Bronchitis

Bronchitis

Bronchitis is a common respiratory illness characterized by inflammation of the air passages called bronchial tubes (or bronchi). It is one of the top reasons for seeking medical care.^[1]

Types

Bronchitis is classified into two, either acute or chronic. Acute bronchitis is a short-term sickness lasting about few days or weeks that usually develops after having a cold or viral infection. On the other hand, chronic bronchitis presents with a persistent, productive cough on at least three months of a year for two consecutive years in the absence of other cause.^[2]

Epidemiology

Acute bronchitis is common throughout the world. In one study, acute bronchitis affects 44 of 1000 adults yearly, and 82% of episodes occurred in fall or winter.  Findings by National Center for Health Statistics in 2006 showed that approximately 9.5 million people, or 4% of the population, were diagnosed with chronic bronchitis. Bronchitis is more common in populations with low socioeconomic status and in urban and highly industrialized areas. Acute bronchitis is most frequently diagnosed in children younger than 5 years while chronic bronchitis appears to be more prevalent in people older than 50 years. ^[1]

Causes

Several viruses cause bronchitis including influenza A and B. Some bacteria may also cause the illness. Inhaling irritating fumes or dust may likewise cause bronchitis. Chemical solvents and smoke, including tobacco smoke, have been associated with acute bronchitis.^[3]Chronic bronchitis is most commonly due to cigarette smoking. Constant attacks of acute bronchitis, toxic gases and fumes emitted from factories can also cause it.^[2] Risk factors include old age, weakened immune status, being smoker and repeated exposure to lung irritants.^[3]

Symptoms

Symptoms include cough, production of clear, white, yellow, grey, or green mucus or sputum,  shortness of breath, wheezing, fatigue, fever, chills, chest discomfort and blocked or runny nose.^[4]

Diagnosis

The physician will inquire on the medical history of the patient and conduct a physical examination. Oxygen level may be tested and laboratory exams like chest x ray, lung function tests, or blood tests may be performed. ^[5]

Treatment

 In most cases, acute bronchitis is caused by virus thus it requires only self-care treatments such as getting more rest and drinking plenty of fluids since the illness is often short-term and will resolve spontaneously. However, if  the bronchitis is caused by a bacteria, antibiotics are given. Inhaler and other medications that will reduce inflammation and open narrowed passages in the lungs may be recommended.^[4] Chronic bronchitis has no cure.^[2]  It is crucial to quit smoking to prevent worse symptoms. Pulmonary rehabilitation often helps.^[4]

References:

1. http://emedicine.medscape.com/article/297108-overview
2. http://www.medicalnewstoday.com/articles/8888.php
3. http://www.emedicinehealth.com/bronchitis/article_em.htm
4. http://www.mayoclinic.com/health/bronchitis/DS00031/DSECTION=symptoms
5. http://www.nhlbi.nih.gov/health/health-topics/topics/brnchi/diagnosis.html

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

St John's Wort (Goatweed, tipton weed, Hypericum Perforatum) [1, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: No recommendation (Available evidence does not support claims that St Johns Wort can help to treat bronchitis)

Grade of Evidence: low quality of evidence

Pokeweed Antiviral Protein (PAP) [1, 12, 13, 14, 15, 16]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present. Warning! All parts of the plant, Pokeweed (Phytolacca Americana), is poisonous and should not be ingested. Thoroughly cooking the plant reduces that toxicity. The effects of the improperly prepared plant include vomiting, diarrhoea, cramps, headache, confusion, convulstions, low blood pressure, heart block and death. Only plant extracts (PAP) or thoroughly prepared plants should be ingested, and even then, under professional medical guidance.

Recommendation: no recommendation (There is insufficient evidence to support claims that PAP helps to treat bronchitis)

Grade of Evidence: very low quality of evidence

Peppermint Oil [1, 6, 7, 8, 9, 10, 11]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: no recommendation (There is insufficient evidence to support claims that peppermint helps to treat bronchitis)

Grade of Evidence: very low quality of evidence

Larch (Larix Occidentalis)  [1, 2, 3, 4, 5]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: No recommendation (Although approved for external use in Germany, available evidence does not support claims that Larch helps to treat bronchitis)

Grade of Evidence: low quality of evidence

Black Cohosh (cimicifuga Racemosa):

Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present.

Recommendation: no recommendation (Available evidence does not support claims that Black Cohosh helps to treat symptoms of bronchitis in any way. Studies have yielded mixed results)

Grade of Evidence: moderate quality of evidence

* www.gradeworkinggroup.org

Treatment References:

1. Ades T, Alteri R, Gansler T, Yeargin P, "Complete Guide to Complimentary & Alternative Cancer Therapies", American Cancer Society, Atlanta USA, 2009

2. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/larch

3. http://www.dermnetnz.org/dermatitis/plants/lichen.html

4. Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin, TX: American Botanical Council; 1998.

5. Bown D. New Encyclopedia of Herbs & Their Uses. New York, NY: DK Publishing Inc; 2001.

6. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/peppermint

7. http://www.ncbi.nlm.nih.gov/pubmed/17420159

8. http://www.ncbi.nlm.nih.gov/pubmed/19507027

9. http://www.medicine.ox.ac.uk/bandolier/booth/alternat/AT022.html

10. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-peppermint.html

11. http://nccam.nih.gov/health/peppermintoil/index.htm

12. http://www.cbif.gc.ca/pls/pp/ppack.info?p_psn=12&p_type=all&p_sci=sci&p_x=px

13. http://www.pfaf.org/user/Plant.aspx?LatinName=Phytolacca+americana

14. http://www.ncbi.nlm.nih.gov/pubmed/315368

15. http://www.nlm.nih.gov/medlineplus/ency/article/002874.htm

16. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/pokeweed

17. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/st-johns-wort

18. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-stjohnswort.html

19. http://www.ncbi.nlm.nih.gov/pubmed/18843608

20. http://www.ncbi.nlm.nih.gov/pubmed/11939866

21. http://nccam.nih.gov/health/stjohnswort/ataglance.htm

22. http://nccam.nih.gov/health/stjohnswort/sjw-and-depression.htm

23. http://www.nimh.nih.gov/health/publications/depression/how-is-depression-detected-and-treated.shtml

24. http://www.ncbi.nlm.nih.gov/pubmed/11939872

25. http://www.ncbi.nlm.nih.gov/pubmed/12132963

26. http://www.ncbi.nlm.nih.gov/pubmed/16423519

27. http://jama.ama-assn.org/cgi/content/full/299/22/2633

Public Discussion