Asthmatic bronchitis – Symptoms and Treatment

Asthmatic bronchitis is an infectious and allergic disease that affects the medium and large airways, causing an excessive production of mucus beyond the normal limit. The lining of the airways swells, causing temporary constriction, especially during external respiration and coughing.

Currently, this condition is usually referred to as acute or chronic bronchitis with secondary bronchial obstruction syndrome. When symptoms occur in children, pediatricians typically diagnose “allergic bronchitis,” which requires a differential diagnosis from bronchial asthma.

Causes of asthmatic bronchitis:

The causes of the disease can be varied. Mostly, the following factors or their accumulation lead to the development of the disease:

  • Infectious factors: including viruses such as cold viruses, respiratory syncytial virus, influenza viruses, and common cold viruses, as well as bacteria such as mycoplasma, chlamydia, clostridium bacteria, staphylococcus, streptococcus, and haemophilus influenzae, and fungi.
  • Non-infectious factors: including dust, mold, smoking, genetic predisposition, plant pollen, animal hair, specific foods, dairy products, detergents, chemicals in the workplace, and over-the-counter medications, such as aspirin and beta-blockers.
  • Occupational hazards: working with acids, alkalis, paints, and coatings; the most dangerous category is also for workers in mines (coal dust), builders (dust and sawdust), railway workers (oils, petroleum, fuel), and agricultural workers (dust, plants, chemicals).
  • If bronchitis is due to plant pollen, symptoms often appear in spring, and if it is due to viruses or bronchial spasms in cold weather, symptoms often appear in autumn.

Adults are often more susceptible to infection than children, as viral factors are more common compared to bacteria. Meanwhile, allergic causes in children recur with a similar frequency to infectious causes.

Symptoms of asthmatic bronchitis:

  • Dry cough, which can be persistent at times, accompanied by a little mucus secretion. The cough may become less severe afterward but intensifies again later.
  • Resting can occur in a semi-seated position: the person sits and leans against the back of the chair or bed, or leans forward slightly, resting his hands on his knees or the seat next to him.
  • During coughing or deep breathing (hoping to loosen mucus and alleviate coughing), patients may feel a double sound and tightness in breathing, feeling short of air. Sometimes, coughing may improve after drinking a few sips of hot drinks, greatly improving mucus expulsion. After doing so, the feeling of shortness of breath decreases, and the cough becomes less troublesome.
  • The mucus may be mucous or purulent – yellow-green or green, with a foul smell.
  • In cases of severe exacerbation, breathing difficulties may occur during exhalation – difficult and continuous breathing, and a feeling of chest tightness. During breathing, neck and shoulder muscles may participate, and wheezing may sometimes be heard.
  • The cough intensifies in the evening and at night, during physical exertion, laughing, and sudden changes in temperature (for example, when going out in the cold).
  • Heart rate may increase, blood pressure may rise, and become unstable.
  • Sometimes, nausea and even vomiting may occur during coughing fits.
  • Coughing fits may last from several hours to several weeks.

When asthmatic bronchitis is the result of an infection, body temperature may rise (up to 38 degrees Celsius), the person may lose appetite, and feel weakness, lethargy, irritation, and sweating.
When the causes are allergic, symptoms appear during and after contact with the allergen and do not appear under other conditions.

Classification and Stages of Development of Asthmatic Bronchitis:

  • Acute asthmatic bronchitis.
  • Chronic asthmatic bronchitis.
  • Recurrent asthmatic bronchitis (more than two episodes per year).

Stages of Disease Development:

  • Tense stage (significantly exacerbated symptoms).
  • Stage of improvement after the tense stage (symptoms weaken).
  • Recovery or convalescence stage (no symptoms).

Severity Grades:

  • Mild.
  • Moderate.
  • Severe.

Complications That May Occur:

  • Acute complications: develop rapidly, manifest clear symptoms, pose a life-threatening risk, and require emergency treatment, such as lung collapse, pneumonia, and acute lung failure.
  • Chronic complications: develop over a long period and cause deeper disorders, such as airway dilation, lung fibrosis, and pulmonary edema.
  • Differentiation of pulmonary and non-pulmonary complications, i.e., those occurring in the lungs and those occurring in other organs.

