Bronchitis is a respiratory tract infection (viral or bacterial) that causes inflammation of the mucous lining of the bronchial tubes. It can be acute or chronic. Acute bronchitis generally is reversible. Chronic bronchitis, referred to as smoker's cough, is one of several destructive pulmonary diseases and is not usually reversible.

Acute bronchitis is usually viral but can be bacterial and is generally community-acquired. The main causes of chronic bronchitis are cigarette smoking and prolonged exposure to air pollution or other bronchial irritants such as dust, grain, and mined products.

• Winter
• Cigarette smoking
• Air pollutants and irritants
• Male gender and over 50
• Severe pneumonia early in life

Acute bronchitis:

• Cough that produces mucus
• Burning sensation in the chest
• Sore throat and fever
• Fatigue/weight gain
• Cyanosis
• Wheezing

Chronic bronchitis:

• Chronic cough that produces excessive amounts of mucus or pus
• Wheezing, shortness of breath
• Present for at least three months a year, two years in a row

Differentrial Diagnosis

• Pneumonia
• Emphysema, tuberculosis, cystic fibrosis, asthma, Legionnaires' disease, pertussis
• Lung tumor
• Congestive heart failure
• Pulmonary embolus
• Sleep apnea

Bronchitis must be considered a diagnosis of exclusion because of serious, life-threatening lower respiratory diseases also associated with cough.

Auscultation may reveal wheezing and rhonchi.

Acute bronchitis (distinguish between viral and bacterial causes):

• Sputum culture, which is diagnostic for pneumonia and tuberculosis
• White blood cell count
• Increase in serum antibody titers
• Gamma M immunoglobulin-specific conjugate, which detects current infection
• Moderate to severe hypoxia

Chronic bronchitis (in addition to above):

• Spirometry for large airway obstruction and closing volume; maximal midexpiratory flow rate determinations for small airway obstruction

• Chest X ray to rule out pneumonia, heart failure, or pneumothorax complications
• Chest X ray for bronchovascular markings with chronic bronchitis
• Bronchoscopy or computed tomography for exclusion of endobronchial lesion or localized bronchiectasis

Bronchitis is diagnosed by the exclusion of other disease(s).

• Pulmonary function test
• ABGs
• Chest exam
• Electrocardiogram for differential diagnosis of chest pain
• Pulmonary function tests

Eliminating risk factors, preventing or treating infection, controlling bronchospasm, mobilizing secretions, and preventing chronic hypoxemia.

• Beta-sympathomimetic and anticholinergic bronchodilators for bronchospasm (e.g., from 2 to 4 to 6 to 12 puffs a day of albuterol)
• Corticosteroids (e.g., 20 to 40 mg/day of prednisone or 100 to 200 mcg, 2 to 4 puffs/day of inhaled beclomethasone) to reduce mucus and inflammation
• Symptomatic treatment: humidifier to loosen secretions; cough suppressants (only with dry cough or to allow sleep; not with bacterial infections); hydration
• Expectorant medication (e.g., 10 to 12 drops tid of potassium iodide) or tracheal suction
• Antibiotics with bacterial infection (e.g., 250 to 500 mg of penicillin or tetracycline every six hours for 10 days), sometimes given prophylactically
• Oxygen for hypoxia: more than 12 hours/day required to be effective

While acute bronchitis due to severe underlying pathology requires pharmacologic treatment, alternative therapies can be useful in treating bronchitis secondary to viral agents, allergens, and environmental irritants.

• Eliminate known allergenic foods, food coloring, preservatives, and additives. Reduce intake of mucus-producing foods such as dairy, citrus, wheat, and bananas. Increase fresh vegetables, fruits, and whole grains. Onions and garlic should be eaten liberally to thin mucus.
• Vitamin C (1,000 mg tid to qid), zinc (30 mg/day), and beta-carotene (50,000 to 100,000 IU/day) support the immune system and help to restore the integrity of the respiratory tract. Some studies have suggested that beta-carotene is contraindicated in smokers. N-acetylcysteine (200 mg bid between meals) protects lung tissue from oxidative damage and is a mucolytic agent.

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, it is important to ascertain a diagnosis before pursuing treatment. Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Infusions (teas) are made with 1 heaping tsp. herb per cup of hot water, steeped covered for 10 minutes; drink 3 to 4 cups/day. Tinctures may be used singly or in combination, 30 drops tid to qid.

A well-balanced formula contains herbs to increase the effectiveness of the cough (by stimulating expectoration or calming an irritable cough reflex), soothe irritated tissues, and support immune function. Licorice root should be avoided in hypertension; substitute grindelia (Grindelia robusta).

