Pulmonology focuses on diagnosing and treating lung and airway conditions such as asthma, COPD, and pneumonia, as well as overall respiratory health.
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The diagnosis of bronchitis begins with a thorough physical examination, where auscultation plays a central role. Doctors use a stethoscope to listen to the sounds of air moving through the lungs. In a healthy lung, the sound is clear and rhythmic. In a patient with bronchitis, the airflow is turbulent. The clinician listens for rhonchi, which are low-pitched, rattling sounds that resemble snoring. These sounds indicate the presence of thick secretions in the larger airways and often clear or change character after the patient coughs. Wheezes may also be heard, typically on expiration, signaling the narrowing of the airways. The absence of specific sounds, such as the crackles associated with pneumonia or the diminished breath sounds associated with pneumothorax, is just as crucial for the differential diagnosis. At Liv Hospital, our clinicians combine these acoustic findings with observation of the patient’s breathing mechanics to gauge the severity of the obstruction.
For patients with recurrent or chronic symptoms, pulmonary function tests are essential to evaluate the functional impact of the disease. Spirometry is the most common of these tests. It measures how much air a person can inhale and exhale, and how quickly they can exhale.
While a chest X-ray cannot diagnose bronchitis directly since inflammation of the bronchi is not usually visible, it is a critical tool for exclusion. The primary purpose of a chest X-ray in a patient with a cough is to rule out pneumonia. Pneumonia presents as consolidation, or white patches, on the X-ray, whereas uncomplicated bronchitis typically shows a normal chest or only subtle signs of bronchial wall thickening (sometimes called cuffing). In chronic cases, the X-ray might show hyperinflation or signs of cardiac strain. For more complex cases, a chest CT may be ordered. A CT scan provides much greater detail, allowing visualization of bronchiectasis (permanent widening of the airways) or smaller nodules that an X-ray might miss.
In the majority of cases of acute bronchitis, sputum culture is unnecessary because the cause is viral. However, in specific clinical scenarios, analyzing the sputum is vital.
Blood tests provide systemic evidence of infection and inflammation.
A critical part of the evaluation is distinguishing bronchitis from disorders that mimic its symptoms.
Pulse oximetry is a non-invasive method used to monitor a patient’s blood oxygen saturation. A small clip is placed on the finger or earlobe. In severe bronchitis, mucus plugging and airway narrowing can lead to a mismatch between ventilation and perfusion, resulting in a drop in oxygen levels. Monitoring this vital sign helps determine the need for supplemental oxygen and the severity of the impairment in gas exchange. It is a standard part of the triage and evaluation process for any respiratory complaint at Liv Hospital.
When the distinction between bronchitis and asthma is unclear, measuring fractional exhaled nitric oxide can be helpful. Nitric oxide is a gas produced by cells involved in allergic inflammation. High levels of exhaled nitric oxide indicate eosinophilic airway inflammation, a characteristic of asthma. This test helps clinicians decide whether steroid treatment might be beneficial and aids in refining the diagnosis in patients with persistent cough and wheeze.
Bronchoscopy is an invasive procedure where a flexible tube with a camera is passed into the airways. It is rarely used for acute bronchitis but may be indicated in chronic or atypical cases. It allows direct visualization of the bronchial mucosa, removal of foreign bodies that may be causing symptoms, and collection of deep-tissue samples or lavage fluid for culture. This is typically reserved for cases in which tumors, foreign bodies, or unusual infections such as tuberculosis or fungal diseases are suspected.
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The doctor orders an X-ray primarily to rule out pneumonia, which requires a different treatment, since bronchitis itself typically does not show up clearly on an X-ray.
Spirometry measures how much air you can exhale and how quickly, helping doctors determine whether your airways are narrowed or obstructed.
While not perfect, specific markers in the blood, like the white blood cell count and procalcitonin, can give doctors strong clues about whether an infection is likely viral or bacterial.
No, sputum cultures are usually reserved for complicated cases, patients with chronic lung disease, or when antibiotics are being considered, to ensure the right bacteria are targeted.
Low oxygen levels indicate that inflammation and mucus are preventing enough oxygen from reaching your bloodstream, which may require supplemental oxygen therapy.
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