What is the Difference Between Bronchitis and Pneumonia?
Cold and flu season is here, and dodging these illnesses at school or the office can be a challenge when they are going around. While most people recover from colds and the flu quickly, either of these can lead to bronchitis or pneumonia.
Bronchitis and pneumonia share many of the same symptoms of cold and flu. By determining the difference between bronchitis and pneumonia, you can seek the proper treatment and be back on the road to recovery much more quickly.
Both bronchitis and pneumonia affect the airways, resulting in coughing and discomfort. Their biggest difference is how! In short, bronchitis is an inflammation of the airways while pneumonia is an infection of the lungs.
Bronchitis is an inflammation of the bronchial tubes, which are the airways which carry air to your lungs. Bronchitis can occur from environmental, viral, or bacterial causes. The same viruses which cause cold and flu can also cause bronchitis.
Bronchitis is marked by a persistent cough which brings up mucus, and may be accompanied by chest tightness, a low fever, and shortness of breath. There are two types of bronchitis: acute and chronic.
Acute bronchitis usually goes away within a few days to a few weeks. Chronic bronchitis is one form of COPD (chronic obstructive pulmonary disease) and can occur for several months at a time; treatment can improve symptoms, but not cure them.
Industrial bronchitis refers to a condition which can affect certain people who are regularly exposed to fumes, dust, or smoke. The airways become irritated and result in coughing and mucus production. Symptoms may go away on their own, or medication or air filters (especially face masks) may be required to improve symptoms.
Your doctor can diagnose bronchitis by assessing your symptoms as well as listening to your chest with a stethoscope for the rattling sound in your lungs which accompanies bronchitis.
Pneumonia is an infection of one or both lungs which can result from bacteria, viruses, or fungi. These can be acquired by airborne sources (such as sneezing or coughing), or can occur when bacteria or viruses in the nose and sinuses spread to the lungs.
Much like bronchitis, people with pneumonia will experience a cough which brings up mucus, as well as a shortness of breath. Pneumonia may similarly be accompanied by a fever – although the fever may be high, unlike bronchitis.
Pneumonia may also cause confusion, clammy or sweaty skin, headache, malaise, loss of appetite, sharp chest pain, or leukonychia (white nail syndrome). Unlike bronchitis, pneumonia can be life-threatening.
You may have heard the term “Walking Pneumonia”. This is an informal term for pneumonia which isn’t severe enough to require hospitalization or bed rest. Most people with walking pneumonia can go about their daily activities as normal.
Pneumonia affects how air is distributed to blood cells. When cells do not get enough oxygen, they cannot function properly. As a result, the infection may spread and become deadly.
Pneumonia is diagnosed with a chest x-ray and/or blood tests. Your doctor may also be able to identify pneumonia by the sounds of crackling, wheezing, or bubbling in your chest.
When A Cold or Flu Becomes Something Else
Complications can arise from either a cold or the flu, especially in the very young, the elderly, or people with compromised immune systems.
You should see a doctor if you experience the following symptoms:
- If your cough continues after your cold or flu is gone
- If you have a fever, especially over 101°
- If you are coughing up discolored phlegm (yellow or green; clear to cloudy is normal)
- If you are coughing up blood
- If you are wheezing
- If you are having night sweats
While your doctor is the best resource for making a conclusive identification of your illness, keep an eye out for symptoms at home if you have a cold or the flu. Only you know how you feel. If you have any doubts at all, it may be best to consult your doctor in order to rule out potentially serious conditions.
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Most healthy people can recover from either bronchitis or pneumonia within a few weeks of treatment. However, complications can arise from either a cold or the flu. In these cases, it’s important to see your doctor as soon as possible to prevent your condition from worsening. The sooner that you seek treatment, the shorter your recovery time will be!
Most people with acute bronchitis recover after a few days or weeks. Viral infections, such as the cold or flu, are usually the cause of acute bronchitis. Occasionally, acute bronchitis can be caused by a bacterial infection.
Chronic bronchitis is an ongoing cough that lasts for several months and comes back two or more years in a row. In chronic bronchitis, the lining of the airways stays constantly inflamed. This causes the lining to swell and produce more mucus, which can make it hard to breathe. Chronic bronchitis is often part of a serious condition called chronic obstructive pulmonary disease (COPD).
