Bronchiolitis and Bronchitis: What’s the Difference?
Various lung-related conditions such as bronchiolitis and bronchitis can be triggered by both environmental causes and other factors. The treatment regimen varies with the condition and the length of time a person has it. Common-sense approaches, such as good hygiene and lack of exposure to chemicals in the air can go a long way to prevent complications.
Bronchiolitis vs. Bronchitis
Bronchiolitis and bronchitis, which are both lung infections, are two distinct conditions that share some common symptoms, such as coughing, wheezing, and slight fever. Both tend to occur more frequently in the winter and can be caused by viral infections. Cigarette smoke and other environmental pollutants are risk factors for both conditions. However, there are major differences between the two illnesses.
While most common in older children and adults, bronchitis affects people of all ages, causing the upper bronchial tubes to swell up and become inflamed. It can be either acute (short term) or chronic (long term).
Bronchiolitis, which occurs in younger children, mostly under the age of 2, involves swelling in the small airways in the lungs, the bronchioles, causing obstruction and making it difficult to breathe. In some toddlers and children bronchiolitis is no more severe than a common cold, but in other children it can be dangerous enough to require hospitalization.
Treatments for bronchitis and bronchiolitis are also very different.
Treatments for bronchitis can include:
- Antibiotics to cure bacterial infections
- Cough medicine to aid sleeping
- Steroids and other medications to reduce inflammation
- Inhalants to open the airways
- Pulmonary rehabilitation for chronic bronchitis incorporating breathing exercises
Bronchiolitis treatments can include:
- Helping a baby sleep with his or her head slightly raised by putting a pillow under the mattress
- Having a child drink plenty of fluids
- Going to the hospital for supplemental oxygen or IV fluids
To prevent both conditions, avoid cigarette smoke, including second-hand cigarette smoke, and any other environmental irritants. Maintain good hygiene to minimize the risk of infections. Wash hands regularly and encourage both visitors and children to do the same. Wipe down children’s toys regularly.
To prevent bronchitis, you can also get a flu vaccine every year. An infection after the flu can trigger many cases of bronchitis.
Let's delve into each condition a little more specifically.
Symptoms of bronchiolitis include:
- A dry, raspy cough
- Difficulty feeding, especially in infants
- Slight fever
- Runny nose or stuffy nose
If an infant, toddler, or young child has difficulty breathing, breathes at a rate of 50 to 60 breaths per minute, has a temperature of 100.4 °F (38 °C) or higher, is unusually tired or irritable, has not required a diaper change in 12 hours or more, has eaten less than half of his or her normal amount during the last several meals, or develops a bluish facial color, consult a physician.
Bronchiolitis is spread to infants when they come into direct contact with nose and throat fluids of someone who has the illness. It can happen when someone who has a virus sneezes or coughs nearby and tiny droplets in the air are then breathed in by the infant. You can also transfer the virus to an infant by touching toys or other objects that are then touched by the infant. Risk factors include being or living in crowded conditions; being born before 37 weeks of pregnancy; and having heart disease, lung problems, or immune conditions.
When damaged or infected, bronchioles can become swollen or clogged, blocking oxygen flow. While usually affecting children, bronchiolitis can also concern adults.
Bronchiolitis manifests itself in two forms. Infants get bronchiolitis, which is usually caused by respiratory syncytial virus (RSV). Every winter there are outbreaks of the virus in children less than a year old. The common cold or the flu can also cause the condition.
Many cases of bronchiolitis are minor and require no treatment or are easily treatable. Often, they are no more severe than a common cold. However, severe bronchiolitis must be treated to avoid recurrent wheezing and a reduced quality of life. Some complications of bronchiolitis can last into the teenage years, and some cases can be fatal if untreated. Most children recover at home in 3 to 5 days.
Infants at high risk of the RSV infection may receive the medication palivizumab (Synagis) to decrease the likelihood of RSV infections. For more severe cases in infants, hospitalization—which usually lasts less than 1 week—can provide oxygen, a nebulizer, and intravenous fluid treatments. While antibiotic medications are ineffective against viruses, some medications can help open a baby’s airways.
Dangerous and unusual in adults, bronchiolitis obliterans scars the bronchioles and obstructs the airway. Bronchiolitis obliterans, a rare condition, sometimes occurs for no known reason and can have severe consequences. Possible causes are fumes from chemicals including ammonia, bleach, and chlorine; respiratory infections; and adverse reactions to medications.
There is no cure for bronchiolitis obliterans scarring, but corticosteroids can eliminate mucus from the lungs, decrease inflammation, and create clearer airway passages. Oxygen treatments and immunosuppressant medications may help to regulate the immune system. Breathing exercises and stress reduction may ease breathing difficulties. In severe cases a lung transplant may be necessary.
