Tracheobronchitis : Causes, Symptoms, Diagnosis, and Treatment

1. About Tracheobronchitis

   Tracheobronchitis is a respiratory condition where one of the primary symptoms is a productive cough, although there are other significant symptoms associated with it. The condition is characterized by inflammation of the trachea and bronchial tubes within the respiratory system.

   The trachea and the bronchial tubes are the crucial components of the airway system that connects the nose and mouth to the lungs. These facilitate the passage of air in and out of the lungs.

   According to a review, the terms tracheobronchitis and bronchitis are interchangeable.⁽¹⁾ The difference between the two lies in the area where the inflammation has occurred. In tracheobronchitis, there is inflammation in the trachea, while in acute bronchitis it is in the bronchi only.

   It is important to have an understanding of the causes and signs and symptoms of tracheobronchitis for several reasons:

   • Early detection and diagnosis of symptoms can be helpful in preventing the condition from worsening.
   • Differentiating the causes can be helpful in avoiding unnecessary use of antibiotics.
   • It can be helpful in symptom management and managing discomfort thereby improving the quality of life.
   • Recognition of the environmental factors and behaviors can help a person avoid them to prevent the condition from occurring.
   • Having an understanding of the potential complications can help a person seek medical care when needed and contribute to reducing the spread of infections.
   • Timely diagnosis and treatment can prevent unnecessary healthcare visits, hospitalizations, and complications.
   • Minimizing symptom discomfort and potential complications allows an individual to continue daily activities without any significant disruption.

2. Causes of Tracheobronchitis

   The causes of tracheobronchitis may vary. These may include infectious agents, irritants, and underlying health conditions.

   The main causes include:

   • Viral Infections: Viruses are the most common cause of tracheobronchitis. Viruses account for about 95% of tracheobronchitis cases.⁽²⁾ Rhinovirus is a cause of the common cold and can lead to tracheobronchitis. Some strains of coronavirus cause respiratory infections that may further lead to tracheobronchitis. Also, influenza viruses can cause upper and lower respiratory tract infections including tracheobronchitis.
   • Bacterial Infection: Less common than viral infections, bacterial infection can also lead to tracheobronchitis. Common bacteria involved in causing it include:
     • Streptococcus pneumoniae
     • Haemophilus influenzae
   • Irritant and Environmental Factors: Smoking is a major irritant to the respiratory tract and can increase the risk of tracheobronchitis. Second-hand smoke exposure may also contribute to it.
   • Inhaling air pollutants can irritate the airway and trigger inflammation. Also, exposure to industrial chemicals and dust in workplaces or polluted environments can lead to tracheobronchitis.
   • Allergies: Allergies to pollen, dust mites, pet dander, and allergen can trigger inflammation in the airway and lead to tracheobronchitis. People with asthma are prone to develop tracheobronchitis due to heightened airway reactivity and inflammation.
   • Gastroesophageal Reflux Disease (GERD): Reflux of stomach acid into the throat and airways, can cause irritation and inflammation that may cause tracheobronchitis.
   • Immunodeficiency: Those with weakened immune systems or undergoing immunosuppressive therapy are more susceptible to tracheobronchitis.
   • Viral Coinfection: Sometimes more than one virus may infect simultaneously leading to more severe symptoms, potentially complicating the condition.
   • Chronic Obstructive Pulmonary Disease (COPD): People with COPD including conditions like bronchitis and emphysema are more susceptible to tracheobronchitis. This is due to their compromised lung function and airway inflammation.

3. Symptoms of Tracheobronchitis

   Due to the inflammation associated with the trachea and bronchial tubes, the symptoms of tracheobronchitis may range from mild to severe. The symptoms include respiratory discomfort and irritation. They can linger for up to 3 weeks.⁽³⁾

   Common symptoms associated with tracheobronchitis are:

   • Persistent and productive cough along with mucus production. The mucus varies in color and consistency depending on the underlying cause.
   • A sensation of pressure on the chest due to inflammation and increased coughing.
   • Due to increased mucus and inflammation in the airway, the patient experiences difficulty in breathing, especially with activity or exertion.
   • Soreness and scratching sensation in the upper respiratory tract.
   • Fatigue and reduced energy levels due to constant coughing.
   • Mild fever in some cases.

   Sometimes excess mucus production may lead to a productive cough with copious mucus production.

   These symptoms can also occur in other respiratory conditions such as pneumonia, asthma, and chronic obstructive pulmonary disease. It is important to have a proper diagnosis by a healthcare professional to accurately identify the cause of symptoms and determine an appropriate treatment.