• Acute Bronchitis: Thyme leaf (Thymus vulgaris), licorice root (Glycyrrhiza glabra), coneflower (Echinacea purpurea), ginger (Zingiber officinales), and linden flowers (Tilia cordata). Smokers should substitute Indian tobacco (Lobelia inflata) for the linden flowers. White horehound (Marrubium vulgare) is a gentle stimulating expectorant and circulatory tonic that relaxes spasms of the bronchi. Sundew (Drosera rotundifolia) is a relaxing expectorant and antispasmodic with antimicrobial and mucolytic qualities.
• Chronic Bronchitis: Pleurisy root (Asclepias tuberosa), Indian tobacco, elecampane (Inula helenium), licorice root, lungwort (Sticta pulmonaria), and lomatium (Lomatium dissectum). Boneset (Eupatorium perfoliatum), a diaphoretic and antispasmodic herb, has traditionally been used for chronic bronchitis. Pill Bearing Spurge (Euphorbia hirta), an antispasmodic and mucolytic herb, is a specific for bronchial conditions.
• Garlic (Allium sativum)/ginger tea can be used long-term to relieve bronchitis and support immune function. Use 2 cloves of garlic and 2 to 3 slices of ginger root. Simmer in 1 cup of water for 10 to 15 minutes. Drink 3 to 4 cups/day. May add honey or lemon to flavor.

An experienced homeopath should assess individual constitutional types and severity of disease to select the correct remedy and potency. For acute prescribing use 3 to 5 pellets of a 12X to 30C remedy every one to four hours until acute symptoms resolve. It is imperative that the underlying condition be addressed; however, homeopathic remedies can be helpful in acute coughs or chronic coughs that fail to resolve.

• Antimonium tart for rattling cough with dizziness
• Hepar sulphuricum for later stages of bronchitis with wheezing, scant expectoration, and coughing that comes on when any part of the body gets cold
• Ipecacuanha for first stages of bronchitis with deep, wet cough and gagging from the cough
• Phosphorus for painful cough in patients who are thirsty and chilly

• Castor oil pack. Used externally, castor oil is a powerful anti-inflammatory. Apply oil directly to skin, cover with a clean soft cloth (e.g., flannel) and plastic wrap. Place a heat source (hot water bottle or heating pad) over the pack and let sit for 30 to 60 minutes. For best results, use for three consecutive days.
• Chest rubs with 3 to 6 drops of essential oil in 1 tbsp. of food grade oil (olive, flax, sesame, almond, etc.). Thyme, eucalyptus, and pine oils can be applied to ease bronchial spasm and help thin mucus. May combine this treatment with the castor oil pack.
• Running a humidifier with essential oils such as eucalyptus, tea tree, or marjoram at night may help thin mucus and ease cough.
• Postural drainage can be of great help in relieving congestion and removing mucus from the chest.

Acupuncture can bring relief to bronchial spasm and enhance immune function. Smoking cessation through acupuncture can be very successful.

Therapeutic massage can increase circulation. Tapotement (striking with the side of the hand), can be helpful in loosening mucus and aiding expectoration.

For acute presentation, closely follow temperature, respiratory rate, and white blood cell count. Altered mental status, infection, serious shortness of breath, and electrolyte abnormality warrant hospitalization.

Avoid causative environmental pollutants. Smoking cessation, annual influenza vaccinations, and a polyvalent pneumococcal vaccination (once in a lifetime or every five years if spleen has been removed) prevent complications and, possibly, irreversible progression.

• Lowered resistance to bronchopulmonary infection
• Pulmonary hypertension
• Pneumonia
• Inappropriate antibiotic use may cause resistance

Acute bronchitis: This condition takes one to eight weeks to resolve (with no complications).

Chronic bronchitis: Progressive airway damage, worsening exercise tolerance, acute respiratory failure, resting tachycardia, cor pulmonale, and comorbidity are indicators of poor prognosis.

Avoiding fetal hypoxia is essential in treating respiratory disorders during pregnancy. Ventilator support is sometimes required. Medications used for bronchodilation or for infection need to be carefully selected, as many have deleterious effects (e.g., use of albuterol has not been associated with congenital abnormalities, but tachyphylaxis can occur with prolonged use in late pregnancy). High doses of vitamins and herbal support should not be undertaken without physician supervision.

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Cecil RL, Plum F, Bennett JC, eds. Cecil Textbook of Medicine. 20th ed. Philadelphia, Pa: WB Saunders Co; 1996:382-389.

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