Your risk for either type of bronchitis is higher if you smoke cigarettes or have asthma or allergies. Chronic bronchitis is most often caused by smoking cigarettes, but it can occur in non-smokers as well. Women who smoke may be more at risk than men. Those who are older, have been exposed to fumes or secondhand smoke, have a family history of lung disease, have a history of childhood respiratory diseases, or have gastroesophageal reflux disease (GERD), are also at higher risk of getting chronic bronchitis.
The most common symptom of bronchitis is coughing associated with mucus production. Other symptoms include wheezing or shortness of breath, chest pain, or a low fever. To diagnose bronchitis, your doctor will do a physical exam and ask about your medical history and symptoms. The doctor may also order a blood test to look for signs of infection or a chest X-ray to see if your lungs and bronchial tubes look normal and rule out pneumonia.
Usually, acute bronchitis goes away on its own, without treatment. Sometimes over-the-counter medicines that loosen mucus or a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen can help manage acute bronchitis. Taking a couple of teaspoons of honey or using a humidifier may also reduce the symptoms and help with comfort. Doctors typically prescribe antibiotics only if they find that you have a bacterial infection, which is more common in young children. To prevent acute bronchitis from recurring, your doctor may recommend that you get a seasonal flu vaccine, quit smoking, and avoid being around secondhand smoke.
The goal of treatment for chronic bronchitis is to help you breathe better and control your symptoms. Your doctor may recommend healthy lifestyle changes such as quitting smoking; taking medicines to help clear your airways or to prevent symptoms from getting worse; or, in some cases, getting oxygen therapy to help you breathe better. Pulmonary rehabilitation can teach you breathing techniques such as pursed-lip breathing and help you prevent symptoms from worsening.
Learn more about Acute Bronchitis and Chronic Bronchitis.
Is it bronchitis or pneumonia?
Acute bronchitis, the infectious form of which affects most people with the disease, is only very rarely fatal. Chronic bronchitis, however, can slowly destroy lung function and may become life threatening.
Bronchitis is the inflammation of the bronchial tubes, which carry air from the trachea, or windpipe, into and through the lungs.
Acute bronchitis has distinct forms that vary, depending on the causes:
- Viral bronchitis: Viral infections cause most cases of bronchitis. A person may develop a cough or trouble breathing after a virus, such as the common cold or flu.
- Bacterial bronchitis: Bacterial infections can also cause bronchitis. A person may suddenly develop breathing difficulties or notice breathing problems following another illness.
- Fungal infections occasionally cause bronchitis.
- Other causes: Besides infection, exposure to substances that irritate the lungs, such as tobacco smoke, dust, fumes, vapors, and air pollution can also cause bronchitis.
Chronic bronchitis causes ongoing inflammation of the airways. It is a type of chronic obstructive pulmonary disease (COPD).
The symptoms of bronchitis are similar, regardless of which type causes the disease. However, chronic bronchitis does not go away, although symptoms can wax and wane.
Viral and bacterial bronchitis typically last anywhere from a few days to a few weeks. Some symptoms include:
- severe coughing, often producing mucus
- clear, green, or yellow mucus
- fever or chills
- wheezing or trouble breathing, especially when lying down
- feelings of fullness or tightness in the chest
- sore throat
Learn more about the symptoms of bronchitis here.
Since most cases of acute bronchitis are viral, they will not respond to antibiotics.
The following treatment options may help:
- drinking plenty of fluids
- over-the-counter pain relievers
- cough medication
A humidifier can also ease coughing at night. When a bacterial infection causes bronchitis, a doctor may recommend antibiotics.
Chronic bronchitis, on the other hand, is not curable. However, a number of interventions can help a person breathe more easily.
Some doctors might recommend inhalers, oxygen, pulmonary rehabilitation therapy, or other medications to help reduce inflammation in the airways.
Both acute and chronic bronchitis are more common in people who smoke. Quitting smoking can reduce the risk of bronchitis and prevent further damage to the airways.
Read about some home remedies for bronchitis here.
Chronic bronchitis can lead to serious complications, including death from heart or lung damage. Over time, a person’s body may not be able to get enough oxygen from the blood, damaging organs and potentially causing other illnesses.
Chronic bronchitis also greatly increases the risk of pneumonia and can make it more difficult for a person’s body to fight pneumonia.
Acute bronchitis does not usually cause serious complications. However, in a person with a weak immune system, it may lead to other infections, including pneumonia and sepsis.