Bronchiolitis obliterans and viral bronchiolitis have the same symptoms. They include coughing, labored breathing, rapid breathing, blue skin tone from oxygen deprivation, recessed ribs when children inhale, flaring of the nostrils in babies, rattling or crackling noises in the lung cavity, and exhaustion. Sometimes, chemicals trigger reactions—from 2 to 4 weeks with bronchiolitis obliterans and from a few months to a few years with lung infections.
Both types of bronchiolitis can be diagnosed with imaging testing, including chest X-rays. Spirometry, which measures how much and how quickly someone takes in air with each breath, is another analytical tool. There are arterial blood gas tests for both bronchiolitis types to measure how much oxygen and carbon dioxide are in the blood. Mucus or nasal discharge samples help doctors diagnose the type of virus causing the infection, especially in babies and small children.
Bronchitis symptoms include cough, mucus production, shortness of breath, slight fever, chills, chest tightness or discomfort, and fatigue. People should see a physician if the cough lasts more than 3 weeks; is accompanied by wheezing, yellow or green mucus, or sputum that has blood in it; or makes it difficult to sleep.
Bronchitis may have a barking cough as a symptom. A barking cough simply is a cough that sounds unusual, resembling an animal bark. It is harsh, loud, and hoarse, usually indicating inflammation of the voice box or windpipe (trachea). It is frequently seen with conditions like croup but can also occur with other respiratory tract conditions.
Acute bronchitis is often caused by viruses, especially the flu and the common cold. The most common viruses that cause acute bronchitis are: influenza (which causes colds), parainfluenza, RSV, rhinovirus, adenovirus, and corona viruses.
Smoking cigarettes and exposure to lung irritants are cited as the biggest culprits in chronic bronchitis. A study published in The International Journal of Occupational and Environmental Medicine showed that being exposed to passive smoking at work almost doubled the risk of chronic bronchitis (an 89% increased risk!). Passive smoking at home increased chronic bronchitis risk by more than two-and-a-half times.
Living close to a busy road almost doubles the risk, as does heating the home with hot air conditioning rather than electric heating. Close proximity to a diesel-burning power plant has also been associated with a 62% increase in the risk of chronic bronchitis.
Bronchitis can also be bacterial. Risk factors specific to bronchitis include: gastric reflux, which can cause throat irritation; regular exposure to irritants; and low immune resistance, especially after a virus or primary infection.
Doctors diagnose bronchitis by listening to the lungs with a stethoscope and asking about other symptoms and medical history. If they suspect pneumonia, they may order a chest X-ray, which can also rule out other conditions, such as lung cancer. Doctors may also order sputum tests to send to the lab for a culture or order a pulmonary function test to measure how well the lungs work and how well a person can breathe.
When clinicians suspect or find bacterial acute bronchitis, they treat it with antibiotics. While evidence suggests that antibiotics usually have little efficacy, somewhere between 65% and 80% of people who have acute bronchitis are treated with antibiotics. Experts do not recommend antibiotics for routine acute bronchitis treatment.
Home remedies that may be useful include:
- Drinking fluids to stay hydrated
- Using a humidifier to moisten the air
- Avoiding dairy products that thicken mucus secretions
- Eliminating alcohol and caffeine because of potential drug interactions
- Reducing exposure to environmental smoke and other air pollutants
- Taking OTC cough suppressants and cough drops to alleviate a near-constant cough
Robitussin and Delsym should not be used over the long term or too often, as coughing serves an important role in ushering irritants out of the air passages. Mucolytics (Mucinex, Mucomyst) remove sticky mucus from the airways. Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) and/or acetaminophen (Tylenol and others) may reduce inflammation and/or discomfort. Inhaler bronchodilators open airways, making it easier to breathe.
While bronchitis is not usually a cause for great concern, it can lead to complications such as pneumonia. Clinicians caution against ignoring bronchitis, especially recurrent cases that may be linked to chronic obstructive pulmonary disease (COPD), a lung disease that should never be ignored.
To recover from both bronchitis and bronchiolitis, people need:
- Extra rest
- Increased fluid intake
- Air free of smoke and chemicals
- Moist air via humidifier
Recovery time for viral bronchiolitis in babies and children is usually less than a week with the proper treatment regimen. In the case of bronchiolitis obliterans, the prognosis is affected by the time and the condition of the person at diagnosis.
Common-sense ways to prevent the spread of bronchiolitis include:
- Frequent hand washing
- Minimizing contact with people who have a fever or cold
- Cleaning and disinfecting surfaces
- Covering coughs and sneezes
- Covering the mouth and nose with a tissue
- Using individual drinking glasses
- Using a hand sanitizer
To keep the immune system strong against pathogens that cause bronchiolitis and bronchitis, you can also supplement with nature’s most vital nutrient: amino acids.