The following symptoms and complaints may indicate bronchitis:
Acute bronchitis
Leading symptoms
- Initially painful nonproductive cough (= dry cough; irritating cough), later productive cough (= loosening of secretion/mucus).
- Sputum (sputum) – tough, glassy, later purulent-yellow [Sputum color has no predictive value for the diagnosis of bacterial bronchitis, it also does not allow differentiation between pneumonia (pneumonia) and bronchitis].
- Barking cough
Associated symptoms
- Fever (frequent)
- Chest pain (chest wall pain/chest pain).
- Usually in combination with rhinitis (cold), pharyngitis (pharyngitis) and laryngitis (laryngitis).
Chronic bronchitis
Leading symptoms
- Frequent or prolonged cough, especially in the morning
- Whitish to purulent yellow sputum especially in the morning
Associated symptoms
- Dyspnea (shortness of breath)
- Coughing attacks
- Yellow fingernail syndrome (yellow-nails; yellow-nail syndrome) – yellowish discolored nails.
Wg. differential diagnosis “pneumonia”
In a study from the United Kingdom, a good 86 percent of patients with pneumonia had at least one of the following 4 symptoms:
- Body temperature >37.8°C (relative risk [RR] = 2.6).
- Crackling sound in the lungs (RR = 1.8)
- Pulse > 100 beats per minute (RR = 1.9)
- Arterial oxygen saturation (SpO2) < 95 percent (finger pulse oximetry) (RR = 1.7).
Warning signs (red flags) wg cough
- Anamnestic information:
- Residence in countries with high TB prevalence, TB contacts, homeless.
- Infant with daily moist mucusy cough → think: protracted bacterial bronchitis (PBB); possible germs: Haemophilus influenza, Streptococcus pneumoniae, Moraxella catarrhalis; often confused with bronchial asthma (see below “Cough/differential diagnoses/protracted bacterial bronchitis (PBB)”).
- Smokers → think of: Bronchial carcinoma (lung cancer).
- Abnormal weight loss → think of: Bronchial carcinoma (lung cancer), tuberculosis.
- Immunodeficiency, HIV infection, immunosuppressive therapy.
- Severe underlying medical conditions (chronic obstructive pulmonary disease (COPD); malignancy (cancer)).
- Altered vital signs (high fever: 39.1 °C – 39.9 °C; tachycardia: heartbeat too fast: > 100 beats per minute).
- Dysphonia (hoarseness) + dyspnea (shortness of breath) → think of: Laryngeal carcinoma (cancer of the larynx).
- Dyspnea (shortness of breath)
- Hemoptysis (coughing up blood) → see under “Causes” of hemoptysis; e.g., pulmonary embolism (occlusion of a pulmonary artery).
- Tachypnea → think of:
- Left ventricular failure (left-sided heart failure).
- Pulmonary edema (water retention in the lungs)
- Pneumonia (pneumonia)
- Pneumothorax (collapse of the lung caused by an accumulation of air between the visceral pleura (lung pleura) and the parietal pleura (chest pleura)).
- Thoracic pain → think of:
- Bronchitis (inflammation of the bronchi).
- Pulmonary embolism
- Tuberculosis
- Cyanosis (bluish discoloration of the skin, nail beds and mucous membranes) → think of: Pneumonia (pneumonia)
- Continuous medication: immunosuppressants (drugs that reduce the functions of the immune system).
If any of the above warning signs are present, a chest X-ray and pulmonary function test is required regardless of the duration of the cough! Exception: infant with daily moist mucus cough, here for the time being only examination of sputum and pulmonary function testing.