Chronic lower respiratory diseases, including bronchitis, claimed 160,201 lives in the United States in 2016.
Ever hear the term “bronchial asthma” and wonder what it means? When people talk about bronchial asthma, they are really talking about asthma, a chronic inflammatory disease of the airways that causes periodic “attacks” of coughing, wheezing, shortness of breath, and chest tightness.
According to the CDC, more than 25 million Americans, including 6.8 million children under age 18, suffer with asthma today.
Allergies are strongly linked to asthma and to other respiratory diseases such as chronic sinusitis, middle ear infections, and nasal polyps. Most interestingly, a recent analysis of people with asthma showed that those who had both allergies and asthma were much more likely to have nighttime awakening due to asthma, miss work because of asthma, and require more powerful medications to control their symptoms.
Asthma is associated with mast cells, eosinophils, and T lymphocytes. Mast cells are the allergy-causing cells that release chemicals like histamine. Histamine is the substance that causes nasal stuffiness and dripping in a cold or hay fever, constriction of airways in asthma, and itchy areas in a skin allergy. Eosinophils are a type of white blood cell associated with allergic disease. T lymphocytes are also white blood cells associated with allergy and inflammation.
These cells, along with other inflammatory cells, are involved in the development of airway inflammation in asthma that contributes to the airway hyperresponsiveness, airflow limitation, respiratory symptoms, and chronic disease. In certain individuals, the inflammation results in the feelings of chest tightness and breathlessness that’s felt often at night (nocturnal asthma) or in the early morning hours. Others only feel symptoms when they exercise (called exercise-induced asthma). Because of the inflammation, the airway hyperresponsiveness occurs as a result of specific triggers.
Bronchial asthma and cardiac asthma
Bronchial asthma is another name for the common form of asthma. The term ‘bronchial’ is occasionally used to differentiate it from what doctors sometimes call ‘cardiac’ asthma, which is not true asthma but breathing difficulties caused by heart failure. Although the two conditions have similar symptoms, including shortness of breath and wheezing (a whistling sound in the chest), they have quite different causes.
In cardiac asthma, the reduced pumping efficiency of the left side of the heart leads to a build up of fluid in the lungs (pulmonary oedema). This fluid build-up can cause breathlessness and wheezing. Cardiac asthma has very similar symptoms to bronchial asthma. The main symptoms and signs of cardiac asthma are:
- shortness of breath with or without wheezing;
- rapid and shallow breathing;
- an increase in blood pressure and heart rate; and
- a feeling of apprehension.
The pattern of shortness of breath helps doctors determine which type of asthma you have — people with bronchial asthma tend to experience shortness of breath early in the morning, whereas people with heart failure and cardiac asthma often find they wake up breathless a few hours after going to bed, and have to sit upright to catch their breath. This is because in people with heart failure, lying down for prolonged periods will cause fluid to accumulate in the lungs leading to shortness of breath.
Both bronchial and cardiac asthma can make people short of breath when they exert themselves. In bronchial asthma, symptoms are usually brought on by vigorous exercise and tend to be worse after the exercise than during it. On the other hand, cardiac asthma tends to happen during less vigorous exertion — someone with heart failure can find themselves short of breath while climbing stairs, or in severe cases, while getting dressed.
People with heart failure also often have problems with swollen ankles that worsen during the course of the day. They may also feel very tired, put on weight and have to urinate frequently.
Cardiac asthma can be a life-threatening condition, and you should consult your doctor if you think you have symptoms of cardiac asthma.
For most people with bronchial asthma, the pattern is periodic attacks of wheezing alternating with periods of quite normal breathing. However, some people with bronchial asthma alternate between chronic (long-term) shortness of breath and episodes in which they feel even more breathless than usual.
Risks for developing bronchial asthma include being a person who is genetically susceptible to asthma and being exposed early in life to indoor allergens, such as dust mites and cockroaches, and having a family history of asthma or allergy. Exposure to the effects of tobacco smoke before birth or during early childhood also increases the risk of developing bronchial asthma.
