Bronchitis

Words: Dr Rajgopal NIDAMBOOR 

All of us have tiny, bristly hair that protect the openings of our nostrils. Their occupation — when we breathe in air — is to sieve dust, pollen, pollutants, and other particles, including germs. Yet, the downside is tiny bits of such particles, and other airborne offenders, slip through the ‘defence,’ at times and reach the respiratory tract. This could activate certain disorders, such as bronchitis.

Bronchitis is inflammation [the elementary response to infection] of the respiratory tract [airway] that delivers air into the lungs. It isn’t, nonetheless, as simple as it sounds. Clinicians say that death rates owing to complications arising from bronchitis have swelled during the last two decades. This is a source for disquiet — it highlights, no less, the magnitude of discounting, or not attending promptly to certain warning signs and symptoms, viz., allergic cough, or sinusitis.

Types

Bronchitis may present as acute [short-term], or chronic [long-lasting] infection. Acute bronchitis is a condition that comes on swiftly; it can cause irritating cough and other symptoms. Most often, it lasts for no longer than a couple of weeks. The cause may be one among the several viruses that infect the respiratory tract and attack the bronchial tubes [airways]. Infection by bacteria can also cause acute bronchitis. Most of us would have had acute bronchitis at some point in time.

What occurs in bronchitis? The respiratory airways and their branches in the lungs get swollen. This may be a result of infection, or allergy [allergic bronchitis]. Likewise, inhalation of fumes, including tobacco smoke, or pollutants, aside from chemical solvents, may also lead to bronchitis. When acute bronchitis is left untreated, it can cause pneumonia. By the same token, untreated, or neglected, chronic bronchitis can lead to lung tissue damage and subsequent drop in breathing capacity [volume of air we breathe in and exhale].

Symptoms

Fever, sore throat, nasal obstruction, or sinusitis. These may often precede bronchitis. When the problem becomes intense, or chronic, there may be excess cough with phlegm [thick mucous, or mucous plugs], discomfort in the chest, shallow breathing and sometimes wheezing. Chronic bronchitis is a long-standing inflammatory condition — it results in increased production of mucous, as well as other changes, such as frequent and severe respiratory infections and narrowing of the breathing tubes [bronchi], along with difficulty in breathing.

Things To Do

  • Drink plenty of fluids; avoid smoking, caffeine and alcohol
  • Get plenty of rest
  • Never give aspirin to a kid; it may lead to Reye syndrome and affect the liver and brain
  • Increase the humidity in your home, or use a humidifier.

Diagnosis

It isn’t as easy as one may think to make a distinction vis-à-vis the signs and symptoms of bronchitis from those of a common cold, especially during the first few days of the illness. Your doctor may listen carefully to what happens in your lungs as you breathe — with the stethoscope — and, arrive at a possible diagnosis.

The following tests are often handy:

Chest X-ray. This helps to establish the presence of pneumonia, or a different respiratory condition — the cause of your cough. This is especially important if you ever were, or currently, are a smoker.

Sputum tests. Sputum is the mucous that you cough up from your lungs. It can also be tested for signs of allergies.

Pulmonary function test. This test prompts you to blow into a device called the spirometer, which measures the amount of air your lungs can hold and how quickly you’d get it out of your lungs. This helps to decipher the signs of asthma, or emphysema — a lung condition that causes shortness of breath.

Treatment

Ayurveda

Introduction. Talisadi churna [TC] is an Ayurveda formulation indicated in managing Kaphaja kasa. The symptoms of Kaphaja kasa, narrated in the Ayurveda classical texts, resemble chronic bronchitis [CB].

This open-label, single-arm, prospective study was planned to evaluate the efficacy of TC in the management of CB.

Materials & Methods. Seventy-five patients, who fulfilled the inclusion criteria for CB, were enrolled at Central Ayurveda Research Institute for Respiratory Disorders, Patiala. They were treated by oral administration of TC 3gm, thrice a day, for 12 weeks, with a post-treatment follow-up after four weeks.

The results were assessed by change in Leicester Cough Questionnaire [LCQ] Score, episodes of acute exacerbation, change in St George’s Respiratory Questionnaire [SGRQ] Score for quality-of-life, functional/exercise capacity [change in peak expiratory flow rate [PEFR] and FEV1%, viz., total volume of air that can be exhaled during a maximal forced expiration effort] and occurrence of adverse events.

Results. Sixty-eight participants completed the study. Significant results [P<0.001] were found in wheezing, nausea, etc., and in the cardinal symptoms, such as breathlessness, cough, and expectoration. Statistically significant changes were found in LCQ, SGRQ, and PEFR parameters. No adverse events were reported during the study period.

