Bronchitis

The bronchioles and bronchi present in the respiratory system consist of airways or tubes that carry the air inhaled by the nose to the lungs. After inhalation, air enters the nose, crosses the larynx, and enters the trachea. The trachea first divides into the two airways known as the right bronchus and the left bronchus. These bronchi further divide into many small bronchioles and ultimately supply air to the right and the left lung, respectively. Any inflammation occurring in the bronchi is known as bronchitis.

Symptoms of Acute Bronchitis

Symptoms of acute bronchitis last for a week or two and usually do not cause any lingering effects. The following symptoms are seen with acute bronchitis:

• Persistent cough
• Coughing up sputum, which may be colorless or yellowish. Occasionally, it may be greenish or blood-tinged.
• A runny or a stuffy nose
• Sore throat
• Chest pain or tightness
• Wheezing or whistling sounds during breathing
• Dyspnoea or breathlessness while performing activities or at rest
• Fever, chills, weakness, and body aches
• Dizziness and confusion
• Low levels of oxygen

Symptoms of Chronic Bronchitis

When the symptoms of acute bronchitis last for a longer time and recur frequently, it may indicate a condition known as chronic bronchitis, which is an ongoing illness. Chronic bronchitis is characterized by a productive cough that may continue for a minimum of three months for two or more consecutive years. If left untreated, chronic bronchitis may lead to emphysema (a type of respiratory disease), which in turn can cause chronic obstructive pulmonary disease (COPD), a serious and potentially life-threatening respiratory disorder.

Causes of Acute Bronchitis

• Infections: Acute bronchitis can be caused by viral or bacterial infections of the respiratory tract. The same viruses that cause the common cold or the flu can also lead to acute bronchitis. Viruses and bacteria can enter your body if you are in close proximity to someone with a respiratory illness. When a patient coughs or sneezes, millions of tiny droplets laden with microorganisms are released into the air. Inhaling such contaminated air may result in infection.
• Inhalation of Irritant Substances: Inhaling dust particles, smoke, and industrial pollutants such as tiny fibers, asbestos granules, and acid fumes can cause inflammation in the airways, leading to acute bronchitis.
• Seasonal Changes: For some individuals, seasonal changes can increase the risk of acute bronchitis due to allergic reactions. It is observed that during the winter season, many people experience episodes of acute bronchitis annually.

Causes of Chronic Bronchitis

• Air Pollution: Living in polluted areas and constantly breathing polluted air can lead to the development of chronic bronchitis.
• Industrial Exposure: Working in industries that continually expose a person to tiny fibers, dust, smoke, and acid fumes, which irritate the lungs, may cause chronic bronchitis.
• Smoking: Long-term smoking, whether actively or passively (being exposed to smoke from others), is a significant cause of chronic bronchitis.

• Are a smoker
• Have a family history of respiratory diseases
• Work in an industry that exposes you to lung irritants
• Have asthma or allergic diseases
• Have a weak immune system
• Suffer from repeated bouts of severe acidity (gastric reflux)

Acute bronchitis is commonly caused by respiratory viruses. In most cases, it is a self-limiting illness that resolves within 8 to 10 days. Doctors do not usually suggest any investigations for a single episode of acute bronchitis as the diagnosis is primarily based on the patient’s history and clinical symptoms. Laboratory investigations and imaging studies may be necessary when symptoms are severe or recurrent and do not resolve within 8 to 10 days.

Laboratory Investigations

• Blood tests: Blood tests such as Complete Blood Count (CBC), Erythrocyte Sedimentation Rate (ESR), and C-Reactive Protein (CRP) may be required to evaluate if the patient is suspected of having a severe infection or inflammation.
• Sputum analysis: This has a limited role in diagnosing acute bronchitis. Viruses are the most common cause of acute bronchitis and are not sufficiently detected in a sputum analysis. A sputum examination is necessary when a patient is suspected of having additional infections or pneumonia, which are complications of acute bronchitis.
• Pulmonary function testing: Pulmonary Function Tests assess the functioning of the airways and their sensitivity to bronchodilator medications. They are an important diagnostic tool for evaluating chronic bronchitis and COPD.

Imaging Studies

X-Ray chest PA view and HRCT chest (plain) are used to visualize the lungs and the airways to help establish a diagnosis for respiratory symptoms.

Although bronchitis can affect anyone and it is not possible to prevent it entirely, certain precautions and lifestyle modifications can help prevent frequent episodes of bronchitis.

• Do not smoke or be around people when they are smoking.
• Wear a mask when you are exposed to dust, smoke, or other lung irritants.
• Wash your hands frequently, and do not touch your eyes, ears, and mouth repetitively.
• Get yourself vaccinated yearly with the flu vaccine.

In most cases, you do not produce noticeable amounts of phlegm unless you are sick or suffer from any respiratory problem. However, the presence of phlegm (known as sputum) could indicate the presence of an allergen, irritant, or infection in your lungs or sinuses. Moreover, the color of the phlegm can provide insight into your health condition.

The treatment for bronchitis is primarily based on the type and severity of the condition. Some of the most common treatments suggested include:

1. Physiotherapy and Pulmonary Rehabilitation

Physiotherapy exercises for postural drainage effectively loosen the secretions in the chest and facilitate the easy expulsion of mucus. Pulmonary rehabilitation exercises comprise breathing techniques and, over time, gradually progress to aerobic exercises to help improve a patient’s lung capacity and strengthen their respiratory system. Pulmonary rehabilitation is an important aspect of managing chronic bronchitis and COPD.