Bronchial asthma attacks can be triggered (precipitated or aggravated) by various factors, including:
- respiratory tract infections;
- cold weather;
- allergens (substances that trigger an allergic reaction) such as pollen and house dust mites;
- cigarette smoke and other air pollutants; and
Some people can develop asthma due to an intolerance that their body develops to aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) (in which case exposure to aspirin or NSAIDs can trigger an asthma attack). Other medicines, such as beta-blockers, can worsen or unmask bronchial asthma. Other people develop asthma due to an allergy that they develop to certain chemicals in the workplace (this is called ‘occupational asthma’, in which case exposure to the chemical triggers an asthma attack).
The symptoms of bronchial asthma include:
- a feeling of tightness in the chest;
- difficulty in breathing or shortness of breath;
- wheezing; and
- coughing (particularly at night).
Although there is currently no cure for bronchial asthma, it can be controlled. There is little reason why you cannot continue to do many of the activities you enjoy. Work with your doctor to develop an asthma action plan and learn to control your asthma — don’t let it control you!
Last Reviewed: 26/01/2010
- Han MK, Tayob N, Murray S, et al. Predictors of chronic obstructive pulmonary disease exacerbation reduction in response to daily azithromycin therapy. Am J Respir Crit Care Med. 2014;189(12):1503-8.
Comment: Role of azithromycin for prevention in COPD remains controversial. Authors here suggest that daily use of drug was most helpful in older patients and with GOLD scores of 1 or 2 (milder disease). Use of the drug did seem to prevent flares that required both antibiotic and steroid therapy.
- Vollenweider DJ, Jarrett H, Steurer-Stey CA, et al. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2012;12:CD010257.
Comment: Review of trials of abx v. placebo RCTs only (2068 pts), found benefit in patient in ICU while those on non-ICU hospitalizations and outpatients were not consistent. Of note, these trials ranged in years from 1957 to 2012. There was no apparent impact on mortality or LOS in hospital for those patients.
- Albert RK, Connett J, Bailey WC, et al. Azithromycin for prevention of exacerbations of COPD. N Engl J Med. 2011;365(8):689-98.
Comment: This is a randomized controlled trial in 1,142 patients with COPD given placebo vs. azithromycin 250 mg/day. azithromycin recipients had a significant reduction in exacerbations (1.5/year vs. 1.8/year; p=< 0.001) and improved lung function.
- Albertson TE, Louie S, Chan AL. The diagnosis and treatment of elderly patients with acute exacerbation of chronic obstructive pulmonary disease and chronic bronchitis. J Am Geriatr Soc. 2010;58(3):570-9.
Comment: Recommended antibiotics for exacerbations of COLD: amoxicillin, ampicillin, pivampicillin, trimethoprim/sulfamethoxazole and doxycycline. “Second line agents:” amoxicillin/clavulanic acid, second and third generation cephalosporins and fluoroquinolones. The latter are described as better versus resistant bacteria but risk driving resistance.
- Dimopoulos G, Siempos II, Korbila IP, et al. Comparison of first-line with second-line antibiotics for acute exacerbations of chronic bronchitis: a metaanalysis of randomized controlled trials. Chest. 2007;132(2):447-55.
Comment: First line agents (ampicillin, TMP-SMX and doxycycline) vs. 2nd line (amox-CA, macrolides, quinolines and 3d gen cephalosporins). First line agents were inferior (RR 0.5).
- Mensa J, Trilla A. Should patients with acute exacerbation of chronic bronchitis be treated with antibiotics? Advantages of the use of fluoroquinolones. Clin Microbiol Infect. 2006;12 Suppl 3:42-54.
Comment: The authors make a case for fluoroquinolones as preferred antibiotics for exacerbation of COPD because: Purulent sputum is a good indicator of large bacterial load. Fluoroquinolones penetrate mucous well, they are bactericidal and they reduce bacterial load better than beta-lactams or macrolides. (Nevertheless, clinical trials don’t show these advantages).
- Fernaays MM, Lesse AJ, Sethi S, et al. Differential genome contents of nontypeable Haemophilus influenzae strains from adults with chronic obstructive pulmonary disease. Infect Immun. 2006;74(6):3366-74.
Comment: The authors, noted authorities on COPD, examined genetic differences between 59 H. influenza strains implicated in exacerbations of COPD and 73 that merely colonized the lower airway in these patients. They noted gene patterns that were associated with exacerbations supporting the thesis that these strains have greater pathogenic potential.
- Wilson R, Jones P, Schaberg T, et al. Antibiotic treatment and factors influencing short and long term outcomes of acute exacerbations of chronic bronchitis. Thorax. 2006;61(4):337-42.
