Acute Bronchitis

Overview of Acute Bronchitis:

In more than 90% of cases, the cause is a viral infection. The most common symptom is a cough. Other symptoms include coughing up mucus, wheezing, shortness of breath, fever, also chest discomfort. The infection may last from a few to ten days. Therefore, the cough may persist for several weeks afterward with the total duration of symptoms usually around three weeks. Some have symptoms for up to six weeks.[1]

Causes

• Viruses,
• Bacteria or
• External irritants.

Types of Acute Bronchitis

Acute Bronchitis depends on its causes i.e.:

• Viral bronchitis: Viral infections cause most cases of bronchitis.
• Bacterial bronchitis: Bacterial infections can also cause bronchitis.
• Fungal infections occasionally cause bronchitis.[4]

Risk Factors

• Infection – Either bacterial or viral, or descending infection from nasal sinuses or throat.
• Complicating other diseases – e.g. measles, whooping cough.
• Physical and chemical irritants – Inhaled dust, steam, gases like SO2, ether
• Allergic bronchitis – following inhalation of pollens or organic dusts.

Pathophysiology of Acute Bronchitis

• The causative agent is transmitted through the large and medium size airway tracts.
• Following transmission, the agent inoculates the tracheobronchial epithelium.
• This process leads to inflammation, thickening, and increased mucus production in the airways compared to normal bronchi
• On microscopic analysis, epithelial-cell desquamation and denuding of the airway to the level of the basement membrane, in association with the presence of a lymphocytic cellular infiltrate, have been demonstrated.

Sign & Symptoms:

1. Toxemic– such as Malaise, fever, palpitation, sweating, etc.
2. Irritative – Cough with expectoration, at first scanty viscid sputum, later more copious and mucopurulent; either substernal pain or raw sensation under the sternum.
3. Obstructive – Choked up feeling, paroxysms of dyspnea particularly following spells of coughing relieved with expectoration.[1]

Signs
In early stages few abnormal signs apart from occasional rhonchi. Then, After 2 or 3 days diffuse, bilateral rhonchi, often with rales at the bases, prolonged expiration and an expiratory wheeze.[1]

Clinical Examination of Acute Bronchitis

A physical examination will often reveal decreased intensity of breath sounds, wheezing, rhonchi, and prolonged expiration.

During examination for physicians rely on history and the presence of persistent or acute onset of cough, followed by a URTI with no traces of pneumonia. After that, Acute bronchitis is typically a clinical diagnosis that relies on patients’ history and exam, and should be suspected in patients with an acute onset of cough, which often follows a URTI without traces of pneumonia.

Diagnostic Criteria:

Although there is no universally-accepted clinical definition for acute bronchitis, there is a proposed set of practical criteria that include:

• An acute illness of less than three weeks.
• Cough as the predominant symptom.
• At least one other lower respiratory tract symptom, such as sputum production, wheezing, chest pain.
• No alternative explanation for the symptoms.[1]

Furthermore, Decreased breath sounds, crackles, wheezing, and rhonchi that clears with coughs may be heard in the chest. Dullness to percussion and pleural rub suggest disease extension beyond the bronchi such as seen with pneumonia. Paroxysms of cough followed by inspiratory whoop and vomiting suggests pertussis.[1]

Differential Diagnosis of Acute Bronchitis

• Chronic Bronchitis
• Pneumonia
• Asthma
• GERD[5]

Investigations 

A variety of tests may be performed in people presenting with cough and shortness of breath for example:

• A chest X-ray is useful to exclude pneumonia which is more common in those with a fever, fast heart rate, fast respiratory rate, or who are old.
• A sputum sample showing neutrophil granulocytes (inflammatory white blood cells) also culture showings that has pathogenic microorganisms such as Streptococcus
• A blood test would indicate inflammation (as indicated by a raised white blood cell count and elevated C-reactive protein).

