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It's not BRONCHITIS, is it?

We should talk about this. It helps to think about the basic anatomy of the lungs. Remember that big oak tree in the front yard? Well, that’s how you should think of the lungs, except the tree is upside down. That is to say, the trunk is at the top with branches (the bronchi) coming off as you go down, the smallest ones being at the bottom. The deep lung tissue is where oxygen is exchanged, much like the leaves of a tree. In bronchitis, the larger airways (the trunk of the tree and nearby branches) are inflamed. This contrasts with pneumonia, in which the deep lung tissues are affected.

How can you distinguish bronchitis from pneumonia?

In addition to cough, the symptoms of bronchitis may include pain in the chest with deep breaths. Less commonly, there may also be fevers and chills, wheezing, and shortness of breath.

Because acute bronchitis is usually caused by a virus, antibiotics are usually not effective in alleviating the cough. However, the presence of a high fever, as well as rapid breathing or rapid heart rates, or the presence of abnormal breath sounds through a stethoscope, alert your health care provider to the possibility of pneumonia. To make the important decision about antibiotic use in this case, a chest x-ray may be helpful.

It is also important to make a distinction between acute bronchitis and chronic bronchitis. The latter is typically associated with years of cigarette smoking, is often caused by bacterial infection, and should generally be treated with antibiotics to prevent worsening breathing problems. (Smokers are also more susceptible to respiratory illness of any kind than non-smokers.)

Are there other conditions that can produce coughing?

Yes, among which are postnasal drip, asthma, allergies, gastroesophageal reflux (otherwise known as “GERD” or “heartburn”), and sinusitis.

What about all the phlegm I am coughing up?

Research indicates that the color or consistency of phlegm is not a reliable predictor of bacterial infection. Sometimes, your clinician may need to order a lab test on the phlegm to tell if it is caused by bacterial infection.

So are you going to prescribe antibiotics? My friend just got an antibiotic prescription for her bronchitis.

The American College of Physicians, in an important consensus statement in 2001, advised: “Routine antibiotic treatment of uncomplicated acute bronchitis is not recommended, regardless of duration of cough.” Again, this is because most cases are caused by viruses.

Non-routine cases include bacterial infection with pertussis, due to Bordatella pertussis bacteria, commonly known as whooping cough, which can cause persistent coughing in adults and should be treated early with antibiotics to help prevent spread to other adults and, especially, young children.

Other causes of acute bacterial bronchitis include Mycoplasma pneumoniae bacteria which can be treated with antibiotics to shorten the course of symptoms. The presence of bacterial infections may be confirmed through laboratory testing.

So, I would request that your health care provider explain the rationale for prescribing antibiotics for a cough. A couple of important considerations are that the more antibiotics are used, even when indicated, the more we select for resistant strains of bacteria, which has implications for treating infections in others. Also, adverse reactions to antibiotics are not uncommon, ranging from less serious conditions such as stomach upset, diarrhea, and yeast infections, to potentially life threatening ones, such as anaphylaxis or liver failure.

If you’re not prescribing antibiotics, how can I get better?

A few ways that you can feel better are to get plenty of rest, drink extra fluids (non-caffeinated, non alcoholic), inhale steam in the shower, and avoid cigarette smoke or other fumes. If you are having post nasal drip ( a sense of fluid from the nose collecting in the back of the throat), taking pseudoephedrine (Sudafed, and others) may help. A combination of guiafenesin and dextromethorphan (Robitussin DM and others) may also provide some relief. Prescription medications that may help include codeine and inhaled ipratropium.

The cough of viral types of acute bronchitis should clear up within two weeks. If you have been coughing for more than a week and are concerned, please contact HBS Health Services in Cumnock Hall (495-6455) to make an appointment for further evaluation.

How can I prevent this in the future?

Viruses are not very smart, but they are good at what they do. So, despite one’s best efforts, bronchitis can still occur. Nonetheless, some of the things you can do to lower the chance of acquiring respiratory infections are: getting adequate rest, trying to avoid close contact with others with respiratory illness (admittedly a challenge in a classroom setting), washing your hands regularly using soap and water or Purell hand sanitizer, and not smoking.

Gee, this is helpful information. Thanks.

You are very welcome. By the way, studies also indicate that patient satisfaction is most closely tied to how carefully a provider listens and explains. Get better soon!!

This Harbus article was created by Dr. Perlo to help the HBS community manage a problem that is very common among HBS students and staff. The information contained in the article reflects current medical evidence and best practices. I hope you find it helpful. If you need medical advice or assistance for this or any other problem, please call us at 495-6455. Thanks!

Dr. Bruce Biller

January 18, 2005
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