Bronchitis

Acute bronchitis:

• Cough that produces yellow or green mucus
• Burning sensation in the chest
• Wheezing
• Sore throat
• Fever
• Fatigue

Chronic bronchitis:

• Chronic cough that produces mucus
• Wheezing, shortness of breath
• Blue-tinged lips
• Ankle, feet, and leg swelling

Acute bronchitis is usually caused by the same viruses that cause colds. Exposure to cigarette smoke or pollution, a digestive system condition called gastroesophageal reflux disease (GERD), and bacterial infections can also cause bronchitis.

The main causes of chronic bronchitis are cigarette smoking and prolonged exposure to air pollution, dust, and environmental tobacco smoke. During their lifetime, 40% of smokers develop chronic bronchitis. One study shows that snoring is also associated with chronic bronchitis.

Your doctor will listen to your chest and back, look at your throat, and may draw blood and take a culture of the sputum from your lungs. If there is concern about possible pneumonia or COPD, your health care provider may order a chest X-ray or a lung function test (which measures the amount of air in your lungs).

The best way to prevent chronic bronchitis is to avoid smoking and stay away from air pollutants. For acute bronchitis, take steps to avoid colds and respiratory infections, such as washing your hands frequently, and getting an annual flu shot. If you are over age 65 or have a chronic illness ask your health care provider about the pneumococcal vaccine (Prevnar).

Acute bronchitis from a virus generally clears up on its own within 7 to 10 days. Using a humidifier, taking a cough medicine that contains an expectorant (something that helps you "bring up" mucus), and drinking plenty of fluids can help relieve symptoms. If a bacterial infection is the cause, your doctor may prescribe antibiotics.

Lifestyle

• DO NOT smoke. Avoid secondhand smoke.
• Use a humidifier or inhale steam from a bowl.
• Drink plenty of fluids.
• Rest.
• If you have low oxygen levels from chronic bronchitis, you may need home oxygen therapy.

Medications

For chronic bronchitis:

Bronchodilators. Increase airflow by opening airways and help make it easier to breathe.

Corticosteroids. Reduce inflammation. They are either inhaled using an inhaler or taken by mouth. These drugs are usually used to treat moderate to severe COPD.

For acute bronchitis:

Cough medicines. Two types of cough medicines, cough suppressants (for a dry cough) or expectorants (for a wet, productive cough that brings up mucus), are available over-the-counter and by prescription. Usually, doctors recommend not suppressing a cough in cases of acute bronchitis, unless your cough is keeping you from sleeping at night.

Antibiotics. Studies show that antibiotics are not an effective treatment for acute bronchitis, and they may contribute to antibiotic resistance.

Nutrition and Dietary Supplements

Supplements may have side effects or interact with medicines, so you should take them only under the supervision of a knowledgeable health care provider. Be sure to talk to your physician about any supplements you are taking or considering taking.

For chronic bronchitis:

N-acetylecysteine (NAC). NAC is a modified form of a dietary amino acid that works as an antioxidant in the body. Several studies suggest it may help relieve symptoms of COPD by acting as an antioxidant to reduce oxidative stress on the lungs (damage caused by free radicals, particles that harm cells and DNA). Although not all the studies agree, some suggest that taking NAC can reduce the number of attacks of severe bronchitis.

For acute bronchitis:

Because bronchitis often follows a cold, some of the same supplements used to prevent or treat a cold may be helpful.

• Probiotics (Lactobacillus). So called "good" bacteria, probiotics help prevent infections in the intestines, and there is preliminary evidence they might help prevent respiratory infections, too. One study found that children in daycare centers who drank milk fortified with Lactobacillus had fewer and less severe colds. Several studies that examined probiotics combined with vitamins and minerals also found a reduction in the number of colds caught by adults, although it is not possible to say whether the vitamins, minerals, or probiotics were most responsible for the benefit.
• Chicken soup. It is the most traditional cold remedy you can find (at least in modern history). In fact, chicken soup and warm liquids (such as broth and tea) can help soothe a sore throat and loosen mucus, which in turn helps ease congestion from a cold.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider.