Treatment of Acute Bronchitis:

• Most cases are self-limited and resolve themselves in a few weeks. Pain medications may help with symptoms. Other recommendations may include rest and keeping well hydrated
• Appropriate antibiotic therapy, e.g., amoxicillin, cephalosporin or clarithromycin. Bronchodilators in patients with chronic airflow limitation. [1]

Prevention of Acute Bronchitis

• Stopping smoking i.e.: It is essential to take steps to quit smoking and avoid secondhand smoke. Smoking weakens the immune system, making it harder to fight infections. Quitting smoking is the single best thing a person can do to improve their lung health.
• Avoiding pollution i.e.: Avoiding areas with high levels of air pollution, dust, or fumes can help lower the risk of bronchitis and other lung conditions, such as asthma.
• Wearing a mask i.e.: A mask that covers both the mouth and the nose can help to prevent exposure to lung irritants and decrease airway inflammation.
• Getting vaccinated i.e.: In most cases, people should get a yearly flu shot, along with routine vaccinations for pneumonia and whooping cough. Preventing lung infections keeps people healthier year round.
• Hand washing i.e.: Washing hands regularly, as well as keeping surfaces clean, may help to prevent viruses from infecting others.[4]

Homeopathic Treatment 

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

Which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?
The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.
The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improve with homeopathic medicines.

Homeopathic Medicines:

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.
So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

Aconite

Short, dry, titillating cough, resulting from an exposure to dry, cold air, also increased by every respiration; painful sensitiveness of the affected parts, aggravated by breathing, coughing and talking; dry cough morning and evening; sleep constantly disturbed by the cough; cough dry and tickling at night.
Incipient stages of catarrhal and inflammatory conditions, with fever, great restlessness, hot skin, anxiety; from exposure, whereby the perspiration is suddenly suppressed. In addition, Affection of larynx and bronchi (>) when lying on back.

Allium Cepa

Cough with coryza, acrid discharge from the nose, bland lachrymation. Smarting and redness of the eyes; cough (<) in the evening and at night; amelioration in the fresh air; left side of the head more affected than the right one; sneezing as often as he takes a long inspiration; cough worse in the evening, with sensation as if it would tear the larynx. Disease goes from left to right.

Antimonium Tartaricum

Especially useful for children, older people, lymphatic constitutions and catarrhal dispositions; violent tickling in windpipe, causing cough, (<) after midnight, so that he has to sit up on account of oppression and dyspnoea; coughing spell begins with suffocative feeling, a crowing, gasping for air, finally relieved by copious mucous expectoration; cough after angry spells in children; large collection of mucus in bronchial tubes, inhibiting the child from cough, and this causes drowsiness; cough with vomiting of food after eating; flapping, wing-like motion of the alae nasi at every act of respiration. All pulmonary symptoms associated with asthenia also prostration.

Antimonium Crudum

Especially if caused by bathing. The cough seems to start from the abdomen; gastric derangement.[2]

Apis Mell.

Laborious and panting breathing, no thirst; scanty urine; insomnia: abdominal breathing with sensation AS IF EVERY BREATH WERE HIS LAST ONE; (<) in warm room.

Aralia rac

Dry wheezing respiration with sense of impending suffocation; Additionally, the catarrhal process extending to the bronchial mucous membrane and constant desire to clear the chest; raw, burning, sore feeling behind the whole length of the sternum and in each lung.

Arsenicum

Arsenicum Iod

Catarrhal affections of the respiratory organs, with profuse, irritating watery discharge; pain in head as if from taking cold; hawking up thick mucus and clotted blood mixed; abdomen hard and distended with flatus; diarrhoea diurnal with urging; Lastly, itching of skin.

Badiaga

Spasmodic cough, with sneezing and lachrymation; during paroxysms crying and pressing hands upon head; sometimes strangling face turning dark, and thick, yellow, viscid mucus flying out of mouth and nostrils. Cough loose A.M., tight, P.M.

