Bronchitis: (Un)Usual Symptoms

While speaking with a friend the other day he mentioned how his spouse had had some surgery and how she had come down with a bad case of bronchitis afterward. Although she has since gotten somewhat better, she now seems more susceptible to recurrent bronchitis attacks and other infections.

It’s been my experience that many bronchitis cases are undertreated. Specifically, medications to “open” the bronchial tubes (bronchodilators) are under-utilized and/or stopped prematurely. As a result it takes longer for a bronchitis episode to resolve and the chance for repeat attacks is increased.

I asked my friend whether his wife was on a bronchodilator and he said “no.” Because she wasn’t having any wheezing the doctors did not prescribe any ongoing treatment with a bronchodilator spray inhaler. Although he did say that she was treated with steroids. Steroids act against bronchial inflammation to improve symptoms but inhaled bronchodilators usually work much faster.

Having had bronchitis myself and having seen many patients with the illness, I mentioned that  often times bronchial inflammation is clinically underestimated and incompletely treated. It starts with recognizing the symptoms; everyone looks for the wheezing not realizing that cough, chest tightness, and shortness of breath can be independent signs of the disease also. Sometimes people with frequent “clearing of the throat” from mucus do this because of low-grade bronchitis.

Although my friend’s wife was not a smoker, she was exposed fairly frequently to her brother who was a heavy smoker. She was therefore at risk for second-hand smoke-induced bronchitis, especially if exposed to an additional respiratory irritant trigger. Bronchitis can get better without bronchodilators, but the patient will get better faster and stay better longer with a somewhat prolonged prescription of the inhaled spray(albuterol is the most common one). I would tell my patients that when the symptoms (cough, shortness of breath, wheezing, tight chest) got better, the serious healing was starting. But it takes 4-6 weeks on the average to “reline” the bronchial tubes. Side-effects  of the spray include possible palpitations and some insomnia if taken close to bedtime. However, if the inhaler indeed helps the breathing, the quality of sleep is improved and the insomnia is non-existent. The dose of medication can also be modified if the side-effects are bothersome.

A relatively simple test called spirometry is available in many physicians offices, or it can be obtained in a pulmonary (lung medicine) laboratory. This test may objectively make the diagnosis but sometime a bronchodilator trial when the patient has symptoms is necessary. My friend said he would share the information with his wife and they will discuss the issue with her physician. I hope she has as good a response as I have had with maintenance bronchodilators! Fewer attacks, less laryngitis and sore throats, less mucus production and secondary infections may result.

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