Best Bronchitis Treatment​ in Hyderabad, India | Expert Pulmonology Care

The diagnostic evaluation of bronchitis includes an assessment of the patient's symptoms, medical and social history, physical examination, and diagnostic tests based on the severity of symptoms, age, and any underlying medical conditions.

A general physician or pulmonologist reviews the following to facilitate an accurate diagnosis and effective management. Below is an overview of the diagnostic steps for both acute and chronic bronchitis.

Patient history: A general practitioner can easily identify bronchitis condition in a person by inquiring about symptoms such as cough with mucus production, fever, wheezing, shortness of breath, chest discomfort during cough, tightness in the chest and duration of symptoms.

• Medical history: The healthcare expert will ask question about recent cold, flu or other medical issues including, asthma, COPD and pneumonia.

• Social history: The physician inquires about smoking habits and second-hand smoke, as well as recent exposure to lung irritants such as pollutants, dust, fumes, vapours, or air pollution. And also confirms exposure duration.

Based on the above factors, the general physician or pulmonologist differentiates acute and chronic bronchitis.

Acute bronchitis diagnosis

The diagnosis of acute bronchitis depends on the patient’s symptoms, as it is self-limiting condition caused by viral infections and also through bacteria’s hence, early diagnosis helps in managing symptoms and prevent complications. The diagnostic process of acute bronchitis involves:

Acute bronchitis physical examination findings: A healthcare practitioner (general physician or pulmonologist) will do a quick medical exam with a stethoscope to listen any abnormal sounds in the lungs, such as wheezing and rhonchi (gurgling sounds), pharyngeal emphysema (redness in the throat), localized lymphadenopathy (swelling of lymph nodes in the neck, heart rate, breathing rate and oxygen levels.

If vital signs such as breathing and temperature are normal and there is no evidence of pneumonia such as a lung infection, extra tests are not required. However, certain age groups, such as elderly individuals over 75 years, may require additional evaluation.

Lab tests for acute bronchitis

• Complete blood count: A CBC for bronchitis is suggested if the patient has a fever to confirm signs of bacterial infection or inflammation. In some cases of acute bronchitis, the white blood cell count may be high. These elevated WBC indicate that the body is responding to infection.

• Multiplex polymerase-chain-reaction (PCR): This test uses nasopharyngeal swabs or throat to detect nearly 23 respiratory infections in a single test. This method helps detect diseases caused by certain bacteria, such as B pertussis (the causative agent of whooping cough), M. pneumoniae, or C pneumonia. 

• This test detects the genetic material of the bacteria, which helps the healthcare professional to detect the exact cause of infection. This test is usually not suggested in acute bronchitis because viruses cause bronchitis but not bacteria. This test helps in choosing the right treatment.

• Procalcitonin levels (PCT): Procalcitonin is a serum biomarker that distinguishes bacterial infection from other forms of infection or inflammation because it is the substance produced in the body during bacterial infection. In patients with acute bronchitis, procalcitonin can be used as clinical judgment to guide antibiotic therapy.

Acute bronchitis x-ray

Chest x-ray: Chest X-rays are generally not recommended for detecting acute bronchitis because they frequently show normal. Sometimes, acute bronchitis chest x-ray findings may show minor changes like increased interstitial marks, which refer to bronchial wall thickening and indicate inflammation. A CXR is especially useful in identifying pneumonia from acute bronchitis when infiltrates are present.

Other diagnostic tests for acute bronchitis

Spirometry in acute bronchitis: This diagnostic test evaluates the amount of air a person can breathe in and out and how long it takes to exhale after a deep. It may be beneficial in patients with acute bronchitis because they frequently suffer from substantial bronchospasm, resulting in a significant reduction in forced expiratory volume in one second (FEV1). This often resolves between 4–6 weeks.

Chronic bronchitis diagnosis

Chronic bronchitis is a kind of COPD caused by smoking and long-term exposure to lung irritants. Early detection is essential for effective treatment and prevention of disease progression. The diagnostic procedure for chronic bronchitis is as follows:

Chronic bronchitis physical exam findings

Auscultation is a physical examination that can be used by the healthcare expert to diagnose chronic bronchitis. The symptoms are difficult to notice in most cases of mild to moderate disease. The findings of a general physical examination can be cyanosis (bluish colour in the lips or fingertips), tachypnoea (fast breathing), use of accessory respiratory muscles (using neck and shoulder muscles to help breathe), Hoover's Sign (inward movement of the lower chest during inhalation), swelling in the neck veins, swelling in the legs and feet (peripheral oedema). 

Chest X-ray

The findings of chest radiography show non-specific, but include bronchovascular markings (due to inflammation and airway thickening) and cardiomegaly (often due to right-sided heart failure or cor pulmonale from chronic lung disease). These findings can be seen in chronic bronchitis as well as other lung conditions. Hence, other tests are necessary for accurate diagnosis.

Pulmonary function tests (PFT)

PFTs find out how well the lungs perform by measuring how much air can inhale and exhaled, as well as how quickly one exhales.

PFTs measure lung performance by assessing air intake and exhalation speed.

• Spirometry: This test can provide information on lung function and capacity, which are important indicators in identifying and treating chronic bronchitis. As chronic bronchitis progresses, the airways in the lungs become inflamed, narrowed and blocked, resulting in reduced lung function and capacity. These are the chronic bronchitis spirometry results.

• Lung volumes: In addition to spirometry, lung volume can be assessed. Lung volumes are made up of three components including total lung capacity (TLC), residual volume (RV), and functional residual capacity (FRC).
• RV: Residual volume increases because of air trapped in narrowed airways
• FRC: Functional residual capacity also increases due to an increase in RV because functional residual capacity includes residual volume and expiratory reserve volume.
• TLC: Total lung capacity is increased due to hyperinflation of the lungs (expansion of lungs than their normal size) and air trapped in narrowed airways.

• Diffusing capacity of the lung for carbon monoxide (DLCO): The lung's diffusing capacity for carbon monoxide (DLCO) measures how quickly CO molecules pass from the alveolar gas to the haemoglobin of red cells in the pulmonary circulation. To determine DLCO, the patient takes a single breath containing a small amount of carbon monoxide (CO) and retains it for 10 seconds. The breath is then exhaled and tested for CO.

• DLCO in chronic bronchitis is normal because it mainly affects the airways. Lower DLCO indicates that the disease progresses where chronic bronchitis develops into emphysema, which involves destroying the alveoli walls.

Arterial Blood Gas (ABG) Test

An ABG for chronic bronchitis determines the amount of oxygen and carbon dioxide in the blood. It also measures the acidity of the blood. This is known as acid-base balance or pH level. The blood sample is obtained from an artery, which is a blood channel that transports oxygenated blood from the lungs to the body. 

The blood oxygen level in an ABG test indicates how well the lungs transport oxygen from the air into the blood as we breathe in. The carbon dioxide measurement shows how effectively the lungs eliminate carbon dioxide from the blood when breathed out. 

Sputum examination

A sputum culture is a test that detects bacteria or other germs that could be causing a respiratory tract infection. It is unnecessary if the healthcare expert suspects a viral infection.

Sputum can be one of several different colours. Chronic bronchitis sputum colour may vary from clear to yellow, green, and sometimes blood-tinged. The colours can help identify the type of infection one may have or check if a chronic illness has become worse. This allows a healthcare professional to determine the best treatment.

High-resolution computed tomography (HRCT)

It is a type of advanced CT scan that gives detailed images of the lungs in chronic bronchitis. It helps identify the inflammation of the airways.