Immune | July 4, 2018 | Author: Naturopath
Bronchitis is an inflammation of the airways or bronchi (or bronchus when referring to the singular) restricting air flow from the main windpipe (trachea) to the lungs causing chest tightness, shortness of breath and an irritating cough with or without phlegm.
It can happen on the tail-end of an infection in the upper airways or from inhaled pollutants and allergens. People who are exposed to smoke either from cigarette or other types of smoke or pollution are more susceptible.
Bronchitis can be acute or chronic or “acute on chronic”. When it lasts for about 3 weeks it is called acute bronchitis.
Acute bronchitis typically lasts for 10-20 days with the potential to reach a duration of 4 weeks. Though transient, acute bronchitis causes the airways to narrow and the bronchial tissue to become hyper-responsive. It is a self-limiting condition – meaning it usually resolves on its own and does not have long-lasting effects on the person’s health.
Chronic bronchitis, along with emphysema, is classed as a Chronic Obstructive Pulmonary (or Lung) Disease (COPD). Chronic bronchitis is a much more serious lifelong condition affecting 5-10% of adults over 40 years. It is defined as cough and sputum present almost every day for at least three months of the year and for 2 consecutive years and is caused by a combination of cigarette smoke exposure, industrial and other pollutants plus a genetic predisposition.
Inhaled irritants trigger an over-secretion of mucus in the airways and the branches of the bronchi fill up with fluid. Inflammation sets in as the white blood cells rush in an attempt to clear up the infection. As chronic inflammation damages the lining of the airways, in chronic bronchitis, the smooth muscle of the airway is permanently scarred.
In 95% of cases of acute bronchitis it is secondary to a virus but sometimes can also be a result of allergens, irritants (like smoke, polluted air, dust and other irritants) and bacteria.
More likely to affect people in the flu season, it can follow any Upper Respiratory Tract Infection (or URTI).
The most common viruses leading to bronchitis are respiratory syncytial virus, Influenza A and B, Parainfluenza, rhinovirus and similar viruses.
When inflammation reaches down to bronchi, causing acute inflammation of bronchi, the result is bronchitis.
Chronic bronchitis is caused by cigarette smoke exposure and other environmental pollutants resulting in chronic inflammation of the airways, leading to progressive airflow limitations.
Click Here For Article on Influenza A
Bacterial bronchitis. Though it is rare to find in healthy adults, where there is a case of bacterial bronchitis (usually in immunocompromised patients), the culprit is the same bacteria which causes community-acquired pneumonia – Streptococcus pneumonia or Staphylococcus aureus.
Click Here For Article on Pneumonia
The symptoms may have been preceded by cold or flu symptoms such as a runny nose, sore throat, fever and malaise. A low-grade fever may be present as well. Having high fevers in the setting of acute bronchitis is a sign that the infection has reached the smaller branches of the bronchi – the bronchioles.
On physical exam, lungs may have wheezing and low-pitched snoring sounds called rhonchi. Tachycardia- a faster than normal heart beat can be present reflecting fever as well as dehydration caused by the viral illness.
In general practice, acute bronchitis is diagnosed on the basis of symptoms, physical examination and clinical judgement.
In chronic bronchitis lung function tests by spirometry show abnormal peak expiratory flow and forced expiratory volume rates.
As chronic bronchitis advances and the lungs perfusion fails, increased carbon dioxide can be found in the blood.
In the literature, acute bronchitis has not always been distinguished from other causes of cough – like common cold, acute asthma and acute flare-up of chronic bronchitis. However, to avoid unnecessary antibiotics, it helps to distinguish the cause of coughs and rule out other diseases with radiographical and clinical diagnosis as antibiotics are of no use in the majority of cases of bronchitis.
Conventional treatment for acute bronchitis includes pain relief and antipyretics to reduce fevers, nebulisers and inhalers to improve air flow and sometimes steroid drugs to treat inflammation. Anti-biotics only have a minor role in reducing symptoms are not routinely prescribed unless that person is at risk of a bacterial form of bronchitis – such as older adults, infants, pregnant women or immunocompromised patients.
Treatment for chronic bronchitis includes inhaled medications such as long-acting beta antagonists, ipratropium bromide and corticosteroids. These are given along with oral theophylline to sufferers of chronic bronchitis. Central cough suppressants such as codeine and dextromethorphan may be given for temporary relief. Expectorants (medications that encourage coughing), physiotherapy, postural drainage and preventative antibiotics have not been proven effective based on current evidence. Anxiety management may be needed to cope with COPD-related breathlessness.
Flu vaccines are indicated for adults over 65 years, patients in aged-care facilities, infants and newborns, pregnant women and asthma patients.
One third of cases of bronchitis do return, so preventative measures are important. Stopping smoking and avoiding pollutants are highly recommended.
Pelargonium sidoides, sold in some countries as “Umkaloabo” or in Australia as “Kaloba”, was found to have good safety and tolerability and an overall positive effect in all forms of bronchitis that were trialled across 6 different trials on adults and children, with complete resolution of cough and sputum
A combined herbal cough syrup including the traditional respiratory herbs: marshmallow, horehound, thyme and ivy leaf and aniseed was trialled on 60 people with bronchitis, cough or mucus-producing respiratory conditions for an average of 12 days. Patients reported these botanicals alleviated the cough, with up to 90% improvement compared with the baseline.
Animal studies using plant medicines have also shown that many plant constituents and extracts (but in particular the plant chemical group called “flavonoids”), may reduce lung inflammation. Baicalin a component of the herb Baikal skullcap with anti-inflammatory, anti-bacterial and antiviral properties reduced the markers of lung inflammation caused by bronchitis and cigarette smoke exposure animal studies.
Experimental studies of an herbal root extract of Echinacea (subspecies purpurea) has been moderately effective in laboratory testing against:
All of which can lead to bronchitis.
Certain vitamins such as vitamin A, B5, C and D are known to be important for immune function. Consuming a wide variety of coloured fruit and vegetables imparts antioxidants needed to prevent free radical damage caused by infection. They are also a source of beta-carotene which is converted into Vitamin A- needed for immune defences in the liver, lung and intestine.
Vitamin C is needed for a long list of functions in the immune system. 100-200 mg a day can be taken to prevent infection. Higher (1000 mg) doses during infections may be needed to compensate for higher requirements during infections.
Vitamin D: Adequate sources of vitamin D from sunlight or ultraviolet radiation and from cod liver oil have long been recommended in respiratory infections and may reduce the overall risk of respiratory infections. Food sources of vitamin D include fish and organ meats
Steam inhalation may help to loosen mucus, improve air flow and help reduce wheezing.
Protein requirements increase during infection, so 1-2 extra serves of lean meat, seafood or chicken and vegetarian proteins such as eggs, tofu and legumes combined with grains may be needed to make up for losses during times of illness. Adequate fluids to replace those lost during fevers are also recommended.
Though not common, there are complications to having bronchitis. Aggressive coughing can cause lung collapse (pneumothorax) or air in the centre of the chest due to leakage or injury in the lungs (pneumomediastinum) so it is important to seek medical treatment for coughs that persist longer than 3 weeks.
Hectmann, L. Clinical Naturopathic Medicine, Churchill Livingstone Elselvier, Sydney 2012: Chapter 10 : Respiratory System