Comment: Patients with AECB were randomized to treatment with moxifloxacin or placebo. Clinical cure was significantly associated with antibiotic treatment (OR 1.5) and negatively associated with age >65, and bronchodilator use. The conclusion was that the benefit of moxifloxacin was seen primarily in those >65 yrs.
- Chodosh S. Clinical significance of the infection-free interval in the management of acute bacterial exacerbations of chronic bronchitis. Chest. 2005;127(6):2231-6.
Comment: Author discusses a new goal with antibiotics for AECB: delay in the time to the next exacerbation or the infection – free – interval (IFI).
- Murphy TF, Brauer AL, Grant BJ, et al. Moraxella catarrhalis in chronic obstructive pulmonary disease: burden of disease and immune response. Am J Respir Crit Care Med. 2005;172(2):195-9.
Comment: The Buffalo group has studied this cohort of 104 pts with COPD for 10 years with monthly sputum cultures. In this study they showed M. catarrhalis was newly detected in 57 of 560 exacerbations. This was accompanied by a serologic response and clearance. They conclude M. catarrhalis causes 10% of exacerbations.
- Sethi S, Wrona C, Grant BJ, et al. Strain-specific immune response to Haemophilus influenzae in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004;169(4):448-53.
Comment: Longitudinal study of patients with COPD showing some exacerbations are associated with an immune response to a newly acquired strain of H. influenzae. (This supports the role of H. flu as a pathogen in exacerbations).
- Murphy TF, Brauer AL, Schiffmacher AT, et al. Persistent colonization by Haemophilus influenzae in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004;170(3):266-72.
Comment: Analysis of sequential (monthly) samples of sputum from patients with COPD defined a group with a less than six month lapse with negative cultures for H flu. The subsequently recovered strain was identical to the initial isolate suggesting it was always there and that sputa culture are unreliable sources of this agent.
- Sethi S. Bacteria in exacerbations of chronic obstructive pulmonary disease: phenomenon or epiphenomenon? Proc Am Thorac Soc. 2004;1(2):109-14.
Comment: The author reviews methods and conclusions of studies to determine exacerbations of COPD with 2 categories: 1) Conventional: sputum culture, serology & placebo-controlled trial; 2) New: Bronchoscopic sampling, molecular epi of sputum isolates, immune response & markers of airway inflammation. Most exciting are the new methods which include studies showing a new strain of H. influenzae is associated w/some exacerbations & there is an immune response that is strain specific to support its potential role.
- Wedzicha JA. Role of viruses in exacerbations of chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2004;1(2):115-20.
Comment: Viruses implicated in 168 cases in 83 patients are: All viruses – 66 (40%), Rhinovirus – 59% (of the 66), RSV – 29%, Coronavirus -11%, influenza – 16%.
- Seemungal T, Harper-Owen R, Bhowmik A, et al. Respiratory viruses, symptoms, and inflammatory markers in acute exacerbations and stable chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001;164(9):1618-23.
Comment: Study of 168 exacerbations – viruses found in 67 (40%) – most common were rhinovirus and RSV.
- Nouira S, Marghli S, Belghith M, et al. Once daily oral ofloxacin in chronic obstructive pulmonary disease exacerbation requiring mechanical ventilation: a randomised placebo-controlled trial. Lancet. 2001;358(9298):2020-5.
Comment: Results showed a benefit of ofloxacin with mortality decrease (4% vs 22%) & reduced duration hospitalization & mechanical ventilation. The study raised concerns about ethics of a placebo control with such seriously ill pts, but the accompanying editorial notes that the benefit of antibiotics had never been clearly shown.
- Snow V, Lascher S, Mottur-Pilson C, et al. Evidence base for management of acute exacerbations of chronic obstructive pulmonary disease. Ann Intern Med. 2001;134(7):595-9.
Comment: Position paper of ACP for managing exacerbations of chronic bronchitis. Indications to Rx: Increased dyspnea, increased cough AND increased sputum purulence. Agents recommended: Amoxicillin, doxycycline, TMP-SMX.
- Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA. 1997;278(11):901-4.
Comment: This review of antibiotic prescribing patterns shows that exacerbations of chronic bronchitis account for 5-10% OF ALL ANTIBIOTIC SCRIPTS in the U.S. This is a big market.
