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Bronchitis | | Description |
Bronchitis is an inflammation of the bronchial lining caused by cold, or
by the excessive consumption of tobacco. It is marked by an intense and
persisting cough, hypersecretions in the morning, respiratory difficulty
when exercising, and variable fever.
Bronchitis is an inflammation
of the trachea and bronchial tree. Bronchitis may be either acute or
chronic. Acute bronchitis may be caused by viral or bacterial infections
and is often preceded by an upper respiratory tract infection. Acute
bronchitis may also result from irritation of the mucous membranes by
environmental fumes, acids, solvents, or tobacco smoke. Bronchitis usually
begins with a dry, nonproductive cough. After a few hours or days, the
cough may become more frequent and produce mucus. A secondary bacterial
infection may occur, in which the sputum (bronchial secretions) may
contain pus. People whose cough and/or fever continues for more than seven
days should visit a medical practitioner.
Chronic bronchitis may
result from prolonged exposure to bronchial irritants. Cigarette smoking,
environmental toxins, and inhaled allergens can all cause chronic
irritation of the bronchi. The cells lining the bronchi produce excess
mucus in response to the chronic irritation; this excess mucus production
can lead to a chronic, productive cough.
Bronchitis can be
particularly dangerous in the elderly and in people with compromised
immune systems. These people should see a doctor if they develop a
respiratory infection.
What are the symptoms of bronchitis?
Acute infectious bronchitis is often preceded by signs of an upper
respiratory tract infection: stuffy or runny nose, malaise, chills, fever,
muscle pain, and sore throat. The cough is initially dry and does not
produce mucus. Later, small amounts of thick green or green-yellow sputum
may be coughed up.
Chronic bronchitis is characterized by a
productive cough that initially occurs only in the
morning.
Conventional Treatment Options: Rest and oral fluids are
recommended in the fever stage of acute bronchitis. Antibiotics are used
when the sputum becomes dark green or yellow, indicating a bacterial
infection. For most adults, tetracycline (Achromycin, Sumycin) or
ampicillin (Amficot, Omnipen, Principen, Totacillin) are the antibiotics
used first. Alternatively trimethoprim/sulfamethoxazole (Bactrim, Septra)
may be recommended. Symptomatic treatment of cough may be given to aid
sleep, although coughing is important during the day to clear out infected
sputum. Antitussives (cough suppressants) include dextromethorphan (e.g.,
Benylin DM, Vicks Formula 44) and codeine. The most commonly used
expectorant (drug that stimulates expulsion of bronchial secretions) is
guaifenesin (e.g., Guiatuss, Humibid, Robitussin).
Treatment of
chronic bronchitis includes smoking cessation and a variety of drugs
directed at relieving symptoms (e.g., Beta2-agonists) or treating
superimposed bacterial infections (antibiotics).
Dietary changes
that may be helpful: Dietary factors may influence both inflammatory
activity and antioxidant status in the body. Increased inflammation and
decreased antioxidant activity may each lead to an increased incidence of
chronic diseases, such as chronic bronchitis. People suffering from
chronic bronchitis may experience an improvement in symptoms when
consuming a diet high in anti-inflammatory fatty acids, such as those
found in fish. In a double-blind study of children with recurrent
respiratory tract infections, a daily essential-fatty-acid supplement
(containing 855 mg of alpha-linolenic acid and 596 mg of linoleic acid)
reduced both the number and the duration of recurrences.
In people
with bronchitis, lipids in the lung tissue may undergo oxidation damage
(also called free-radical damage), particularly when the bronchitis is a
result of exposure to environmental toxins or cigarette smoke. A diet high
in antioxidants may protect against the free radical-damaging effect of
these toxins. Studies comparing different populations have shown that
increasing fruit and vegetable (and therefore, antioxidant) consumption
may reduce the risk of developing chronic bronchitis.
Food and
environmental allergies may be triggering factors in some cases of chronic
bronchitis. Cows' milk allergy has been associated with bronchitis in
children, and some doctors believe that dairy products may increase mucus
production and, therefore, that people suffering from either acute or
chronic bronchitis should limit their intake of dairy products. Ingestion
of simple sugars (such as sucrose or fructose) can lead to suppression of
immune function; therefore, some doctors believe simple sugars should be
avoided during illness.
Lifestyle changes that may be
helpful: Breast-feeding provides important nutrients to an infant and
improves the functioning of the immune system. Studies have shown that
breast-feeding prevents the development of lower respiratory tract
infections during infancy. Whether that protective effect persists into
adulthood is not known. Exposure to environmental chemicals, including
passive smoke, can increase the incidence of respiratory illness among
children.
Chronic bronchitis is frequently associated with smoking
and/or environmental exposure to chemicals or allergens. These exposures
should be avoided to allow the cells of the bronchi to recover from
chronic irritation and to decrease the burden on the immune
system.
Nutritional supplements that may be helpful: In a
double-blind study of elderly patients hospitalized with acute bronchitis,
those who were given 200 mg per day of vitamin C improved to a
significantly greater extent than those who were given a placebo. The
common cold may lead to bronchitis in susceptible people, and numerous
controlled studies, some double-blind, have shown that vitamin C
supplements can decrease the severity and duration of the common cold in
otherwise healthy people.
Vitamin C and vitamin E may prevent
oxidative damage to the lung lipids by environmental pollution and
cigarette smoke exposure. It has been suggested that amounts in excess of
the RDA (recommended dietary allowance) are necessary to protect against
the air pollution levels currently present in North America, although it
is not known how much vitamin E is needed to produce that protective
effect.
