Bronchitis and Pneumonia

Dear Dr. Z.,
How do I know if I have bronchitis or pneumonia?

Bronchitis and Pneumonia are both infections of the lower respiratory tract, and are common ailments during the winter months. Lower respiratory infections are those that infect the bronchi and or lungs where as upper respiratory infections are those that infect the sinuses, ears, and throat.

Bronchitis occurs when a virus, bacteria, or irritant from the environment disrupts the cilia in the cells that line the trachea and bronchi. The trachea or windpipe is the airway and leads to the bronchus which divides into smaller segments and conducts air into the lungs. The cilia are hairs that help keep the airways free of irritants, and when these hairs are not functioning properly the cells drown in the rubble. Their reaction is to produce mucus, leading to the classic symptom of bronchitis, a cough that produces thick yellow, green or brown mucus. Other symptoms can include, fever, nasal congestion, body aches, sore throat, difficulty breathing, chest pain, and wheezing. Unfortunately, the associated cough can continue for 2-3 weeks.

There are several different inhalers that can be prescribed for acute bronchitis that will help open the airways and reduce the inflammation. Oral steroids may be prescribed for the inflammation in some cases. Cough suppressants, decongestants, antihistamines, and plenty of fluids can be used to help dry up the mucus. Antibiotics are given when a bacterial infection is suspected. Acute bronchitis can occur in all age groups; however it is most common in children under 5 years of age. Asthmatics, smokers, and people with a history of bronchitis or pneumonia are also more susceptible to bronchitis. An important point to mention is chronic bronchitis is bronchitis that persists for 3 months or more. The causes for this are more commonly an environmental irritant and or a history of smoking.

Depending on the severity of symptoms the provider may order a chest x ray to rule out pneumonia or other respiratory ailments.

Pneumonia can be caused by a virus, bacteria, or fungi. Pneumonia actually infects the smaller air sacs in the lungs, where the oxygen exchange occurs. Depending on the type or cause of pneumonia it can produce a liquid or even purulent substance inside these alveoli (air sacs). The symptoms of pneumonia are highly variable ranging from cold symptoms with a cough to much more serious symptoms. Viral pneumonia accounts for about half of the cases of pneumonia. It will present with a dry non-productive cough, headache, malagias (body aches), and a fever. The cough may begin to produce small amounts of white or clear mucus. One may even mistake this for the flu, because in healthy individuals it is self-limited. A secondary bacterial infection can develop as in acute bronchitis. Bacterial pneumonia typically presents with 1-10 days of a productive cough with yellow or green sputum, difficulty breathing, fever, shaking chills, chest pain, and a rapid heart rate. The severity of the pneumonia will depend on the specific underlying bacteria. For example “walking pneumonia” is acquired from the community in healthy individuals. Mycoplasma is a bacterium but the symptoms present the same as viral pneumonia. If a patient has any of the above symptoms the health care provider will order a chest x-ray to confirm pneumonia and rule out other pathology. A sputum sample can be taken if provider is concerned about the specific pathogen causing the pneumonia.
Those who are at risk for getting pneumonia and developing complications are the elderly, immunocompromised, alcoholics, stroke patients, and those with any other form of chronic illness. The treatment for pneumonia varies depending on the underlying cause; antibiotics are given if it is bacterial, and antifungal medications are used for fungal pneumonia. If the fever continues despite treatment, and oxygen levels are compromised due to fluid accumulation in the lungs, hospitalization is needed.
There are several ways to prevent pneumonia; the yearly influenza vaccine is suggested to prevent viral pneumonia in all ages. For those under 2 years of age, older than 55 and or immunocompromised are urged to get vaccinated with the pneumaonia vaccine. Other simple methods of prevention include hand washing, eating a well balanced diet, exercise and not smoking. Participating in all of the above will help prevent bronchitis as well as lead to an overall healthier lifestyle.
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