- Emerman CL, Cydulka RK. Use of peak expiratory flow rate in emergency department evaluation of acute exacerbation of chronic obstructive pulmonary disease. Ann Emerg Med. 1996;27(2):159-63.
Comment: The authors show the ADVANTAGES OF MEASURING FEV-1 AND/OR PEFR for baseline evaluation and response to treatment. Both require patient effort
- Emerman CL, Lukens TW, Effron D. Physician estimation of FEV1 in acute exacerbation of COPD. Chest. 1994;105(6):1709-12.
Comment: The authors show PHYSICIAN ESTIMATES OF THE SEVERITY OF AIRWAY OBSTRUCTION in exacerbations of COPD correlate poorly with FEV-1 measurements
- Jørgensen AF, Coolidge J, Pedersen PA, et al. Amoxicillin in treatment of acute uncomplicated exacerbations of chronic bronchitis. A double-blind, placebo-controlled multicentre study in general practice. Scand J Prim Health Care. 1992;10(1):7-11.
Comment: One of many controlled trials of amoxicillin vs. placebo, this one with 262 outpatients with AECB. Analysis by symptom score and peak expiratory flow rate showed NO ADVANTAGE FOR ANTIBIOTICS.
- Wiedemann HP, McCarthy K. Noninvasive monitoring of oxygen and carbon dioxide. Clin Chest Med. 1989;10(2):239-54.
Comment: The data support use OF PULSE OXIMETRY to evaluate oxygenation except when O2 saturation is < 70%
- Anthonisen NR, Manfreda J, Warren CP, et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med. 1987;106(2):196-204.
Comment: There are many trials of antibiotics, but this is THE BEST AND MOST QUOTED TRIAL. Anthonisen et al, studied 362 exacerbations and showed that antibiotics have a significant benefit, but only when the exacerbation is relatively severe with at least 2 of the major 3 symptoms–increased cough, sputum, and sputum purulence. Clinical success was noted in this group for 75% of antibiotic recipients vs. 63% of placebo recipients. This is close, but the number of patients was sufficiently high to push it over the p=0.05 threshold for statistical significance.
- Gump DW, Phillips CA, Forsyth BR, et al. Role of infection in chronic bronchitis. Am Rev Respir Dis. 1976;113(4):465-74.
Comment: One of the MOST COMPREHENSIVE STUDIES EVER DONE. Authors followed a group of pts with chronic bronchitis & obtained quantitative bacterial cultures of sputum & viral cx at 2-week intervals. They showed that exacerbations of bronchitis were often due to viral infection (positive cultures in 32% of exacerbations vs. <1% in periods of stability), sputum bacterial culture showed no significant changes in either frequency of recovery or counts of the big 2–H. flu & S. pneumo). S. pneumo was recovered in 37% of exacerbations & in 33% of control periods; for H. flu, it was 57% & 60%, respectively
- Bjerkestrand G, Digranes A, Schreiner A. Bacteriological findings in transtracheal aspirates from patients with chronic bronchitis and bronchiectasis: a preliminary report. Scand J Respir Dis. 1975;56(4):201-7.
Comment: The tracheobronchial tree below the larynx is normally sterile. This study using transtracheal aspirations shows that about one-third of patients with chronic bronchitis have COLONIZATION OF THE LOWER AIRWAYS by the same bacteria implicated as the major causes of AECB–H influenzae and S. pneumoniae. This presumably accounts for the common observation that sputum cultures show the same bacteria during stability and during exacerbations.
- Pines A, Raafat H, Plucinski K, et al. Antibiotic regimens in severe and acute purulent exacerbations of chronic bronchitis. Br Med J. 1968;2(5607):735-8.
Comment: One of many controlled trials of tetracycline vs. placebo in 149 patients hospitalized for AECB. There was SIGNIFICANT BENEFIT FOR TETRACYCLINE TREATMENT in terms of symptom scores and peak expiratory flow rate.
- Saint S, Bent S, Vittinghoff E, et al. Antibiotics in chronic obstructive pulmonary disease exacerbations. A meta-analysis. JAMA. 1995;273(12):957-60.
Comment: A META-ANALYSIS OF ANTIBIOTIC TRIALS, which shows a slight advantage to these drugs compared to placebo. The benefit was measured in duration of symptoms and in peak expiratory flow rates, but the advantage of antibiotics was tiny and was statistically significant only because the numbers were large.