4. Diagnosis of Tracheobronchitis

   Diagnosing tracheobronchitis involves a combination of assessment of medical history, physical examination, and sometimes diagnostic tests to confirm the presence of inflammation in the trachea and bronchial tubes.

   Steps involved in diagnosing tracheobronchitis include:

   • Medical History Assessment: A doctor takes a complete medical history and looks for associated factors such as irritants, recent illness, and medical history. The patient should also provide information about cough, mucus production, chest discomfort, and other respiratory problems.
   • Physical Examination: The doctor examines the chest and lungs and breathing with a stethoscope to detect abnormal sounds such as wheezing and crackles.
   • Diagnostic Tests: Depending on the severity of symptoms, additional diagnostic tests may be recommended to rule out other conditions:
     • Chest X-ray or Chest CT Scan: The imaging test helps visualize the lungs and airway and rule out other conditions like pneumonia or structural abnormalities.
     • Sputum Test and Microbiological Test: It is done to identify the presence of bacteria, viruses, or microorganisms that may be causing inflammation.
     • Pulmonary Function Test (Spirometry): It is a test done to look for how well the lungs are functioning. It assesses the degree of airflow limitation and determines if there is any respiratory condition such as asthma or chronic obstructive pulmonary disease.
     • Differential Diagnosis: Tracheobronchitis symptoms overlap with other respiratory conditions such as pneumonia, asthma, and chronic bronchitis. These are taken into consideration and the doctor may base the diagnosis on clinical assessment and observation.

   Working with a healthcare professional is important for an accurate diagnosis. Once diagnosed a treatment plan is tailored depending on the specific situation.

5. Treatment of Tracheobronchitis

   The treatment focuses on managing symptoms, reducing inflammation, and addressing the underlying cause. The treatment options include:

   • Self-Care and Symptomatic Relief: Adequate rest and hydration are important for supporting the immune system and facilitating recovery. Moistening air with a humidifier or inhaling steam can be helpful in soothing irritated airways and reducing coughing. Over-the-counter pain relievers can be helpful in alleviating discomfort and fever.
   • Medical Interventions: Antibiotics are given if bacterial infection is suspected In cases of viral infection, antiviral medications may be prescribed, though not all viral cases of tracheobronchitis necessarily benefit from or require such treatments. The decision to administer antiviral medications depends on the specific virus and the severity of the infection. Bronchodilators are medications that help in relaxing airway muscles and improve airflow. Corticosteroids are prescribed to reduce airway inflammation and swelling.
   • Lifestyle Changes: The person is advised to quit smoking, avoid irritants and allergens and practice good hygiene.

   Regular follow-up is needed to track progress and adjust treatment if needed.  If someone experiences a high fever, severe difficulty in breathing, or confusion, medical help should be taken.

6. Complications and Prevention

   Tracheobronchitis is generally a self-limiting condition, but if not managed properly complications can arise. These include:

   • Pneumonia⁽⁴⁾
   • Chronic bronchitis
   • Exacerbation of underlying conditions
   • Spreading of infection to other body parts

   Prevention involves a combination of adopting healthy practices and reducing exposure to irritants and infectious agents. Some of the preventive measures include:

   • Washing hands frequently with soap and water when being around sick individuals.
   • Avoid touching the face, mouth, eyes and especially the nose.
   • Staying away from individuals who are coughing or sneezing.
   • Staying up-to-date with vaccination may reduce the risk of contracting infection.
   • Quitting smoking and avoiding secondhand smoke.
   • Eating a healthy and well-balanced diet.
   • Engaging in regular physical activity to maintain good respiratory health

   Adopting preventive measures can be helpful in reducing the risk of tracheobronchitis and other respiratory infections. This can improve the overall quality of life of the individual.

Tracheobronchitis, characterized by symptoms such as persistent coughing, sore throat, and fatigue, can result from bacterial or viral infections, as well as exposure to various airborne irritants. In most instances, the condition typically resolves within three weeks. However, complications like pneumonia can arise in certain cases.

Prompt medical consultation is crucial if one experiences severe symptoms like difficulty breathing or the presence of bloody mucus. While many standard cases of tracheobronchitis may not necessitate specialized treatment and can be managed through pain relievers, home remedies, and hydration, more severe cases, especially those requiring ventilator support, can be life-threatening.⁽⁴⁾

Given the potential severity of complications, early diagnosis and appropriate intervention are paramount to ensuring swift recovery and minimizing risks.