What is tracheitis and how to cure it

Inflammation of the trachea can have several causes, each requiring appropriate therapy. Let’s find out together how to deal with a tracheitis.

Sore throat: under this label we store all infections and inflammations that affect the throat and that bring with them discomfort and pain. But they are not all the same, so much so that more correctly we speak of pharyngitis, laryngitis and tracheitis, depending on the part of the respiratory tract affected.

Let us now focus in particular on tracheitis, i.e. the inflammatory process affecting the tracheal mucosa.

The respiratory system and the trachea

Our respiratory system consists of a series of hollow organs (the airways) that have the function of allowing 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), but a distinction is made between upper airways (nose, mouth, nasal cavities, paranasal sinuses, pharynx and larynx) and lower (trachea, bronchi, bronchioles).

Speaking of throat, in particular, we refer to the internal cavity of the neck consisting of the back of the mouth and in which the pharynx, larynx and trachea and the initial part of the esophagus converge.

The trachea, specifically, is the organ, located in the central part of the chest, in front of the esophagus, which connects the larynx to the bronchi and constitutes the first stretch of the lower airways.

It is a cylindrical duct about 12 centimeters long, consisting of elastic fibrous tissue: it is formed by cartilaginous rings superimposed in a horseshoe, so as to leave a rear opening that is closed by muscle tissue. Cartilaginous rings are held together by connective tissue ligaments.

The inner walls of the trachea are covered by a mucosa and vibrating cilia, tiny hairs very similar to those present in the nostrils, but microscopic, which, with a movement comparable to that of a wheat field shaken by the wind, keep the respiratory tract clean, moving upwards the mucus normally present in them and necessary to capture the agents harmful to the health of the organism that are introduced together with the air.

Tracheitis: the causes

The term tracheitis refers to an inflammation, acute or chronic, of the mucosa that covers the internal relatives of the trachea.

This inflammatory process can be attributable to different causes (see summary table), although more often it is among infectious diseases, as a result of the attack of bacteria or viruses. In this case the infection can be primary, if it directly affects the trachea, or secondary to other upper respiratory tract infections (such as rhinitis, sinusitis, pharyngitis, laryngitis or tonsillitis) that then extend to the tracheal duct. In general, those who already have a deficient immune system for other causes are more exposed to the risk of developing tracheitis.

Bacterial tracheitis can depend on different types of bacteria, although probably one of the most frequent forms, especially in children, is that attributable to Staphylococcus aureus, which can also appear following a superinfection secondary to viral forms (such as a cold or flu). Other bacteria that can trigger tracheitis are streptococcus pneumoniae, Klebsiella pneumoniae, both known to cause forms of bacterial pneumonia, and Haemophilus influenzae (against which there is mandatory vaccination for children).

Viral tracheitis is very often secondary to viral infections of the upper airways and therefore can be mainly attributable to influenza and parainfluenza viruses, adenoviruses and rhinoviruses (responsible for colds).

Although less frequently, tracheitis as well as infectious can have an irritative or allergic origin. In the first case it is due to the inhalation of irritants such as cigarette smoke or substances deriving from pollution. In the second case it concerns subjects with allergies when they inhale pollen, dust, animal hair or other allergens.

Tracheitis can also be secondary to gastroesophageal reflux: it is always an irritative form, resulting from the insult on the tracheal mucosa by the acidic material that, rising from the stomach along the esophagus, manages to reach the trachea through the epiglottis.

Tracheitis form	Causes
Bacterial	Infections with Staphylococcus aureus, Streptococcus pneumoniae, Klebsiella pneumoniae, Haemophilus influenzae etc.
Viral	Infection with influenza and parainfluenza viruses, adenovirus and rhinovirus etc.
Irritative	Inhalation of irritants Gastro-esophageal reflux
Allergic	Inhalation of allergens

Tracheitis: symptoms

Tracheitis usually begins with fever, rhinorrhea (runny nose) and cavernous cough, i.e. deep, often preceded by a burning or tickling sensation in the throat. An initial dry cough may be followed by the appearance of purulent catarrh (especially in the case of bacterial tracheitis).

Within a few days there is also a pain and a sense of tightness in the chest, retrosternal, which are accentuated when coughing. The inflamed mucosa also swells and this causes a narrowing of the tracheal duct that causes breathing difficulties (dyspnea) and the appearance of some characteristic sounds emitted with the breath, such as wheezing and what doctors call stridor.

