Bronchitis is an inflammation of the main bronchial tubes-the bronchi-caused by a bacterial or viral infection. It may develop suddenly, following a head cold (acute bronchitis), or it may persist or return regularly over many years, causing progressive degeneration of the bronchi and lungs (chronic bronchitis).
Certain people are more susceptible than others. Men are more likely to develop the condition than women; the reasons for this are unclear.
Acute bronchitis is usually caused by a virus, such as the rhino virus, which causes the common cold, although sometimes it may be caused by bacteria such as Chlamydia.
Acute bronchitis can last from several days to several weeks. People are more likely to develop acute bronchitis if they have had a recurrent respiratory illness like cold, have other lung disease like asthma or cystic fibrosis, or are cigarette smokers.
Patient comes with a history of irritating, unproductive cough, with discomfort behind the sternum, associated with tightness, shortness of breath and wheezing for two to three days. Cough, he says, has gradually become productive with greenish yellow sputum and has mild fever.
On auscultation one finds an occasional crackle with wheeze and blood examination shows neutrophilic leucocytosis. In otherwise healthy person, without the patient being seriously ill, the whole episode can improve within 4-8 days.
It is either because of bacterial or viral infection, from nasal sinuses or throat. Or this attack can be complication of measles, whooping cough etc. and inhalation of dust, gases like SO2, or pollens or organic dust.
Chronic bronchitis, part of the spectrum of chronic obstructive pulmonary disease (COPD), is the more serious disease; it is defined as persistent cough sputum (the liquid secretion that comes up from the lungs when a person coughs) on most days for at least three months and for at least two successive years.
It is a slowly progressive type of COPD, limiting airflow in the lungs and causing a chronic cough and difficulty breathing due to shortness of breath.
Precipitating causes of Bronchitis
- Infection (bacterial or viral)
- Cigarette smoking
- Weakened immune system
- Frequent exposure to lung irritants
- Association with complicating diseases
Types of Bronchitis
On the basis of duration of disease it is divided into two types
- Acute bronchitis
- Chronic bronchitis
Symptoms of acute bronchitis
- Toxemic symptoms – malaise, fever, palpitation, sweating, etc
- Irritative symptoms – cough with expectoration, at first scanty, viscid sputum, later more copious and mucopurulent, substernal pain or raw sensation under the sternum.
- Obstructive symptoms – chocked up feeling, paroxysms of dyspnoea, particularly following spells of coughing relieved by expectoration.
- Cough lasts more than 5 days
- Usually self limited, resolves in 2–3 weeks
- Runny nose and sore throat (likely symptoms of the preceding or simultaneous URI)
- Chest pain and difficulty in breathing.
- General weakness
- Body ache.
- Fever may present.
Signs of acute bronchitis – in early stages few abnormal signs apart from occasional ronchi, after 2-3 days diffuse, bilateral ronchi, often with rales at the bases, prolonged expiration and an expiratory wheeze
Causes of acute bronchitis
Viruses which cause upper respiratory infection like coryza, cold are responsible in 90% of cases of acute bronchitis. These include
- Influenza A and B
- Air pollution
Diagnosis of acute bronchitis
- History of upper respiratory infections and clinical symptoms are sufficient to make a diagnosis.
- Wheezing may be heard on chest examination.
Diagnosis of acute bronchitis
Diagnosis of acute bronchitis is based on a suggestive history and a physical examination. Neither blood cell counts nor sputum analyses are particularly diagnostic in otherwise healthy patients. Chest radiography may be helpful in distinguishing bacterial bronchitis from pneumonia.
Patients with recurrent bouts of acute bronchitis should be evaluated for possible asthma. This evaluation would include pulmonary function testing.
Patient with persistent symptoms in the course of presumed viral bronchitis should be evaluated to determine possible underlying etiologies. Sputum culture might prove useful in these circumstances.
Chronic bronchitis does not have a sudden onset and is most frequently caused by long term and repeated irritation of the bronchial tubes. Irritated and inflamed bronchial tubes are more prone to be infected.
A case if bronchitis is considered “chronic” if symptoms continue for three months or longer. Bronchitis caused by allergies can also be classified as chronic bronchitis.
Causes of chronic bronchitis
- Smoking is the major cause for chronic bronchitis
- Repeated exposure to harmful fumes at workplace.
- Air pollution
Symptoms of chronic bronchitis
- Cough – constant, paroxysmal, worse in winter or on exposure to cold winds or sudden change in temperature.
- Expectoration – variable, may be little, thin or mucoid, or thick or frothy, mucoid and sticky. May become mucopurulent during attacks of chronic bronchitis in winter.
- Dyspnoea – in advanced cases, breathing becomes quick and wheezing present even at rest.
- Fever- absent except in acute exacerbation.
- Haemoptysis – usually in the form of streaks of blood.
Signs of chronic bronchitis
(a) Build – usually short and stocky, (b) Cyanosis – rarely with clubbing. Signs of airway obstruction- prolonged expiration, pursing of lips during expiration, contraction of expiratory muscles during respiration, fixation of scapulae by clamping the arms at the beside, jugular venous distension during expiration, widespread wheeze of variable pitch usually most marked in expiration.