Belladona

Dry, barking, spasmodic cough in paroxysms; with titillation in trachea and bronchi; (<) at night and then continuous every quarter of an hour or oftener in three or four fits at a time; crying when coughing; sensation of constriction in throat with difficulty of swallowing; stitches in chest, congestion to head, hot skin, inclined to be moist; drowsy; sleepy, but cannot sleep; cough causes acute pain in left hypochondrium, shooting upward; (<) lying on either side or walking much; attacks of cough ending with sneezing.

Bryonia Alba

Concussive cough, dry, from the sternal region all over the chest, as if it would burst, with scanty, yellow or blood- streaked thin mucus, frequently with vomiturition and vomiting, especially after eating; difficulty of breathing, pleuritic stitches, producing pain in the head and chest, worse at night in bed, compelling one to spring up and assume an erect posture at once;

Cactus Grandi.

Especially for children; catarrh with mucous rales; great anguish, suffocation also palpitation of heart; oppression of chest, as from a great weight, difficult breathing, uneasiness, as if an iron band prevented normal motion of chest; spasmodic cough, with thick yellow sputa, like boiled starch; In addition, bronchial catarrh from overaction of the heart.

Calcarea Carb

Teething children; loose cough, rattling of mucus; oppression of chest as if too full; cough dry at night, loose in day time, (<) by inspiration also eating, playing piano profuse head sweat, particularly, during sleep.

Carbo Veg

Evening hoarseness; burning under sternum; soreness of chest and heat of body when coughing,. itching from throat down to centre of chest when coughing; paroxysmal cough, (<) by going into cold air from a warm room; cold knees in warm bed; pyrosis with great flow of water during day.

Causticum

Morning hoarseness; hollow, racking cough, (<) on getting warm in bed from evening to midnight, relieved by A SWALLOW OF COLD WATER; continual annoying cough, with involuntary discharge of drops of urine also pain over left hip; tightness of chest, must often take a deep breath, rattling in chest, expectoration cannot be raised, must be swallowed.[2]

Chamomilla

Dry cough, (<) at night, by anger and cold air, (>) from warmth and warm drinks; constant irritation to cough beneath the upper part of the sternum; expectoration only in day time; none at night; oppression of the chest either as if it were not wide enough, or as if the throat were throttled, with constant desire to cough; over sensitiveness of the nerves of women and children.

Chelidonium

Capillary bronchitis; difficult respiration with short fits of coughing RATTLING OF MUCUS IN CHEST, and forcible ejections of small lumps of mucus; bright-yellow thin stools; Furthermore, bronchitis of persons of blonde complexion, disposed to diarrhoea, failure of strength, sensation of throbbing in lungs; violent chills in evenings; sensation of dust in trachea and behind sternum; loose morning cough with copious expectoration.

Dulcamara

Cough from damp, cold atmosphere or from getting wet; patients have to cough a long time to expel phlegm, especially infants and old people, as the cough seems to come from abdomen and convulses the muscles of chest and abdomen, patient tries to relieve the pain in chest and hypochondria, holding them tightly; perspires immediately on waking from sleep; bronchitis from offensive- smelling night-sweats.

Hepar Sulph

Cough tight or loose, (<) mornings; from uncovering any part of the body; . from wrapping up and keeping warm; soreness and weakness in chest; tenacious mucus in the chest, with anxious, short, wheezing breathing, must bend the head back and sit up (Spong. forward). Additionally, Repelled eruptions.

Kali Bichrom

Dullness on percussion on either side of the spine; hard, barking cough starting from epigastrium; expectoration stringy and consisting of bluish lumps; additionally difficulty of breathing from thickening of the lining membrane of the bronchial tubes; cough (<) after eating or drinking, when undressing, morning on awaking; (>) after getting warm in bed; slight sore throat; pain at epigastrium; flatulence.

