The symptoms of respiratory system diseases can often overlap and cause confusion over the exact pathology affecting the patient. A very common question faced by primary care physicians is whether a patient has bronchitis or pneumonia and, if so, possible causes of the condition at hand. Treatment of the conditions is also a pressing issue, as antibiotic resistance is one of the hot topics in modern medicine that continues to alter how treatment can be tailored for a patient.
Bronchitis
Acute bronchitis will usually present in a normally healthy adult with a persistent cough with possible sputum production and other respiratory symptoms such as wheezing. It basically is a result of an inflammatory response in the trachea or bronchi which causes damage to the epithelium of the respiratory tract. It does not extend lower into the remainder of the lower respiratory tract, such as the alveoli. It usually occurs in the fall and winter, and it is no surprise that viruses have been implicated as culprits, especially influenza A and B, parainfluenza virus, respiratory syncytial virus and mycoplasma pneumonia, among many others.
Pneumonia (Typical)
Pneumonia is basically an infection of the lung parenchymal tissue, and affected patients typically complain of cough, fever, trouble breathing and chest pain. There is no "typical" constellation of symptoms; radiography is employed, and if infiltrates are seen on a chest X-ray in conjunction with the appropriate clinical presentation, that is considered the "gold standard" of diagnosis. The most common bacterial causes are streptococcus pneumonia, staphylococcus aureus, and haemophilus influenza. Normally empiric therapy is initiated, but tests on specific microbes are done if suspicion is high, as they have different therapeutic considerations; these include Legionella spp, methicillin-resistant staphylococcus aureus or avian flu, among others. Admission to the hospital is done under certain circumstances, such as altered mental status, high fever, high white blood cell count, comorbidities and others.
Pneumonia (Atypical)
These cases are atypical in that they begin as mild respiratory illnesses that progress to pneumonia, with accompanying dyspnea and a cough without sputum. Usually symptoms progress from the upper to lower respiratory tract, with typical symptoms of pleuritic chest pain (pain on inspiration) and respiratory distress not obviously apparent. The radiograph typically looks much worse than the clinical picture, with patchy infiltrates present in multiple lung segments, but usually the lower lobes. Usually the clinical course is not particularly distressing to the patient (hence its nickname: "walking pneumonia") and the constitutional symptoms resolve in a few weeks with occasional persistence of cough and X-ray changes for weeks afterward. It does not always follow such a benign course, as certain microbes, especially Legionella spp, require ICU admission and care.
Warnings
The above descriptions of the disease processes in pneumonia and bronchitis are useful but should not be used as a method to make a self-diagnosis. If you suffer from these symptoms, consult a health care provider who is trained to look at the complete clinical picture and employ other methods to aid in diagnosis. Therapy varies based on the predominant microbes present in a community and where exactly the pneumonia was contracted, and only a professional can make the best choice for you.
References
- "Conn's Current Therapy;" Rakel & Bope; 2008
- "Textbook of Family Medicine;" Rakel; 2007
