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Tracheitis: symptoms, causes, diagnosis and treatment

By Cristiano Antonino On Jun 28, 2023

Even the trachea, like other organs, can become inflamed due to viruses and bacteria. In this case we speak of “tracheitis”

Our respiratory system is made up of a series of hollow organs (the airways) which serve to allow the passage of air from the outside to the lungs and vice versa.

These pathways are in continuity with each other, starting from the nose to the bronchi and bronchioles present in the lungs.

However, a distinction is made between the upper airways (nose, mouth, nasal passages, paranasal sinuses, pharynx and larynx) and lower airways (trachea, bronchi, bronchioles).

What is the trachea?

Focusing on the trachea, it is none other than that part of our body, which is centrally located in the chest in front of the esophagus and connects the larynx to the bronchi, representing the first section of the lower airways.

In particular, it is a cartilaginous duct about 12 centimeters long, made of elastic fibrous tissue.

Its cartilaginous rings are superimposed in a horseshoe shape, to allow for a posterior opening that is closed by muscle tissue.

These rings are connected to each other by connective tissue ligaments.

The internal parts of the trachea are lined with mucous membrane and very small vibrating cilia, i.e. hairs like those found in the nostrils, but in this case microscopic.

The movement of these hairs keeps the respiratory tract clean, moving upwards the mucus normally present in them and necessary to capture the agents harmful to the health of the body, which enter our body through the atria we breathe.

Even the trachea, as mentioned above, can be attacked by viruses and bacteria.

This inflammation leads to tracheitis

Often it is a condition, which manifests itself as a consequence of other processes, all characterized by an underlying inflammatory state such as:

bacterial;
viral;
allergies caused by the presence of some specific allergens in the environment where the patient lives;
inhalation of air containing irritating agents, such as those of a chemical nature.

But let’s go in order, starting from what can be the symptoms attributable to tracheitis.

Symptoms of tracheitis

Tracheitis generally manifests itself with a deep cough called canine for the typical barking and dry sound, often preceded by burning and tickling in the throat, in some cases fever.

In fact, the dry cough characteristic of tracheitis can transform itself and lead to the appearance of purulent catarrh if it extends to the lungs.

This happens especially in the case of bacterial tracheitis.

To this state can also be added the birth of a strong pain and sense of tightness in the chest, retrosternal, which are accentuated when coughing.

Furthermore, the inflamed mucosa can swell and lead to a moderate narrowing of the tracheal duct, which generates discomfort in the respiratory act and the appearance of some characteristic sounds emitted with the breath, such as rales.

Below we list the typical symptoms associated with a tracheitis:

but of the throat, with redness caused by vasodilatation and exudate of an inflammatory nature;
presence of more or less thick mucus, the color of which will depend on the underlying process;
persistent cough, whether productive or not;
respiratory problems.

The causes of tracheitis

The causes that can lead to inflammation of the trachea are various and of different nature, viral or bacterial.

The infection can be primary, if it directly affects the trachea, or secondary to other upper respiratory tract infections, such as rhinitis, sinusitis, tonsillitis, laryngitis.

In this case the infection can extend up to the tracheal tape. In general, those who already have a deficient immune system for other causes are more exposed to the risk of developing complicated tracheitis.

Bacterial tracheitis

The bacteria that can inflame tracheitis are different.

One of the most frequent forms, especially in children, is that of Staphylococcus aureus, which can also appear following a secondary superinfection to viral forms, such as the common cold.

There are other bacteria that can lead to this state of the trachea, such as streptococcus pneumoniae, Klebsiella pneumoniae, both of which are known to later cause complications such as bacterial pneumonia.

Viral tracheitis

Inflammation of the trachea due to the virus is often the consequence of other viral infections, such as those of the upper airways and therefore can be mainly attributed to influenza and parainfluenza viruses, adenoviruses and rhinoviruses.

Irritative or allergic tracheitis

Although less frequently, tracheitis can also be irritating or allergic.

In the first case it is due to the inhalation of irritating agents such as cigarette smoke or substances deriving from pollution.

In the second case it can be caused by the patient’s allergies such as those to pollen, dust, animal hair or other allergens.

Irritation of the trachea can also be secondary to gastroesophageal reflux.

Acid exhalations, rising from the stomach along the esophagus, can reach the trachea through the larynx and cause consequent irritation.

When to see a doctor

Although the prognosis is usually excellent, tracheitis can become an emergency situation.

In this case and especially in children, it is advisable to go to the Emergency Department when, in addition to the infection, the following symptoms appear:

fever;
cough that persists and gets worse;
respiratory difficulties;
noisy breathing;
symptoms of poor oxygenation (cyanotic color of the face, fatigue, sweating, retraction of the jugular at the base of the neck in the respiratory act).

The diagnosis

To diagnose an infection of the trachea it is important to start from a careful history, which goes back to the causes.

The patient in question may in fact have found himself exposed to specific sources of infection or to some types of antigens.

Afterwards, the oral cavity and pharynx are examined, which may show signs of hyperemia (redness) or mucopurulent discharge (phlegm).

The execution of a fibroendoscopy (a thin camera that passes through the nose explores the larynx and the trachea) is essential to visualize the first tracheal rings and evaluate if they are inflamed.

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Usually, after the visit, no other specific tests are prescribed, in case of doubts the specialist may decide to request a sputum culture with associated antibiogram, to isolate any bacterium responsible for the inflammatory process and have the best antibiotic available for the specific infection in progress.

Tests for viral tracheitis

In the case of viral tracheitis, however, the doctor will use the sputum to look for specific components of the virus.

Blood tests will also be prescribed to demonstrate both the absence of other concomitant pathologies of a different nature, and to confirm the rise in inflammation indices (VES, CRP, white blood cells) or the presence of components of the microorganism in the circulation.

Finally, when the situation appears much more serious, further investigations such as chest radiography can be carried out, in order to exclude the progress of the infectious process in the lower airways and evaluate the patency of the channel.

If allergies are suspected, it will be sufficient to subject the patient to “allergy tests”, skin or blood tests, aimed at detecting individual sensitivity to certain allergens.

With the pulse oximeter, the amount of oxygen in the blood can be determined (oximetry).

In summary, therefore, the diagnosis is based on:

clinical symptoms,
presence or absence of sputum (phlegm can often lead to the origin of tracheitis),
physical examination of the pharynx larynx and trachea first rings,
possibly culture of sputum or search for viral material.

How to cure tracheitis

The therapies envisaged to treat tracheitis are very varied because they depend on the severity of the clinical picture and above all on the responsible etiological agent.

Sometimes tracheitis can also be self-limiting, requiring no treatment, while in the most serious cases, especially when there is a reduction in the tracheal caliber and consequent difficulty in breathing in children, hospitalization is necessary to provide adequate respiratory support.

But let’s focus now on the main therapies recommended in case of tracheitis, what are they?

1) In case of bacterial infection, the use of an antibiotic may be required, preferably prescribed following an antibiogram.

2) To cure a viral infection, on the other hand, a simple supportive therapy will suffice (antipyretics for fever, any sedatives or mucolytic syrups for cough, the latter however contraindicated under two years of age) until resolved.

3) Allergic tracheitis is managed with antihistamines and cortisones.

How to do prevention

The first preventive approach consists in avoiding risk situations such as:

exposure to known allergens in the case of allergy sufferers,
overcrowded, closed environments, in contact with possible infected subjects.

It is also necessary to prevent all processes capable of weakening the defenses of the respiratory tract and which can determine conditions of transient immunosuppression such as: