to reduce complications whether you are dealing with acute or chronic lung symptoms. If you smoke, quit. Avoid any other triggers that may worsen your symptoms. And perhaps most importantly, listen to your body.

If something feels not just abnormal, but different for you, talk to your doctor. Our bodies are pretty good at letting us know when there is a problem...if we only listen.

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