When tracheitis is secondary to viral infections of the upper airways, symptoms such as:

• nasal congestion
• sore throat
• pain when swallowing
• hoarseness.

Tracheitis: possible complications

Often tracheitis is accompanied by bronchitis and, if not treated properly, can extend to involve the lung tissue and therefore determine pneumonia.

In forms of very serious inflammation, fortunately also very rare,swelling of the trachea can be such as to cause an important narrowing, until, at times, total closure, strongly hindering breathing: you can thus risk cyanosis (insufficient oxygenation of the blood, with blue-violet coloration of skin and mucous membranes) or even respiratory arrest, with even fatal results.

It is therefore important to contact your doctor immediately if the symptoms do not seem to improve, especially if the fever remains high, if the cough becomes more demanding and if you experience increasing breathing difficulties.

Tracheitis: the diagnosis

In general, the doctor (family doctor or otolaryngologist specialist) may be sufficient to visit with physical examination to diagnose tracheitis: the anamnesis (collection of information on symptoms, time of their appearance and in general on the patient’s clinical history) is generally associated with the evaluation of respiratory capacity, in order to detect any characteristic stridor that accompanies inflammation.

The doctor can also resort to further investigations, especially to understand precisely the type of tracheitis in progress (if it is for example bacterial and, in that case, to which specific bacterium it is attributable), so as to be able to establish the therapy in a more targeted way and also to verify the possible severity of the inflammation (especially if the physical examination finds serious breathing difficulties.

Among the investigations, in particular, a nasopharyngeal and/or tracheal swab and a culture examination of the samples taken may be required. The nasopharyngeal swab is a very simple test and does not cause any discomfort to the person who undergoes it: a small sterile cotton swab is rubbed on the mucous membrane of the nose and throat, thus taking a small amount of secretions and cells. The removal from the trachea is, however, more complex and requires sedation: also for this reason it is reserved only for cases in which the symptoms are more serious, while in most cases it is limited to the nasopharyngeal swab (the presence of bacteria in the upper respiratory tract, moreover, suggests that these are the same microorganisms that then colonized the trachea, resulting in secondary tracheitis).

The culture examination, which is done in the laboratory, can also be associated with an antibiogram, which allows to verify whether the possible bacterium found in the sample is sensitive or not to a specific antibiotic. In times of ever wider diffusion of the phenomenon of antibiotic resistance, it therefore allows to identify the most suitable drug.

Finally, in case of significant breathing difficulties, the doctor may also request an X-ray of the trachea, to check the state of the duct, and possibly also an oximetry, ie the measurement of oxygen saturation in the blood (it is done by applying a small device, similar to a sort of forceps, on a finger).

Tracheitis: cures and remedies

Tracheitis therapy is closely connected to the cause of inflammation.

In viral forms, specific drugs (such as antivirals) are generally not used, but medicines can possibly be used to alleviate the associated symptoms (such as anti-inflammatories, antipyretics, etc.). Often the doctor decides to prescribe aerosol drugs, which can more effectively reach the trachea, without unnecessarily exposing the rest of the body to their pharmacological action.

In allergic forms, in addition to avoiding further exposure to the offending allergen, it is possible to intervene with drugs normally indicated against allergic reactions, mostly antihistamines.

In the case of a bacterial tracheitis, the treatment is based on the prescription of antibiotics targeted against the agent responsible for the infection.

In the presence of a tracheitis resulting from gastroesophageal reflux it becomes essential to treat the disorder upstream, possibly associating (but always on the recommendation of the doctor) symptomatic drugs (anti-inflammatory, antipyretics, etc.).

If it is a severe inflammatory form, with a significant narrowing of the trachea, hospitalization with intubation of the patient may be necessary, to avoid total occlusion of the trachea and ensure breathing, while at the same time the appropriate treatments are prepared (for example intravenous antibiotics in the case of a bacterial form, or anti-inflammatories).

Tracheitis: prevention strategies

To prevent a possible tracheitis it may be advisable:

• avoid active and passive cigarette smoking (and do not expose children to it)
• limit exposure, as far as possible, to pollutants
• implement all strategies to reduce the risk of upper airway infections, for example by avoiding closed and crowded places in the cold season, considering the use of any specific vaccinations (such as pneumococcus);
• Do not neglect the appearance of sore throat and flu.