Pulmonary Complications:

  1. Bronchiectasis: Expansion of parts of the airways due to long-term disease progression. It occurs due to the thickening and stiffening of mucus in some areas of the airways, leading to swelling of the airway wall in those areas. Mucus density increases in these areas, gradually killing the ciliated cells that expel mucus from the airways. Mucus accumulates and becomes infected with bacterial infections, manifested by coughing and expectoration of green and/or yellow mucus. Incomplete passage of air through the affected airways leads to oxygen deficiency and supply to the organs and tissues (this phenomenon is clearly evident in non-pulmonary complications).
  2. Atelectasis: Decrease in lung tissue. When bronchial damage develops rapidly, a highly critical condition occurs where breathing difficulty and severe chest pain from the damaged side appear. The person cannot lie down, usually sits frequently, breathes shallowly, and may lose consciousness. The condition resembles an asthma attack, but asthma medications do not help.
  3. Pneumosclerosis: Airway obstruction leads to a reduction in lung tissue volume and gradual replacement with connective tissue. The process does not reverse, and only supportive treatment in the form of inhaling an oxygen-enhanced air mixture can be provided.
  4. Emphysema: Due to the obstruction of medium and large airways, pressure increases on small airways and alveoli. This leads to destruction of the alveoli and reduced ventilation capacity in the lungs, causing oxygen deficiency to the organs and tissues. In case of extensive destruction of alveoli, bullae (air cavities in the lung) appear, and their rupture can cause internal bleeding in the chest.
  5. Pneumothorax: Accumulation of air in the pleural space, compressing the lung from the pleura side and may displace the mediastinum where the heart is located towards the second lung.
  6. Pneumonia: Severe oxygen deficiency. It can also develop in case of extensive destruction of alveoli. Without early diagnosis and rapid medical treatment, the patient can die.
  7. Respiratory failure: Inflammation in lung tissues. Due to airway spasm, mucus cannot exit the airways, thus accumulating and becoming infected with bacterial infection. Pneumonia occurs more frequently in children who suffer from poor health and immune deficiency.

Complications Outside the Lungs:

Complications outside the lungs from asthmatic bronchitis typically appear 3-4 years after the onset of the disease. They result in decreased oxygen supply to the brain and cardiovascular system. Oxygen deficiency in the brain manifests as decreased vision, insomnia or drowsiness, reduced work capacity, depression, aggression or apathy, memory deterioration, and decreased concentration.

One of the most severe complications from the cardiovascular system is the development of pulmonary heart – enlargement of its walls, leading to deteriorated heart function and oxygen deficiency. Additionally, severe hypotension, arrhythmia, and sometimes acute myocardial infarction and cardiac arrest can develop in individuals with asthmatic bronchitis.

Rib pains – chest pains between the ribs, which usually occur during coughing and repeated deep breathing.

Diagnosis of Asthmatic Bronchitis:

Diagnosis of asthmatic bronchitis involves collecting complaints, examination, blood and sputum tests, X-rays, and other methods.

During Examination:
During asthmatic bronchitis, persistent cough with difficult-to-expectorate sputum, breathing difficulties, and weakness are the characteristic symptoms. The doctor will definitely inquire if the patient works in unfavorable conditions, such as working with paints and dyes.

During the examination, it may be evident that the chest is swollen downwards and appears barrel-shaped, with the upper lungs protruding above the clavicles. Sometimes, the lips may turn blue, and in chronic cases, the nails may take on a clubbing appearance, and the fingers may become drumstick-like.

The respiratory rate (breaths per minute) may increase (ranging between 12 and 16 in a normal resting state).

Upon chest percussion (tapping), shortened sound may be heard at the bottom and a box-like sound, resembling the sound produced from an empty box, in the upper sections.

Upon auscultation of the lungs (listening), moist crackles (often large bubble crackles due to sputum accumulation in the airways) and wheezing may be heard during excessive breathing due to the development of smooth muscle spasms in the airways.

Radiographs may reveal airway wall enlargement, lung fibrosis, lung inflation, and bubbles. In suspected cases, the doctor may refer the patient for a chest computed tomography scan.

In blood, sputum, and stool analyses, the level of white blood cells, lymphocytes/monocytes, or infection may be elevated in the complete blood count. With disease progression, red blood cell count and hemoglobin may increase, along with blood sedimentation rate, and sometimes active protein. In cases of allergic causes of the disease, the level of white blood cells may rise. In chemical analysis, active protein may be elevated in case of infection, in addition to ferritin and procalcitonin.

