What it is and what to do when you have bronchitis

What is it

It is an inflammation of the mucosa that covers the bronchi, tree-like structures that conduct air through the lungs and that gradually branch out until they reach the individual functional units called pulmonary alveoli, the real place of exchange between oxygen and carbon dioxide.

Bronchitis is often preceded by colds or flu and is characterized mainly by the appearance of cough with abundant secretion of phlegm. In case of bronchitis, fever is not always present.

Bronchitis, depending on the duration of the inflammatory state and the type of symptoms presented, can be acute or chronic.

The acute form is generally short-lived: it persists for a few days and usually heals spontaneously without the need for drug therapies although the cough can continue for up to three weeks. Its main cause is due to a viral infection and is quite frequent especially in autumn and winter.

When the inflammation is repeated, prolonging over time and presenting a progressive course, that is, with worsening of the clinical picture and symptoms, we speak instead of chronic bronchitis, a condition among other things typical of chronic obstructive pulmonary disease (COPD), a pathology characterized by irreversible obstruction of the airways, of variable entity depending on the severity. In particular, chronic bronchitis is diagnosed when catarrhal or “productive” cough occurs daily and lasts for more than three weeks a year for two consecutive years.

This occurs when the lining of the bronchial ducts is permanently thickened due to constant irritation and inflammation. Viruses, but also bacteria, can easily infect irritated bronchi and, if this happens, there is a further prolongation and aggravation of symptoms.

There are several methodologies that the doctor can apply to diagnose bronchitis. The following table describes the main ones.

As regards spirometry in particular, this technique aims to recognize in a few minutes states of asthma or emphysema through the breath inside a device, called spirometer, which measures the volume of air left in the lungs after having deeply inhaled and exhaled. It is also able to determine the speed of exhalation.

Always based on the air emitted, it is possible to perform the bronchial provocation test, which measures the variation of respiratory parameters following the inhalation of methacholine, which induces bronchoconstriction (the reaction is accentuated in asthmatics), or evaluate the concentration of exhaled nitric oxide, directly proportional to the level of inflammation.

Causes

There are many causes of bronchitis. In the acute form, in most cases it is due to infectious diseases of viral origin, especially in the case of cold and flu viruses. More rarely the infection is bacterial. Usually the infection in the initial phase concerns the upper respiratory tract such as larynx and trachea and then extends to the bronchi.

In addition to the viral or bacterial component, some substances that can irritate the lungs and airways also increase the risk of the onset of the disease. Among these, the main cause of acute bronchitis, but above all chronic, is cigarette smoking, both by direct inhalation and by passive exposure.

To this are added other factors such as pollution (caused by fine particulate matter in the air, micro-dust, produced by the combustion of hydrocarbons, wood or coal), vapors and toxic gases.

Age would also seem to play an important role. The elderly, infants and young children are in fact the subjects most exposed and at greatest risk of acute bronchitis.

In addition, low immune defenses, perhaps following a previous disease or particular drug therapies, and the presence of frequent gastric reflux with consequent irritation of the mucosa at the level of the throat can be predisposing factors.

As far as chronic bronchitis is concerned, smoking is the first cause of its appearance associated, as for the acute form, with the inhalation of polluted air, dust and fumes present in the environment or in the workplace. However, unlike acute bronchitis, chronic bronchitis is not related to age although it is more frequent in adults over 45 years of age. Women also seem to be twice as likely to develop it as men.

Common symptoms

Characteristic symptoms are coughing, mucus production and chest pains.

Among the symptoms that characterize both acute and chronic form we find:

• persistent cough
• excessive production of transparent or greenish-yellow sputum (phlegm)
• difficulty breathing or wheezing
• asthma
• wheezing
• pain when swallowing
• hoarseness
• sore throat
• fatigue or breathlessness especially during physical activity
• mild fever
• chest pain.

