How Bronchitis Is Diagnosed

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The diagnosis of acute or chronic bronchitis starts with a medical history and physical examination. A chest X-ray or chest CT scan can provide helpful diagnostic information because these tests allow your healthcare provider to assess the appearance of your lungs. Blood tests and pulmonary functions tests may be helpful in determining whether you have bronchitis. These additional tests are most useful for ruling out other causes of your symptoms, including another lung disease, heart failure, or cancer.

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Self-Checks/At-Home Testing

Usually, there are signs that indicate that you or your child has more than just a regular cold. It is important to familiarize yourself with the symptoms of bronchitis because you are the first person who will notice that you might have the condition. You should get medical attention if you have signs of acute or chronic bronchitis. 

Acute and chronic bronchitis are both characterized by a persistent dry or productive cough, which is a cough accompanied by thick mucus. If you have acute or chronic bronchitis, your cough may also be exacerbated by environmental factors, such as smoke or other fumes. ​

Acute Bronchitis

In addition to the signs that are common to both acute and chronic bronchitis, there are indications that are specific to acute bronchitis. If you or your child has a cold in which a cough is the most prominent symptom, or if the cold seems to be lingering for longer than usual, then this may be acute bronchitis. 

Chronic Bronchitis

If you have a daily cough, lasting for at least three consecutive months, then you may be dealing with chronic bronchitis. Pay attention to whether you also experience fatigue and if you develop shortness of breath with physical activity because these are also signs of chronic bronchitis. 

Labs and Tests

A number of labs and tests can support the diagnosis of bronchitis, although diagnostic tests alone are not enough to verify that you have bronchitis. These tests are used to determine the cause of bronchitis and to follow your progress if you have trouble breathing. 

Sputum Culture

A sputum culture is used to confirm the presence of bacteria in your sputum, which indicates that you have a respiratory tract infection.

If you have acute bronchitis, a positive sputum culture suggests that an infection is the cause of your symptoms. If you have chronic bronchitis, you are more prone to frequent lung infections, so you can have a positive sputum culture (usually with worsening symptoms) from time to time.

Complete Blood Count

A complete blood count, or CBC, is a routine blood test that provides your healthcare provider with important information about the types and amounts of blood cells in your body. It can also help your healthcare provider determine if you have an infection, which is more likely with acute bronchitis, but can occur with chronic bronchitis as well. 

Pulse Oximetry

A pulse oximeter is a small device that can estimate the oxygen saturation in your blood through your skin. This test can provide a reading within a few seconds, and it is done without any needles or injections.

An abnormal oxygen level detected by a pulse oximetry reading suggests that you have a very advanced disease, while a normal reading cannot rule out bronchitis. 

Pulmonary Function Testing

Pulmonary function testing (PFT) uses spirometry to measure your airflow as you breathe. This test can determine the presence and degree of airflow obstruction. A spirometry test can be performed in your doctor's office, in the hospital, or in a healthcare clinic. PFT is not performed for acute bronchitis.

Bronchitis Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

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Imaging

Imaging studies can be helpful for evaluating bronchitis because they allow a healthcare provider to see the changes that are happening in your lungs. Your healthcare provider can also assess whether the changes are occurring in the lungs, the bronchi, or in other areas of your respiratory tract.

Chest X-Ray

A chest X-ray is not a definitive tool for diagnosing acute or chronic bronchitis, but your X-ray may show signs of inflammation of the bronchi, which can help in the diagnosis of acute or chronic bronchitis. A chest X-ray may also detect signs of lung infections like pneumoniaChronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis, can cause changes that may be visualized with a chest X-ray.

If you have symptoms of COPD, it's likely your healthcare provider will order a chest X-ray to visualize your lungs. 

Chest CT

A chest CT provides a visual assessment of the lungs that can help identify bronchitis and other conditions such as lung infections, pulmonary embolus, or lung cancer.