2. Acute Bronchitis Treatment

The treatment for acute bronchitis is primarily symptomatic and consists of:

• Antipyretics like paracetamol preparations to control fever.
• Bronchodilators such as salbutamol and ipratropium bromide to improve breathing.
• Antitussives and expectorant syrups to reduce cough and chest congestion. Antitussives suppress cough, while expectorants aid in the expulsion of mucus.
• Lozenges to provide a soothing effect by reducing the coughing sensation.
• Antibiotics (rarely) may be prescribed if a doctor suspects an additional bacterial infection.

3. Chronic Bronchitis Treatment

Chronic bronchitis is a persistent condition that requires additional treatment beyond the symptomatic management of coughing. The treatment may include:

• Antitussive medications to treat the chronic cough associated with chronic bronchitis and COPD.
• Bronchodilators such as salmeterol and tiotropium, along with steroid medications like fluticasone and beclomethasone, prescribed for inhalation to relieve airway inflammation in chronic bronchitis and COPD.
• Patients with severe disease may require supplemental oxygen at home to address hypoxia (insufficient oxygen to the tissues).

If you have a flare-up of acute bronchitis or are suffering from chronic bronchitis, you can do the following to get relief from symptoms:

• Drink plenty of fluids like warm water, herbal teas, and clear soups.
• Take sufficient rest. If you can't sleep at night, use an extra pillow to prop up your head to prevent mucus from settling in the back of your throat.
• Perform steam inhalation as it humidifies the nasal passages and airways and helps loosen chest congestion.
• Using a cold or warm mist humidifier in the bedroom can help clear the mucus.
• Gargling with salt water can help break mucus that irritates the throat. Spit it out after gargling. You can repeat it multiple times a day to soothe your throat.
• You can use a saline nasal spray or drops to help with nasal stuffiness.
• You can suck on lozenges (small medicated tablets for cough) or a mixture of honey and lemon to help with a sore throat and cough. Do not give lozenges to children without consulting a doctor.
• Quitting smoking is one of the key lifestyle modifications advised to patients who smoke. Smoking cessation helps prevent the disease from worsening.

Bronchitis, whether acute or chronic, may cause severe activity limitations and lead to:

• Asthma
• COPD
• Emphysema
• Empyema
• Pneumothorax
• Pneumonia
• Lung collapse
• Chronic hypoxia
• Respiratory failure
• Death

• Honey: It has antiviral and antibacterial properties, making it useful in the treatment of bronchitis. Honey helps soothe the throat and builds a strong immune system.
  Tip: Add half a teaspoon of honey with a pinch of black pepper, fresh ginger paste, and 1-2 clove powder. Consume this paste to alleviate the burning sensation in the throat.
• Ginger: It possesses immune-building and anti-inflammatory properties that help treat colds and soothe inflamed bronchial tubes.
  Tip: Use ginger in its natural form rather than in capsules or supplements. Prepare a mixture of one teaspoon each of pepper, dried ginger, and cloves. Add a small amount of this mixture to milk or honey and consume it three times a day for relief.
• Turmeric: This is an effective natural remedy for cough associated with bronchitis. Its anti-inflammatory properties help resolve excess mucus, providing relief. Turmeric also increases antioxidant activity, which may reduce irritation and boost immunity.
  Tip: Mix 1/2 teaspoon of powdered turmeric with 1 teaspoon of honey to create a paste. Consume this paste 1 to 3 times daily while symptoms persist.
• Garlic: Garlic is a significant home remedy for acute bronchitis. A study published in 2016 indicated that garlic effectively inhibited the growth of the infectious bronchitis virus.
  Tip: Take three fresh garlic bulbs, peel, and chop them. Add the chopped pieces to a glass of milk, boil the mixture, and drink it warm before bedtime.
• Salt Water: Gargling with salt water may help break up mucus and reduce throat pain, soothing the irritated throat.
  Tip: Add some salt to warm water and stir well. Gargle with this warm salt water 3-4 times a day.
• Pineapple: Pineapple contains bromelain, a natural anti-inflammatory that can help expel mucus and provide relief in bronchitis and other respiratory infections.
• Orange Juice: Rich in vitamin C, oranges are recommended for building a strong immune system. Fruit juices are effective home remedies for soothing an inflamed throat.
  Tip: Orange juice can be combined with almonds to alleviate a sore throat. Finely crushed almonds can be added to orange juice and consumed at night.

Ayurveda

Various herbal remedies are used to alleviate cough symptoms, such as sucking on a clove or taking powdered preparations from medicinal herbs and condiments like long pepper, dried ginger, and turmeric. Formulations like Sitopaladi Churna and Karpuradi Churna are used to relieve dry cough. Vyaghriharitaki Avaleha, Bharangyadi Avaleha, and Vasavaleha are beneficial for chronic bronchitis and childhood asthma.

Homeopathy

Although evidence is limited, homeopathic preparations such as Belladonna, Chamomilla, Antimonium Tartaricum, Nux Vomica, and Kali Sulphuricum have been used to treat cough, cold, and other symptoms of bronchitis.

Acute bronchitis does not significantly interfere with the patient’s lifestyle, as the symptoms are temporary and resolve without long-term effects. However, chronic bronchitis can greatly impact a patient’s quality of life.

A patient with chronic bronchitis may find it difficult to perform strenuous physical activities due to breathlessness. As the disease progresses, symptoms can worsen, increasing the risk of respiratory failure.

Patients with Chronic Obstructive Pulmonary Disease (COPD) may often require oxygen supplementation at home, and their physical activities may be severely limited. The quality of life for patients with chronic bronchitis declines as the severity of the disease increases.