For acute bronchitis/Preventing respiratory infections:

• Echinacea (Echinacea purpurea). Echinacea may help prevent colds, which can lead to bronchitis. An analysis of 14 scientific studies found that people who took echinacea reduced their risk of getting a cold by 58% and reduced the duration of a cold by an average of a day and a half. However, many of the studies used echinacea in combination with another herb or vitamin, so it is impossible to say which one was responsible for the benefit. Echinacea should not be used by women who are pregnant or breastfeeding, or by anyone taking drugs that suppress the immune system (such as corticosteroids or methotrexate). Echinacea can interact with many medications. Talk to your doctor before taking echinacea.
• Andrographis (Andrographic paniculata). Andrographis may also help lessen cold symptoms and possibly reduce your risk of getting bronchitis. One study found that andrographis, an herb used in Ayurvedic medicine, combined with eleuthero (Eleutherococcus senticosus) in a formula called Kan Jang, helped reduce cold symptoms. Andrographis may increase the risk of bleeding and may interfere with fertility or cause miscarriage. Andrographis may also be inappropriate for people with autoimmune disorders, or those taking blood-thinning medications.
• Garlic (Allium sativum). In one study, people who took garlic for 12 weeks between November and February had 63% fewer colds than people who took placebo. Those who did get a cold recovered about one day faster. Because garlic can increase the risk of bleeding, people who take anticoagulants (blood thinners, such as aspirin or warfarin) should not take garlic. Garlic can interfere with a variety of medications, including some medications commonly used to treat HIV/AIDS. Women who are pregnant or breastfeeding should talk to their doctor before taking garlic supplements.
• Ginseng (Panax quinquefolius). At least two studies suggest that taking American ginseng may help prevent colds, as well as reduce the number of colds experienced and the severity of symptoms. Special precautions should be taken in people with a history of hormone-sensitive cancers, as well as those with mental health issues. Speak with your physician.

For acute and chronic bronchitis/Expectorants for cough:

• Essential oil monoterpenes. A combination of essential oils, including eucalyptus (Eucalyptus globulus), a citrus oil, and an extract from pine, has been suggested for several respiratory illnesses, including both acute and chronic bronchitis. One study found that people with acute bronchitis treated with essential oil monoterpenes did better than people who took a placebo. Another study found that people who took the herbal treatment did as well as those who took antibiotics. More studies are needed. If someone is having an acute asthma attack, strong essential oils may be more irritating than helpful. Essential oils should not be taken internally because many are extremely toxic. Inhaling the aroma of essential oils delivers sufficient medicinal action.
• Lobelia (Lobelia inflate). Also called Indian tobacco, lobelia has a long history of use as an herbal remedy for respiratory problems including bronchitis. It is an effective expectorant, meaning that it helps clear mucus from your lungs. However, lobelia can be toxic and should only be used under a doctor's supervision.
• Mullein (Verbascum densiflorum). Mullein is an expectorant, meaning it helps clear your lungs of mucus. Traditionally, it has been used to treat respiratory illnesses and coughs with lung congestion. However, it has not been studied for bronchitis.
• Peppermint (Mentha x piperita). Peppermint is widely used to treat cold symptoms. Its main active agent, menthol, is a good decongestant. Menthol also thins mucus and works as an expectorant, helping loosen and break up phlegm.
• Ivy herbal extract. Studies show that ivy herbal extract, in the form of syrup or cough drops, resolved cough-related symptoms among both children and adults.

For acute bronchitis:

South African geranium (Pelargonium sidoides). Although scientific evidence is preliminary, a specific extract from South African geranium did show positive results in a few studies. In one study, people with acute bronchitis recovered faster when taking this extract than those who took a placebo. In another study, people who took the extract did as well as those who took antibiotics, but without some side effects of the antibiotics. Possible side effects include, but are not limited to, increased risk of bleeding. More studies are needed.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of bronchitis in addition to standard medical care. Before prescribing a remedy, homeopaths take into account a person's constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

Aconitum. For early stages of bronchitis or other respiratory disorders; this remedy is most appropriate for people with a hoarse, dry cough who complain of dry mouth, thirst, restlessness, and being awakened by their own coughing. Symptoms tend to worsen in cold air or when lying on your side.

Antimonium tartaricum. For wet, rattling cough (that is usually too weak to bring up mucus material from the lungs) that is accompanied by extreme fatigue and difficulty breathing; symptoms usually worsen when lying on your back. This remedy is particularly good for children and the elderly, and is generally used during the later stages of bronchitis.

Bryonia. For dry, painful cough that tends to worsen with movement and deep inhalation. This remedy is most appropriate for individuals who are generally thirsty, chilly, and irritable.

Hepar sulphuricum. For later stages of bronchitis, accompanied by wheezing, scant mucus production, and coughing that occurs when any part of the body gets cold.