Kali Carb

Capillary bronchitis of children, cough with difficult expectoration, (<) after eating and drinking, and vomiting of sour phlegm; face pale, but red during cough; pains referred to abdomen because the lower lobes of lungs are infiltrated; livid face with puffed eyelids; sputa cannot be expectorated from mere muscular weakness and must be swallowed again; cough day and night, (<) from 3 to 4 A.M. and (>) after breakfast.[2]

Phosphorus

Firstly, Cough, with tearing pain under sternum as if something were torn loose; suffocative pressure in upper part of chest with constriction of larynx; mucous rales through lungs; panting and laboring respiration.
Secondly, dry short, barking cough, with expectoration of stringy sputa and of a salty taste, (<) from evening till midnight, from speaking, laughing, eating, motion also on going into the cold air; cannot lie on left side.

Spongia

Laryngo-and trachea-bronchitis. Croupy, dry, sibilant cough continuing day also night in long-lasting, distressing paroxysms, labored, crowing, wheezing inspirations, sometimes accompanied by rales.
Moreover, On every slight exposure the cough returns violently, with pressing dyspnea, sibilant bronchi, also violent convulsive cough. Dry bronchitis, with terrible, hard, dry, racking cough; much dyspnea and slight expectoration, (<) in hot room, by eating ever so little; stuffed, obstructed sensation, difficult inspiration, (<) by lying down, (>) by leaning forward and by eating and drinking.

Veratrum Alb

Capillary bronchitis, with livid face, blue nails, cold extremities and tumultuous, irregular contraction of the heart; acute bronchial catarrh in the emphysematous; bronchitis of the older people; cold perspiration on forehead when coughing; eyes half open during sleep; (<) morning and late evening till midnight, either going into warm room or getting warm in bed, by change of weather, eating and drinking cold things, especially warm, crying (children), vexation.[2]

Diet and Regimen of Acute Bronchitis:

• Provide a regular or high-calorie diet, specific to the patient’s needs.
• If milk gives a sensation of thickening mucus secretions, skim milk may better tolerate and is important for adequate calcium consumption.
• Provide adequate amounts of vitamins C and E, selenium, also potassium.
• Increase the intake of fluids (2–3 L), unless contraindicated.
• Appropriate fatty acid intake may be beneficial to reduce inflammation.
• A low energy intake may need after the acute phase to promote weight loss, improve BMI, also promote a healthier level of respiratory functioning.[3]

Do’s & Don’ts:

While Harrison’s Principles of Internal Medicine doesn’t explicitly list "Do’s and Don’ts" for acute bronchitis, the following can be inferred from the treatment recommendations and general principles:

Do’s:

• Rest: Get plenty of rest to allow your body to recover.
• Hydrate: Drink plenty of fluids to help thin mucus and make it easier to cough up.
• Relieve Symptoms: Use over-the-counter medications like acetaminophen or ibuprofen for fever and pain, and cough suppressants or expectorants for cough.
• Use a Humidifier: This can help soothe irritated airways and loosen mucus.
• Avoid Irritants: Stay away from smoke, dust, and other pollutants that can worsen your cough.
• Seek Medical Attention: If your symptoms worsen, you develop difficulty breathing, or your cough persists for more than three weeks, consult your doctor.

Don’ts:

• Smoke: Smoking irritates the airways and can worsen bronchitis.
• Overuse Antibiotics: Antibiotics are not effective against viral bronchitis, which is the most common cause. Taking antibiotics unnecessarily can contribute to antibiotic resistance.
• Ignore Worsening Symptoms: If your symptoms worsen or you develop new symptoms, seek medical attention promptly.[7]

References of Acute Bronchitis:

1. Text Book of Medicine by Golwala
2. Homoeopathic Therapeutic’s by Lilienthal
3. Nutrition and Diagnosis-Related Care (Nutrition and Diagnosis-Related Care ( Escott-Stump))
4. https://www.wikidoc.org/index.php/Acute_bronchitis_pathophysiology
5. https://www.wikidoc.org/index.php/Acute_bronchitis_differential_diagnosis
6. phcogj.com/sites/default/files/PharmacognJ-15-3-404.pdf
7. Harrison’s Principles of Internal Medicine, 21st Edition

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