A review of 39 clinical trials of N-acetyl cysteine (NAC)
found that 400 to 600 mg per day was a safe and effective treatment for
chronic bronchitis. NAC supplementation was found to reduce the number of
aggravations of the illness in almost 50% of people taking the supplement,
compared with only 31% of those taking placebo. Smokers have also been
found to benefit from taking NAC. In addition to helping break up mucus,
NAC may reduce the elevated bacterial counts that are often seen in the
lungs of smokers with chronic bronchitis. In another double-blind study,
people with chronic bronchitis who took NAC showed an improved ability to
expectorate and a reduction in cough severity. These benefits may result
from NAC's capacity to reduce the viscosity (thickness) of
sputum.
Vitamin A levels are low in children with measles, an
infection that can result in pneumonia or other respiratory complications.
A number of studies have shown that supplementation with vitamin A
decreased complications and deaths from measles in children living in
developing countries where deficiencies of vitamin A are common. However,
little to no positive effect, and even slight adverse effects, have
resulted from giving vitamin A supplements to prevent or treat infections
in people living in countries where most people consume adequate amounts
of vitamin A. Therefore, vitamin A supplements may only be useful for
people with bronchial infections who are known to be deficient in vitamin
A.
The thymus gland plays a number of important roles in the
functioning of the immune system. Thymus extract from calves, known as
Thymomodulin, has been found, in a double-blind study, to decrease the
frequency of respiratory infections in children who were prone to such
infections. The amount of Thymomodulin used in that study was 3 mg per kg
of body weight per day.
Are there any side effects or
interactions? Refer to the individual supplement for information about
any side effects or interactions.
Herbs that may be helpful:
Several types of herbs may help people with bronchitis, either by treating
underlying infection, by relieving inflammation, or by relieving symptoms
such as cough. For clarity, the table below summarizes which herbs are in
each category of action. Some herbs have more than one action. Herbs
listed in the table have not necessarily been proven to be effective. The
herbs are discussed in more detail following the table.
Expectorant
herbs help loosen bronchial secretions and make elimination of mucus
easier. Numerous herbs are traditionally considered expectorants, though
most of these have not been proven to have this effect in clinical trials.
Anise contains a volatile oil that is high in the chemical constituent
anethole and acts as an expectorant.
Horehound has expectorant
properties, possibly due to the presence of a diterpene lactone in the
plant, which is known as marrubiin.
Mullein has been used
traditionally as a remedy for the respiratory tract, including bronchitis.
The saponins in mullein may be responsible for its expectorant
actions.
Pleurisy root is an expectorant and is thought to be
helpful against all types of respiratory infections. It is traditionally
employed as an expectorant for bronchitis. However, owing to the cardiac
glycosides it contains, pleurisy root may not be safe to use if one is
taking (heart medications. This herb should not be used by pregnant
women.
Anti-inflammatory herbs may help people with bronchitis.
Often these herbs contain complex polysaccharides and have a soothing
effect; they are also known as demulcents. Plantain is a demulcent that
has been documented in two preliminary trials conducted in Bulgaria to
help people with chronic bronchitis. Other demulcents traditionally used
for people with bronchitis include mullein, marshmallow, and slippery elm.
Because demulcents can provoke production of more mucus in the lungs, they
tend to be used more often in people with dry coughs.
Elecampane is
a demulcent that has been used to treat coughs associated with bronchitis,
asthma, and whooping cough. Although there have been no modern clinical
studies with this herb, its use for these indications is based on its high
content of soothing mucilage in the forms of inulin and alantalactone.
However, the German Commission E monograph for elecampane does not approve
the herb for bronchitis.
Ivy leaf is approved in the German
Commission E monograph for use against chronic inflammatory bronchial
conditions. One double-blind human trial found ivy leaf to be as effective
as the drug ambroxol for chronic bronchitis. Ivy leaf is a non-demulcent
anti-inflammatory.
Chinese scullcap might be useful for bronchitis
as an anti-inflammatory. However, the research on this herb is generally
of low quality. Antimicrobial and immune stimulating herbs may also
potentially benefit people with bronchitis.
Echinacea is widely
used by herbalists for people with acute respiratory infections. This herb
stimulates the immune system in several different ways, including
enhancing macrophage function and increasing T-cell response. Therefore,
echinacea may be useful for preventing a cold, flu, or viral bronchitis
from progressing to a secondary bacterial infection.
Thyme contains
an essential oil (thymol) and certain flavonoids. This plant has
antispasmodic, expectorant, and antibacterial actions, and it is
considered helpful in cases of bronchitis. One preliminary trial found
that a mixture containing volatile oils of thyme, mint, clove, cinnamon,
and lavender diluted in alcohol, in the amount of 20 drops three times
daily, reduced the number of recurrent infections in people with chronic
bronchitis.
Horseradish contains substances similar to mustard,
such as glucosinolates and allyl isothiocynate. In addition to providing
possible antibacterial actions, these substances may also have expectorant
properties that are supportive for persons with
bronchitis.
Eucalyptus leaf tea is used to treat bronchitis and
inflammation of the throat, and is considered antimicrobial. In
traditional herbal medicine, eucalyptus tea or volatile oil is often used
internally as well as externally over the chest; both uses are approved
for people with bronchitis by the German Commission E.
Lobelia
contains many active alkaloids, of which lobeline is considered the most
active. Very small amounts of this herb are considered helpful as an
antispasmodic and antitussive agent (a substance that helps suppress or
ease coughs). Anti-inflammatory properties of the herb have been
demonstrated, which may be useful, since bronchitis is associated with
inflammation in the bronchi. Lobelia should be used cautiously, as it may
cause nausea and vomiting.
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A Selection of Products that may be useful for Bronchitis.
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