Ipecacuanha. For the earliest stages of bronchitis accompanied by a deep, wet cough, nausea, and vomiting. This remedy is commonly prescribed for infants.

Phosphorus. For several different types of cough, but usually a dry, harsh cough accompanied by a persistent tickle in the chest and significant chest pain. This remedy is most appropriate for people who are often worn out and exhausted, tend to be anxious and fear death, and require a lot of reassurance.

Massage and Physical Therapy

Aromatherapy

Running a humidifier with an essential oil such as cedarwood, bergamot, eucalyptus, myrrh, sweet fennel, jasmine, lavender, tea tree, or marjoram at night may help thin mucus and ease cough. Talk to an experienced aromatherapist to learn which oil, alone or in combination, is best for you.

Prognosis and Complications

For acute bronchitis, most symptoms usually resolve within 7 to 10 days, although a dry, hacking cough can linger for several weeks.

The chance for recovery is poor for advanced chronic bronchitis. Early treatment, combined with stopping smoking, can stop lung damage from progressing and improve quality of life.

Albert RH. Diagnosis and treatment of acute bronchitis. Am Fam Physician. 2010;82(11):1345-50.

Baik I, Kim J, Abbott RD, Joo S, Jung K, Lee S, Shim J, In K, Kang K, Yoo S, Shin C. Association of snoring with chronic bronchitis. Arch Intern Med. 2008;168(2):167-73.

Belongia EA, Berg R, Liu K. A randomized trial of zinc nasal spray for the treatment of upper respiratory illness in adults. Am J Med. 2001;111(2):103-8.

Berggren A, Lazou Ahren I, Larsson N, Onning G. Randomised, double-blind and placebo-controlled study using new probiotic lactobacilli for strengthening the body immune defence against viral infections. Eur J Nutr. 2011;50(3):203-10.

Blumenthal M, Goldberg A, Brinkman J, ed. Herbal Medicine. Expanded Commission E Monographs. Boston, MA: Integrative Medicine Communications. 2000:33-35, 297-303, 335-40.

Cwientzek U, Ottillinger B, Arenberger P. Acute bronchitis therapy with ivy leaves extracts in a two-arm study. A double-blind, randomised study vs. an other ivy leaves extract. Phytomedicine. 2011;18(13):1105-9.

de Vrese M, Winkler P, Rautenberg P, Harder T, Noah C, Laue C, et al. Probiotic bacteria reduced duration and severity but not the incidence of common cold episodes in a double blind, randomized, controlled trial. Vaccine. 2006 Nov 10;24(44-46):6670-4.

Evans J, Chen Y. The association between home and vehicle environmental tobacco smoke (ETS) and chronic bronchitis in a Canadian population: the Canadian Community Health Survey, 2005. Inhal Toxicol. 2009;21(3):244-9.

Ferri: Ferri's Clinical Advisor 2010. 1st ed. Philadelphia, PA: Elsevier Mosby. 2009.

Frank LG. The efficacy of Echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms: a randomized, double blind, placebo-controlled study. J Comp Alt Med. 2000;6(4):327-34.

Guo R, Pittler MH, Ernst E. Complementary medicine for treating or preventing influenza or influenza-like illness. Am J Med. 2007 Nov;120(11):923-29.e3. Review.

Hasani A, Pavia D, Toms N, Dilworth P, Agnew JE. Effect of aromatics on lung mucociliary clearance in patients with chronic airways obstruction. J Altern Complement Med. 2003 Apr;9(2):243-9.

Lindenmuth GF, Lindenmuth EB. The efficacy of echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms: a randomized, double-blind placebo-controlled study. J Altern Complement Med. 2000;6(4):327-34.

Lindgren A, Stroh E, Montnemery P, Nihlen U, Jakobsson K, Axmon A. Traffic-related air pollution associated with prevalence of asthma and COPD/chronic bronchitis. A cross-sectional study in Southern Sweden. Int J Health Geogr. 2009;8:2.

Lizogub VG, Riley DS, Heger M. Efficacy of a pelargonium sidoides preparation in patients with the common cold: a randomized, double blind, placebo-controlled clinical trial. Explore (NY). 2007 Nov-Dec;3(6):573-84.

Mahady GB. Echinacea: recommendations for its use in prophylaxis and treatment of upper respiratory tract infections. Nutr Clin Care. 2001;4(4):199-208.

