Bronchitis Explained: Causes, Symptoms, and Treatment for Acute and Chronic Types

Bronchitis Explained: Causes, Symptoms, and Treatment for Acute and Chronic Types

Question. Write a short note on bronchitis.

Answer. Bronchitis is an infection of the bronchi.
Types:
1. Acute bronchitis.
2. Chronic bronchitis.

Acute Bronchitis

It is an acute infection of the bronchi and may be caused by infection with organisms such as Streptococcus, pneumococci, Hemophilus influenzae or primarily viral in origin.

Causes Acute Bronchitis

1. Infection: Bacterial or viral, or descending infection from the nasal sinus or the throat.
2. Complicating other diseases, such as measles and whooping cough.
3. Physical and chemical irritants: Inhaled dust, steam, gases such as sulphur dioxide and ether.

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Symptoms of Acute Bronchitis

1. Toxemia: Malaise, fever, ill health, tachycardia
2. Irritative: Cough with expectoration, at first scanty, viscid sputum is present, and later on it becomes more copious and mucopurulent; substernal pain or raw sensation under sternum.
3. Obstructive: Choked up feeling, paroxysms of dyspnea following spells of coughing relieved with expectoration.

Physical Signs of Acute Bronchitis

Fever, tachycardia, flushing of the face, and respiratory rate are slightly increased. Crepitations are heard at the base when secretions collect in the lungs.

Treatment of Acute Bronchitis

1. In the dry stage:

1. Bed rest
2. Nutritious diet
3. Tincture of benzoin inhalation
4. Application of Vicks VapoRub on the chest
5. Capsule amoxicillin 250 mg 8 hourly for 4 to 5 days.
6. Tablet of aspirin or paracetamol twice a day.
7. A cough sedative mixture like linctus codeine to suppress a dry cough.

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2. In the moist stage:

1. Amoxicillin and cloxacillin 500 mg 8 hourly for 4 to 5 days.
2. Expectorant mixture with sodium or potassium iodide to bring out the secretions.

Chronic Bronchitis

Chronic bronchitis may be defined as a “condition where there is a persistent productive cough for at least three consecutive months in at least two consecutive years”.

Etiology of chronic bronchitis.

1. Cigarette smoking
2. Air pollution and clinical factors
3. Infections, i.e., upper respiratory tract infection in smokers
4. Occupation
5. Familial and genetic factors
6. Alpha-1 antitrypsin deficiency.

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Clinical features of chronic bronchitis.

Symptoms

1. It affcts male more commonly than the females
2. Chronic bronchitis is present with recurrent attcks of cough
3. Cough may occur in paroxysms or is more in elderly hours of morning.
4. Cough is dry when start but later sputum is bringing out which is mucoid to mucopurulent sometimes, it is blood tinged.
5. Patient complains sense of tightness in chest, breathlessness and asthma­like picture.
6. Fever and toxemia appear when infection supervenes

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Signs chronic bronchitis.

1. There is increase in respiratory rate.
2. Inspiratory and expiratory ronchi and presence of crepitation at the base of lungs.

Investigation chronic bronchitis.

1. X-ray: In early stage, it is normal and later it shows widening of intercostal spaces, ribs placed more horizontally,diaphragm displaced downwards and some patient shows patches of pneumonia.
2. Sputum for culture and sensitivity test is usually sterile.
3. Lung function tests:

1. Decrease in FEV1
2. Subnormal FEV1/VC
3. Decrease in PEF
4. Normal lung volumes except with emphysema
5. Normal diffsing capacity.

4. Blood gas analysis: In severe cases, there is increase in hypercapnia and decrease in hypoxaemia.

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Management chronic bronchitis.

1. Bronchial irritants should be avoided, i.e.

1. Smoking should be strictly stopped.
2. Passive smoking is stopped.
3. Gas smoke is avoided by housemakers.
4. Aerosols such as hair spray, insecticide spray and aerosols should be avoided.
5. Polluted atmosphere should be strictly avoided.

2. Treatment ofan infection:

1. Ampicillin 250–500 mg every 6 hourly is given for 5 to 7 days.
2. Cotrimazole 960 mg can be given as BD dose.
3. Antibiotics should be given till purulent mucous become mucoid.
4. If necessary modify antibiotics as per culture and sensitivity test.

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3. Bronchodilators:

1. In mild­to­moderate chronic bronchitis oral theophylline 150 mg BD or inhaled salbutamol 200 μg 6 hourly can be given.
2. In severe bronchitis, ipratropium bromide 40–80mcg 6 hourly is added.

4. Mucolytic agents: Bromhexine and carbocystein are to be given.

5. Corticosteroids: Prednisolone 30 mg/day for 2 weeks is given. If improvement occur by oral steroids, they are replaced by inhalational steroids.

6. Domiciliary oxygen therapy: Long­term oxygen therapy in low concentration i.e. 2 L/min by nasal cannula is given to reverse or to delay development of pulmonary hypertension.