A Family Doctor's Tale - BRONCHITIS

DOC I HAVE BRONCHITIS

Bronchitis is caused by infections and chemical fumes which irritates the air tubes and produce narrowing of the air tubes resulting in wheezing and breathlessness in the patient.

The danger is pneumonia especially in the very young and very old.

Treatment is with bronchodilators, oxygen, rest and adequate fluids.

Antibiotics, antivirals and antifungals are used to treat the infections.

Avoid dust and chemical fumes as preventive measures.


Bronchitis is an acute disease which causes inflammation and infection of the trachea, bronchi and bronchioles of the lungs.

The mucous membranes of the bronchi of the lungs becomes inflamed from bacterial or viral infection or irritated by fumes and dust in the air resulting in swelling of the bronchial mucosa with excess mucous discharge causing narrowing of the air passages.

Because of the congestion of the bronchi there is difficulty in breathing and insufficient oxygen to the body thus posing a danger to the patient's life .

The causes of Bronchitis are:


Bacterial Infections:

1.Gram positive bacteria such as Streptococcus Bronchitise and Staphphylococcus may be serious and fatal in some cases.

2.Gram negative bacteria such as Klebsiella,  E.coli,  Pseudomonas, Mycobacteria(including tuberculosis),  Legionaire's Disease, chlamydia

Viral infections:

Influenza,  arbovirus,  Severe Acute Respiratory Syndrome(SARS) virus,  coxsackie virus

Fungal infections:

Cryptococcus neoformans

Non-infectious:


1.chemicals such as fumes can damage the lungs and cause Bronchitis

2.Othostatic Bronchitis occurs in people who are bedridden and are unable to get rid of the fluids accumulated in their lungs

3.Aspiration Bronchitis occurs with saliva or fluids in the throat become sucked into the windpipe and the lungs.
This occurs in comatose patients and people having seizures or stroke.



Symptoms:

1.cold or runny nose is usually the first symptom

2.Fever may be present

3.cough initially dry, followed by productive purulent sputum which can yellow, green or bloody

4.Breathlessness due to airway obstruction

5.chest pain especially the sides of the chest due to coughing and fever

6.Myalgia (bodyaches) and headache which may be related to the fever

Signs:

1.Moist sounds and wheezing on auscultation with stethoscope due to narrowing of the airways(bronchi)

2.rhonchi or wheezing sounds due to narrowing of the airways from pressure in the congested lungs

3.Reduced breath sounds - air movement is reduced in the lungs

4.Hyporesonance on percussion of the lungs

5.Cyanosis (blue color) of the lips and fingers if not enough oxygen is entering.This will considered as a medical emergency.

Children and babies with Bronchitis may not have signs of a chest infection.
They are however quite ill, with fever and lethargy.

Diagnosis of Bronchitis is made through:


1.Symptoms and signs of fever, breathless and productive cough

2.blood tests (complete blood count, ESR and blood culture)

3.Sputum culture to determine the type of micro-organism

4.Chest X-rays to establish site and character of the bronchial infection

5.CT or MRI of the lungs may be done if required especially if there is suspicion of lung cancer.

The complications of Bronchitis are:


1.Pneumonia

2.adult respiratory distress syndrome

3.Emphysema

Treatment of Bronchitis is by:


1.Rest, fluids and oxygen

2.Bronchodilators such as aminophylline, ventolin, bricanyl

3.Antibiotics depending on the organism found:

a.cephalosporin, penicillin, ampicillin, tetracycline, for most streptococci, staphalococci, hemophilus

b.cephalosporins, gentamycin for pseudomonas

c.Tetracycline or erythromycin for mycoplasma and chlamydia

d.Erythromycin and rifampicin for Legionaire's disease.

3.Antivirals such as Tamiflu for Influenza infection
Acyclovir may be given for herpes virus infection

4.High dosages of antifungals may be given for Fungal Bronchitis for a prolonged period of time

5.corticosteroids is useful to reduce complications

6.Humidifiers and steam inhalations

5.cough mixtures and mucolytic agents such as bisolvon

The prognosis of Bronchitis  depends on the severity and type of infection.

Most cases if treated early and correctly recovered completely with return of normal lung function.

In elderly and debilitated patients, breathing can be a problem and recurrence can occur.

Preventive measures taken for Bronchitis are:


1.Avoid smoking and dusty environment.

2.Healthy lifestyle with balanced diet and exercise.

3.Vaccination against the influenza virus may help.