Mandell: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, PA: Churchill Livingstone. 2009;Ch. 61

Marchant J, Masters IB, Champion A, Petsky H, Chang AB. Randomised controlled trial of amoxycillin clavulanate in children with chronic wet cough. Thorax. 2012;67(8):689-93.

Martinez CH, Kim V, Chen Y, et al. The clinical impact of non-obstructive chronic bronchitis in current and former smokers. Respir Med. 2014;108(3):491-9.

Matthys H, Heger M. Treatment of acute bronchitis with a liquid herbal drug preparation from Pelargonium sidoides (EPs 7630): a randomised, double-blind, placebo-controlled, multicentre study. Curr Med Res Opin. 2007 Feb;23(2):323-31.

Nduba VN, Mwachari CW, Magaret AS, Park DR, Kigo A, Hooton TM, Cohen CR. Placebo found equivalent to amoxicillin for treatment of acute bronchitis in Nairobi, Kenya: a triple blind, randomised, equivalence trial. Thorax. 2008;63(11):999-1005.

Pelkonen M. Smoking: relationship to chronic bronchitis, chronic obstructive pulmonary disease and mortality. Curr Opin Pulm Med. 2008;14(2):105-9.

Pelkonen M, Notkola IL, Laatikainen TK, Koskela HO. Twenty-five year trends in prevalence of chronic bronchitis and the trends in relation to smoking. Respir Med. 2014;108(11):1633-40.

Pittler MH, Ernst E. Clinical effectiveness of garlic (Allium sativum). Mol Nutr Food Res. 2007 Nov;51(11):1382-5.

Rantzsch U, Vacca G, Duck R, Gillissen A. Anti-inflammatory effects of Myrtol standardized and other essential oils on alvelor macrophages from patients with chronic obstructive pulmonary disease. Eur J Med Res. 2009;14 Suppl 4:205-9.

Reichling J, Fitzi J, Furst-Jucker J, Bucher S, Saller R. Echinacea powder: treatment for canine chronic and seasonal upper respiratory tract infections. Schweiz Arch Tierheilkd. 2003;145(5):223-31.

Rodriguez E, Ferrer J, Zock JP, et al. Lifetime occupational exposure to dusts, gases and fumes is associated with bronchitis symptoms and higher diffusion capacity in COPD patients. PLoS One. 2014; 9(2):e88426.

Rotblatt M, Ziment I. Evidence-Based Herbal Medicine. Philadelphia, PA: Hanley & Belfus, Inc; 2002:160-5, 252-6, 259-61, 337-8.

Roxas M, Jurenka J. Colds and influenza: a review of diagnosis and conventional, botanical, and nutritional considerations. Altern Med Rev. 2007 Mar;12(1):25-48. Review.

Schmidt M, Thomsen M, Schmidt U. Suitability of ivy extract for the treatment of paediatric cough. Phytother Res. 2012;26(12):1942-7.

Schulz V. Liquid herbal drug preparation from the root of Pelargonium sidoides is effective against acute bronchitis: results of a double-blind study with 124 patients. Phytomedicine. 2007;14 Suppl 6:74-5.

Shah SA, Sander S, White CM, Rinaldi M, Coleman CI. Evaluation of echinacea for the prevention and treatment of the common cold: a meta-analysis. Lancet Infect Dis. 2007 Jul;7(7):473-80. Review. Erratum in: Lancet Infect Dis. 2007 Sep;7(9):580.

Smith SM, Fahey T, Smucny J, Becker LA. Antibiotics for acute bronchitis. Cochrane Database Syst Rev. 2014;3:CD000245.

Stead LF, Hughes JR. Lobeline for smoking cessation (Cochrane Review). In: The Cochrane Library, 1, 2002. Oxford: Update Software.

Stey C, Steurer J, Bachmann S, Medici TC, Tramer MR. The effect of oral N-acetylcysteine in chronic bronchitis: a quantitative systematic review. Eur Respir J. 2000 Aug;16(2):253-62.

Wood LG, Wark PA, Garg ML. Antioxidant and anti-inflammatory effects of resveratrol in airway disease. Antioxid Redox Signal. 2010;13(10):1535-48.

Yildirim A, Mavi A, Oktay M, Kara AA, Algur OF, Bilaloglu V. Comparison of antioxidant and antimicrobial activities of tilia (Tilia argentea Desf ex DC), sage (Salvia triloba l.), and black tea (Camellia sinensis) extracts. J Agric Food Chem. 2000;48(10):5030-4.