Also, specific allergy markers for respiratory diseases, such as polar basic protein and Immunoglobulin E, may be slightly elevated compared to bronchial asthma.

Accumulation of white blood cells in sputum, and sometimes red blood cells, along with an increase in airway fibroblasts, is noted. Sputum analysis can reveal bacteria and allow for identification of sensitive medications and viruses.

Stool analysis is performed using egg concentration to exclude giardia and helminths, which may cause coughing.


During bronchoscopy, pathological changes in the central and large airways can be observed. Microscopic analysis of airway secretions identifies the presence of neutrophilic cells and white blood cells. When culturing secretions, infection with staphylococci is often detected. Additionally, bronchoscopy can be an additional method for treatment: medications (even saline solution) can be delivered, and then airway secretions can be aspirated to reduce viscosity.

Pulse oximetry and electrocardiography:
These are methods used to measure oxygen levels in the blood by determining the degree of hemoglobin saturation with oxygen. This test can show decreased oxygen in the lungs, which warrants further examination, as this deficiency can lead to respiratory failure and pulmonary heart disease.

For exacerbations of bronchitis, electrocardiography (ECG) is necessary.

Treatment of bronchial asthma:
The goal of treatment is to relieve smooth muscle spasm in the airways, reduce sputum viscosity, thus improving its clearance, and reduce excessive sputum secretion, thereby achieving improvement in the disease condition.

First and foremost, harmful factors should be eliminated if possible:

  • Quitting smoking (including avoiding secondhand smoke exposure).
  • Changing workplace or occupation, or at least reducing exposure to dust and paints.
  • Then, mucolytics are prescribed – medications that help reduce sputum viscosity and improve its clearance. These medications (such as Fluimucil) can be used orally or via inhalation using a nebulizer. Nebulizers can also be used to deliver medications directly to the airways, where antibiotics and mucolytics (except for the antibiotic Fluimucil – mucolytic) can be administered. The frequency of nebulizer use depends on the severity of the condition: it can be used from 1-2 to 4 times a day (as determined by the doctor only). Nebulizer treatments also help extend the period of improvement.
  • To relieve smooth muscle spasm in the airways and improve airflow, bronchodilators are used: Berodual and salbutamol. These medications help alleviate painful coughing, relieve breathlessness, and reduce constriction.
  • Antibiotic therapy should be initiated in case of signs of bacterial infection, which can be in the form of tablets or injections. Antibiotics resist infection in the lungs and airways and prevent colonization. Antibiotic therapy should be initiated immediately after sputum is sent for analysis. Antibiotic therapy is started with broad-spectrum first-generation antibiotics because sputum contains a mixed composition of bacteria.
  • After obtaining the analysis results, when the bacterial composition of the sputum and its sensitivity to antibiotics are known, treatment is adjusted as needed.
  • In case of persistent exacerbation of bronchitis, hormone therapy (known as “menopause therapy”) is used. These medications are used for the shortest possible duration. Systemic hormones are more commonly used in advanced cases – in case of long-term self-treatment or severe condition. These medications have many potential side effects: diabetes, high blood pressure, osteoporosis, adrenal insufficiency, or addiction, as patients often call it. Systemic hormones should only be prescribed by a doctor based on indications.
  • Unlike systemic hormones, local corticosteroids are commonly used to alleviate inflammation, known as budesonide. These medications act as anti-inflammatories with minimal side effects, so they are prescribed even for children.
    Allergy and immune therapies
  • Allergy and immune therapy: Specific immune therapy is used to reduce the risk of bronchial asthma progressing to bronchial asthma, especially at a young age. This includes anti-allergy antibody injections and antihistamine use.
  • Physical therapy: Massage and physical therapy may be beneficial in relieving bronchitis inflammation and improving sputum clearance, thus improving the patient’s quality of life.
Pumpkin Seed Massage
  • Diet and Nutrition Therapy: Focusing on a healthy diet and avoiding known triggers for airway irritation can be part of managing bronchial asthma inflammation.
  • Swimming Therapy: Research shows that swimming can be beneficial for individuals with bronchial asthma inflammation, as the aquatic environment helps improve respiratory capacity and fitness without exposure to severe irritation.