It is also often associated with sinusitis, pharyngitis or laryngitis and lowering of the voice.

The most important symptom, however, remains cough. Initially dry, it evolves with the production of phlegm that intensifies when lying down, in the cold and in the presence of irritants such as cigarette smoke.

With regard to chronic bronchitis in particular, the cough worsens in the morning or during wet days. In these subjects, respiratory infections such as colds or flu syndromes, aggravated by catarrhal cough, are also very frequent.

Complications

A single episode usually does not cause any concern although it is in any case to be monitored closely: in some cases it can result in pneumonia, especially in the elderly or predisposed people. In addition, in asthmatics, smokers and those who breathe fumes or polluted air continuously, the disappearance of symptoms of acute bronchitis may be slower and episodes may recur frequently.

In these cases, bronchitis easily becomes chronic and can then evolve into chronic obstructive pulmonary disease (COPD) and emphysema (a disease characterized by loss of elasticity of the lungs and reduction of the respiratory surface). Finally, the risk of developing lung cancer is greater, especially if exposure to smoke, active or passive, is not avoided.

Treatment

Acute bronchitis usually heals spontaneously in less than 15 days. Very often, adequate rest and proper hydration are enough to thin the mucus. If the difficulty in breathing is accentuated at night it is advisable to use a humidifier in the bedroom as well as keep head and shoulders raised with pillows.

If the cough is moderate, but there is a lot of phlegm, it is always better not to suppress it completely because it represents a protective reflex of our body responsible for eliminating foreign bodies and mucus and clearing the airways.

In some circumstances the doctor may recommend a pharmacological approach, which differs depending on the patient’s needs.

To help the expectoration of mucus or if the persistent cough does not allow night rest, over-the-counter drugs with mucolytic or thinning action can be used. Cough suppressants (not recommended in children) should be used only if the cough is very insistent.

In case of fever or general malaise, drugs with antipyretic action such as acetylsalicylic acid, ibuprofen or paracetamol can be taken. Nonsteroidal anti-inflammatory drugs should be used with caution, following the advice of the pharmacist or doctor, in subjects in whom bronchitis is of asthmatic origin.

Especially in patients with asthma or previous medical conditions that hinder normal breathing, it may be necessary to resort to inhaled bronchodilator drugs, possibly combined with corticosteroids to reduce inflammation and facilitate the passage of air.

Finally, the use of antibiotics must be properly evaluated by the doctor because, being the bacterial cause the least likely, they would be useless in curing the disease.

Among the most used and effective we find antibiotics belonging to the class of penicillins or quinolones.

As an alternative to a confirmed diagnosis of bacterial bronchitis, antibiotic therapy could be prescribed to subjects with chronic forms also to reduce the risk of a serious secondary infection or in general of bronchopulmonary complications.

As an alternative or as an accompaniment to drug therapy, in the presence of chronic bronchitis it may also be useful to undertake pulmonary rehabilitation, or a program of exercises performed with a specialized physiotherapist. These exercises aim to teach the patient not only the best strategies to breathe more easily, but also to increase physical endurance in general by reducing the feeling of tightness and tightness of the chest and shortness of breath. In addition to pulmonary rehabilitation, oxygen therapy may also be considered.

When to consult your doctor

If the cough does not improve after a few days, if high fever appears, if you struggle to breathe or breathing is wheezing, if you have significant pain in the chest, a feeling of weakness that is accentuated and in any case in very young children it is good to contact the doctor immediately.

In particular, timeliness and foresight are important in the case of children under three months with high fever.

In young children, bronchiolitis is also very common, a condition similar to bronchitis but affecting the bronchioles, a sub-component of bronchial branching. It is frequent in winter and is the most common cause of hospitalization during the first year of life.

Finally, it is advisable not to underestimate the symptoms in case of chronic lung or heart problems, including asthma, emphysema or congestive heart failure since all these medical conditions increase the risk of complications originating from bronchial infections.