Who are at risk for chronic bronchitis?
- Smoking and having an existing lung disease
- Contact with dust, chemical fumes, and vapors from certain jobs also increases risk for the condition. Examples include jobs in coal mining, textile manufacturing, grain handling, and livestock farming.
- Air pollution, infections, and allergies can worsen the symptoms of chronic bronchitis, especially if a person smokes.
Investigations in case of chronic bronchitis
Ventilatory indices – reduced PEF and VC
Chest radiograph – may be normal, infected episodes may produce patchy shadows, of irregular distribution due to pneumonic consolidation and small line fibrotic scarring may result.
Homeopathic treatment of Bronchitis
Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach.
This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering.
The aim of homeopathy is not only to treat bronchitis but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several remedies are available to treat bronchitis that can be selected on the basis of cause, sensations and modalities of the complaints.
For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. There are following homeopathic remedies which are helpful in the treatment of bronchitis:
Aconite nap – excellent remedy for acute bronchitis; hoarse, dry, croupy cough, loud, labored breathing; cough worse at night or after midnight; constant pressure in the left chest; shortness of breast; stitches through left chest; tingling in chest after cough; great anxiety and restlessness associated with complains.
- Dry cough coming on after first sleep, about middle of night.
- Asthma on lying down at night with spasmodic cough.
- worse after first sleep, with tickling in throat.
- Constriction of chest; feels as if a foreign body were in throat.
- Obstruction worse in spring. Hay-fever; frequent sneezing.
- Rawness and burning behind sternum.
- The least current of air causes sneezing, with copious watery, excoriating nasal discharge, of salty acrid taste.
Bryonia Alba – Great remedy for bronchitis; dry cough hurting the head and distant parts of the body with fever and great thirst of large quantity of water at large intervals; free expectoration in the morning and worse in warm room; hoarseness worse in open air; frequent desire to take long breath; to expand
Lungs; cough dry at night; must sit up; worse after eating and drinking; difficult respiration worse after every movement.
Drosera – important remedy for the cases of chronic bronchitis with spasmodic cough; dry Irritative cough; worse after midnight; yellow expectoration; difficulty in taking solid food.
- A remedy especially marked in the symptoms of the respiratory organs, cough, croup, etc.
- Anxiety and difficult breathing.
- Great dryness of all air-passages.
- Hoarseness; larynx dry, burns, constricted.
- Cough, dry, barking, croupy; larynx sensitive to touch.
- Croup; worse, during inspiration and before midnight.
- Respiration short, panting, difficult; feeling of a plug in larynx.
- Cough abates after eating or drinking, especially warm drinks.
- Chest weak; can scarcely talk.
- Oppression and heat of chest, with sudden weakness.
Antim Ars – remedy for bronchitis; when the breathing is hard, rapid, and wheezy; rattling with marked dyspnoea and restlessness.
Squilla – well known remedy for chronic bronchitis of old people; dyspnoea and stitches in chest; violent, furious, exhausting cough with much mucus; profuse, salty, slimy expectoration; cough provoked by talking; cold drinks, and by taking deep breath; sneezing with coughing.
Ipecauc – excellent remedy for bronchitis of infants; sense of suffocation; cough with loud wheezing; chest seems full of phlegm; yearly attacks of shortness of breath; great nausea.
Rumex– dry teasing cough, preventing sleep; aggravated by pressure, talking, and by inhaling cold air, and at night; thin watery, frothy expectoration by the mouthfuls, soreness behind sternum.
- Odema of larynx. Trachea sore.
- Heat and tension behind the sternum.
- Cough of gastric origin; relieved by eructation.
- Cough, with burning pain in chest; worse, right side.
- Sputum tough, rust-colored, offensive, almost impossible to raise.
- Spasmodic cough after influenza and after whooping-cough.
- Cough returns with every fresh cold.
- Tickling behind sternum, causes a constant hacking cough; worse at night on lying down. Must sit up in bed.
- Burning soreness in right chest, through to right shoulder. Severe soreness under right nipple.
- sudden stoppage of catarrh of air passages brings on diarrhoea.
Carbo veg– remedy for bronchitis especially for old people; oppressed feeling in chest; spasmodic cough with gagging and vomiting of mucus; bluish face; offensive expectoration
- Hoarseness; worse evenings.
- Larynx very painful.
- violent tickling in larynx while speaking.
- Cannot talk on account of pain in larynx.
- Cough from tickling in throat; worse, cold air, reading, laughing, talking, from going from warm room into cold air.
- Sweetish taste while coughing.
- Hard, dry, tight, racking cough.
- Burning pains, heat and oppression of chest.
- Tightness across chest; great weight on chest.
- Much heat in chest.
- Whole body trembles, with cough.
- Sputa rusty, blood-colored, or purulent.
- Pain in throat on coughing.
- Nervous coughs provoked by strong odors, entrance of a stranger; worse in the presence of strangers; worse lying upon left side; in cold room.
Other important medicines for bronchitis mainly include- Antim tart, phosphorous, Hepar Sulph. Capsicum, Sulphur, Tuberculinum, Sticta, kali bi; Mercurius, arsenic album, Pulsatilla, Ledum pal, kali Sulph, ammonium carb and many other medicines