Conclusion. Talisadi churna may be found effective in conditions, such as chronic bronchitis. Based on the promising results of this study, randomised controlled trials with adequate sample size may be planned on Talisadi churna in chronic bronchitis compared to standard care, or as an add-on therapy with conventional medicine.

  • Tomar R, et al, “A Clinical Study to Evaluate the Efficacy of Ayurvedic Intervention in the Management of Chronic Bronchitis.” Journal of Research in Ayurvedic Sciences, 2022; 6:101-8.

Homeopathy

Simple and mucopurulent chronic bronchitis [SMCB] is characterised by recurrent mucoid, or mucopurulent sputum, production in the absence of localised suppurative disease.

This observational open label study was undertaken to evaluate the effects of homeopathic medicine in SMCB.

Methods. 1,902 patients were screened from seven centres, out of which 1,305 were excluded. 597 patients were enrolled as per the inclusion and exclusion criteria. A total of 14 pre-defined homeopathic medicines were shortlisted for prescription after repertorising the pathological symptoms of SMCB.

Outcomes were changes in symptoms score using chronic bronchitis symptom scale [CBSS] and changes in FEV1/ FVC ratio — a ratio that reflects the amount of air you can forcefully exhale from your lungs — using spirometry over a period of two years.

Appearance of any change [relief/worse]/status quo was immediately followed by placebo/change in dilution/change in remedy.

Statistical analysis was done using SPSS version 21.

Results. 532 patients were analysed under intention to treat principle using last observation carry forward method. Mean CBS score reduced from 29.86±4.5 at baseline to 12.33±7.6 at completion of two years. Repeated measures, ANOVA, at time points 0 [baseline], 3, 6, 9, 12, 15, 18, 21 and 24 months, showed significant reduction in CBS scores [Wilk’s Lambda 0.104, F=564, df 524; p=00001]. The FEV1 and FEV1/FVC was maintained within normal limits. 86 per cent of prescriptions included Lycopodium clavatum, Arsenicum album, Pulsatilla, Phosphorus, Stannum metallicum, Calcarea carbonica, Silicea, and Bryonia alba.

Conclusion. The results suggest the effectiveness of homoeopathic treatment in early stages of SCMB patients.

  • Roja Varanasi, et al. “Management of Early Years of Simple and Mucopurulent Chronic Bronchitis with Pre-Defined Homoeopathic Medicines — A Prospective Observational Study with 2-Years’ Follow-Up,” International Journal of High Dilution Research, Vol 18 No. 3-4 [2019].

Nutrition

This study clarifies the possible role of N-acetylcysteine [NAC] in the treatment of patients with chronic bronchitis and chronic obstructive pulmonary disease [COPD]. A meta-analysis was performed to test the available evidence that NAC treatment may be effective in preventing exacerbations of chronic bronchitis, or COPD, and also for evaluating whether there is a substantial difference between the responses induced by low [≤600mg per day] and high [>600 mg per day] doses of NAC.

The results of the present meta-analysis [13 studies, 4,155 COPD patients, NAC n=1933; placebo, or controls n=2222] showed that patients treated with NAC had significantly and consistently fewer exacerbations of chronic bronchitis, or COPD [relative risk 0.75, 95 per cent CI 0.66–0.84; p<0.01], although this protective effect was more apparent in patients without evidence of airway obstruction. However, high doses of NAC were also effective in patients suffering from COPD diagnosed using spirometric criteria [relative risk 0.75, 95 per cent CI 0.68–0.82; p=0.04]. NAC was well tolerated and the risk of adverse reactions was not dose-dependent [low doses relative risk 0.93, 95 per cent CI 0.89–0.97; p=0.40; high doses relative risk 1.11, 95 per cent CI 0.89–1.39; p=0.58].

The strong signal that comes from this meta-analysis leads us to state that if a patient suffering from chronic bronchitis presents with documented airway obstruction, NAC should be administered at a dose of ≥1200mg per day to prevent exacerbations, while for a patient suffering from chronic bronchitis, but is without airway obstruction, a regular treatment of 600mg per day seems to be sufficient.

  • Mario Cazzola, et al, “Influence of N-acetylcysteine on Chronic Bronchitis or COPD Exacerbations: A Meta-Analysis,” European Respiratory Review, 2015; 24: 451-461.
Dr RAJGOPAL NIDAMBOOR, PhD, is a wellness physician-writer-editor, independent researcher, critic, columnist, author and publisher. His published work includes hundreds of newspaper, magazine, web articles, essays, meditations, columns, and critiques on a host of subjects, eight books on natural health, two coffee table tomes and an encyclopaedic treatise on Indian philosophy. He is Chief Wellness Officer, Docco360 — a mobile health application/platform connecting patients with Ayurveda, homeopathic and Unani physicians, and nutrition therapists, among others, from the comfort of their home — and, Editor-in-Chief, ThinkWellness360.

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