Objective clinical signs of an exacerbation are not always evident. Physicians rely on the patient's own observation that his or her sputum has changed in colour, consistency, and/or amount. The problem is that some patients consistently produce purulent sputum without other evidence of infection.

Diagnosis

Because of the chronic symptoms, it is often hard to determine when an acute exacerbation is occurring or has ended, making diagnosis difficult. However, there are some typical signs and symptoms that can help the physician detect acute exacerbations:

• change in colour, consistency, and amount of sputum
• increase in coughing and difficulty breathing
• rapid breathing
• chest tightness
• bluish discolouration of the skin due to chronic inadequate oxygen delivery
• increased fatigue and/or decreased mental status
• fever and chills

The physician listens to the patient's lungs during the physical examination for characteristic sounds associated with bronchitis:

• rales -- crackling sounds resulting from the popping open of small airways that were closed during expiration
• rhonchi -- coarse, bubbling, or rattling sounds resulting from air moving through secretions
• decreased breath sounds

In addition, the chest is percussed or tapped by the physician. In bronchitis, the sound heard is dull compared to the "hollow" sound of normal lungs.

Treatment