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Bronchial asthma and bronchitis are both inflammatory disorders of the respiratory system, but with clear differences. They can overlap though, producing severe symptoms of airway obstruction, which brings up a controversial term Asthmatic Bronchitis.

Asthmatic bronchitis is a term which we can often find in old literature related to bronchitis and asthma. It is hard to classify it as a clinical entity, as we now have a clear differential diagnosis between the two. However, both bronchitis and asthma are caused by the inflammation of the airways, and that is the source of confusion in most cases.

What are the similarities between bronchitis and asthma?

There are many similarities between acute bronchitis and asthma, given that they are both inflammatory disorders of the airways. In terms of symptoms, cough is the main complaint in patients with bronchitis, as well as in patients with asthma. Other mutual symptoms include shortness of breath, chest pain, and increased mucus production. The inflammation that occurs in asthma and bronchitis produces an obstruction of the airways, and therefore it is logical that most of the symptoms are the same.

What are the differences between bronchitis and asthma?

On the other hand, there are several important differences between the two. For example, acute bronchitis is usually caused by an infection of viral, bacterial, or rarely fungal origin. In most cases, the cause of inflammation in bronchitis can be identified and it has little or nothing to do with allergies. There is often a predisposition to frequent bouts of acute bronchitis, especially among children. Finally, acute bronchitis can be treated with antibiotics if it is bacterial and its symptoms usually last from one week up to one month.

Asthma is a chronic inflammatory disease of the airways of currently unknown origin. There are known triggers, such as allergies, cold air, and physical exercise, but we don’t actually know why some people develop it and others don’t and why it becomes a self-sustaining condition even when the trigger is identified and eliminated. Asthma symptoms are treated with bronchodilators and its progress is controlled by inhaled corticosteroids. If asthma appears in early childhood, it can gradually disappear by the time puberty hits. Adult onset asthma is usually more difficult to manage and less likely to resolve.

So what is asthmatic bronchitis in current terminology?

Patients with asthma can have occurrences of acute bronchitis. In fact, these patients are more prone to respiratory infections because of the increased mucus production and airway obstruction.

Local immunity on the inner surface of the airways is also diminished in patients with asthma. Additional inflammation of the airways on top of existing chronic asthma produces symptoms of airway obstruction which are more severe than in persons without asthma. That is why bronchitis in asthma patients lasts longer, has more severe symptoms, and sometimes even requires hospitalization. For example, the pandemic disease swine flu, caused by H1N1 influenza virus, can produce severe symptoms even in healthy patients. Patients with asthma who catch this virus often need to be hospitalized and put on a respirator (a machine which delivers oxygen-rich air under pressure), in order to survive the acute flu infection.

When it comes to terminology, that is usually what doctors and scientists refer to as asthmatic bronchitis today – an acute infection of the airways in patients already suffering from asthma as a chronic condition. Some consider it a separate clinical entity because of the specific approach to treatment and more severe symptoms.

Things around chronic bronchitis and asthma are much more complicated. Chronic bronchitis can be a consequence of long-term untreated asthma, but some scientists also call this combination asthmatic bronchitis.

How to make the right diagnosis?

Acute bronchitis is easy to diagnose in otherwise healthy patients. Inflammation of the airways with cough as a predominant symptom and accompanying symptoms of acute infective syndrome (increased body temperature, feeling of weakness, joint pain, etc.) are typical for acute bronchitis. If the origin is bacterial, the bacteria will usually be found in the sputum culture.

On the other hand, asthma is a chronic inflammatory obstructive condition of the airways, usually related to allergies and triggered by the presence of allergens, physical exercise, or cold air. A spirometry test can verify an obstruction in the airways in this case. Unlike bronchitis, there are no generalized symptoms in asthma. They are all about the breathing difficulties.

If a person with existing asthma gets acute bronchitis, then the generalized symptoms appear and that is the state which can be labeled as asthmatic bronchitis, even though this is not an official diagnosis. The official report would include two diagnoses: the chronic condition – asthma, complicated by the second condition – acute bronchitis.

How to treat acute bronchitis in asthmatic patients?

A different approach to treatment and more severe symptoms than in regular asthma is probably the predominant reason as to why some doctors and scientists define asthmatic bronchitis as a separate clinical entity. The treatment needs to include a strong respiratory support due to the worsening of airway obstruction. This is usually accomplished by higher dosages of bronchodilators, or in severe cases by hospitalization and use of the respirator. Another part of the treatment includes targeting the cause of acute bronchitis. If is of bacterial origin, doctors will prescribe antibiotics, while there is no specific treatment for viral infections. Antiviral medications exist, but they are not very effective and supportive treatment is recommended in this case. This includes hydration, vitamin supplements, and resting.

How to prevent acute bronchitis in asthmatic patients?

Bronchitis in asthma patients cannot always be prevented, but some measures can still be taken. For example, it is recommended that these patients receive a flu vaccine before the flu season in order to develop immunity and avoid this potentially dangerous disease, considering their already impaired respiratory function.

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