Differential Diagnoses

There are several conditions that may produce symptoms similar to those of bronchitis. Your diagnostic tests and medical history can help differentiate between bronchitis and the other conditions. 

Pneumonia

Pneumonia is a lung infection, while bronchitis is inflammation of the bronchi. The bronchi are the airways that lead to the lungs. Both of these illnesses can cause wheezing and fatigue, but acute bronchitis causes a more severe cough than pneumonia, and chronic bronchitis does not typically produce a fever, whereas pneumonia does.

The symptoms are often similar, and a chest X-ray can help your healthcare provider determine whether you have pneumonia or bronchitis. 

Asthma

Asthma can cause bouts of severe breathing difficulties and wheezing, which are usually more acute and severe than the breathing difficulties and wheezing of either acute or chronic bronchitis. Asthma and chronic bronchitis are both recurrent, so your healthcare providers may need to differentiate these illnesses with a thorough medical history and chest imaging studies. 

Allergic Reaction

An allergic reaction can cause a sudden episode of shortness of breath. This is typically more dramatic than the shortness of breath that you may experience with bronchitis. However, because the treatment of the conditions is so different, your healthcare providers may need to order allergy tests if your diagnosis is unclear. 

Emphysema

Emphysema is a condition in which the alveoli, which are the air sacs of the lungs, become affected by long-term pulmonary disease. You can have emphysema and chronic bronchitis, and they both are characterized by shortness of breath and fatigue. Your PFTs and imaging tests can help your healthcare providers determine if you have one or both of these conditions. 

Heart Failure

As with chronic bronchitis, heart failure can cause you to have shortness of breath and fatigue with physical activity. There are differences that your healthcare provider can detect on physical examination by listening to your heart and chest sounds with a stethoscope.

It is not uncommon to have heart failure and chronic bronchitis at the same time, so your medical team will work to determine whether you have one or both of these conditions. 

Cancer

Cancer that involves the lungs can produce a range of symptoms, including a cough, wheezing, and shortness of breath. If your symptoms are suggestive of cancer, your healthcare provider is likely to order additional imaging tests and to consider a biopsy if there is an appearance of cancer on any of your imaging tests. 

Frequently Asked Questions

  • How can I tell if I have bronchitis?

    Symptoms that may point to bronchitis include:

    • A frequent, hacking cough that may or may not be productive (bring up mucus) in the case of acute bronchitis, but always is productive in chronic bronchitis
    • Sputum that is yellow or clear (rather than greenish)
    • Wheezing
    • A whistling sound when you breathe
    • Chills, fever, muscle aches, fatigue, runny nose, and other common symptoms of a viral infection
    • Dyspnea (shortness of breath)
    • Chest pain or tightness

    These symptoms of bronchitis tend to be less severe in the case of acute bronchitis; most will resolve within a few days or weeks without treatment, although the cough may linger for several weeks. Chronic bronchitis symptoms occur for several months at a time per year for at least two years in a row.

  • What tests can diagnose bronchitis caused by a bacterial infection?

    A sputum culture or blood test can confirm a bacterial infection. But fewer than one in 20 cases of acute bronchitis is caused by bacteria. Among bacteria most often associated with acute bronchitis are Chlamydia pneumoniae, Bordetella pertussis, and Mycoplasma pneumoniae.

  • Will I have to take antibiotics to get rid of bronchitis?

    It depends. Chronic bronchitis or acute viral bronchitis are not treated with antibiotics. If you have acute bronchitis caused by bacteria, you might need antibiotic treatment. You can also have an acute exacerbation of chronic bronchitis due to a bacterial infection that requires antibiotic treatment.

  • What does bronchitis look like on an X-ray?

    X-rays are not especially helpful for diagnosing bronchitis, but can identify or rule out other conditions, such as pneumonia. An X-ray may show thickening of the walls of the bronchi (airways) but this is not a definitive sign of bronchitis.

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Article Sources
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