Bronchitis

Bronchitis



I like the analogy of the "bronchial tree". The airway structure in the human chest is like an upside-down hollow tree with the midline trachea as the trunk. The main trunk splits into two smaller trunks called the bronchi. These split into even smaller and smaller trunks to the segments of the lungs. Finally, the tiny limbs called the bronchioles result, which lead to the equivalent "leaves" at the tips, the tiny sacs called alveoli." There are about 5 million alveoli in each lung, so one can imagine there are about as many bronchioles. There are several medical conditions, which happen within these tubular airways. The most common one is "bronchitis," which is inflammation or infection of the inside of the airway tubes.

There are basically two kinds of bronchitis: acute and chronic. Acute bronchitis is what is often a sudden or new infection called the "chest cold". In 90% of the cases it is caused by a viral infection of the tubules. It can often follow the flu or an upper respiratory infection. It is spread by an infected person’s sneeze or cough droplets, or by touching something they’ve contaminated, and then touching your own eyes, nose, or mouth. Technically, antibiotics are not affective upon viruses, but we often find that the extra mucus from bronchitis is a set up for additional bacterial infections, and we can prescribe broad spectrum antibiotics during the course with good results. We have some specific antivirals that we may use as well for virus infections. Bronchitis does two things: It blocks the airway tubes with mucus and causes swelling or edema, and infection which cuts down on airway size. The tiny ciliary hairs, which line the airways, have trouble moving the mucus up toward the upper airway where it may be coughed up. One thing leads to another and now you have severe bronchitis. You might hear wheezing sounds in your chest, feel unusually tired, have a low-grade fever (usually less than 101,) feel a dull tightness in your chest, have a dull burning under the breast bone, and most of all, you cough. The cough may be dry and hacking or productive of clear or whitish or greenish sputum. It should not have blood in it. Acute bronchitis usually lasts about one to three weeks but it can rarely last up to six weeks.

What you can do:

1. Get your flu and pneumonia immunizations as they are available.



2. If you get bronchitis:

a.) Try not to give it to anybody else; cough or sneeze into tissues and dispose of sanitarily.

b.) Wash your hands frequently; do not share glasses, finger foods or towels.

c.) Get a pneumococcal vaccination for prevention of future infections. This could save your life.



3. For your bronchitis:

a.) Breathing humidified air or stream is good to break up secretions.

b.) An over-the-counter expectorant with cough suppressant can be good; do not give anything like this to a child under age 2 without checking with your doctor. Cough drops can soothe a dry or sore throat.

c.) Take acetominophen or ibuprophen for low-grade fever.

d.) Get extra rest; drink extra fluids. This will help break up the bacterial secretions.



4. What your doctor can do:

a.) Decide if you need antibiotics and prescribe the correct medication

b.) Decide if additional testing of spirometry or chest X-rays are necessary to specifically identify the problem.

c.) Decide if you need a stronger cough suppressant.

d.) Decide if you need an inhaled corticosteroid to treat airway inflammation.

e.) Administer pneumococcal vaccine for future infections.



Chronic bronchitis is defined by the presence of cough and signs of bronchitis for over three months a year. Probably the biggest cause of chronic bronchitis is cigarette smoking. Males get it twice as often as females. It can also be caused by industrial irritants like dust, fumes, air pollution, allergies like pet dander, dust mites, or by reflux of stomach acid into the upper airway. Your doctor can check you for all these different things, but if you smoke, he or she is going to tell you to stop. Chances are if you keep smoking, you are going to need several rounds of antibiotics a year, chronic use of bronchodilator and corticosteroid sprays, and you will probably get progressive COPD (Chronic Obstructive Pulmonary Disease.) Keep going and you might have to carry around a bottle of oxygen, with a green tube under your nose. The air sac alveoli do not get enough air to take in oxygen and release carbon dioxide, and it starts to ruin basic body chemistry. You feel tired, cannot think as well, start huffing and puffing with small exertion, and are set up for bacterial infections. It is not a very happy or pretty situation.

What you can do:

1. Don’t smoke

2. Don’t chew tobacco

3. Don’t let people smoke in your house or work place

4. Ask your doctor for help in quitting smoking

5. Wear a mask when you’re around dust, dirt in the air, or smoke

6. Avoid allergens causing foods and environmental allergens

7. Try to stay indoors when the pollution index or dust level is high

8. Get your flu, pneumonia, and all immunizations as they are available

9. Get treatment for sinus infections which can cause flare-ups of bronchitis

10. If you have reflux of stomach acid, take your medicine as directed

11. Ask your doctor if you need to use a bronchodilator or inhaled corticosteroid

12. Avoid other people with flu, colds, coughing, or sneezing

13. Get prompt treatment for flare ups of acute bronchitis

14. Get a spirometry test if more than 1lung infection per year

15. Wash or sanitize your hands frequently

16. Get plenty of rest

17. Try to exercise regularly to gradually increase exercise tolerance

18. If a child has chronic bronchitis, something is wrong; the doctor will check for foreign body in the airway, cystic fibrosis, sinusitis, tonsillitis or adenoiditis

19. Get a good air purifier, especially in the bedroom

20. Get allergy testing



Good luck and good health.



John Drew Laurusonis M.D.

Doctor's Medical Center