Bronchitis

Bronchitis

Quieting the "Bark"
That Won't Abate

It's the cough you notice first. Not the polite, get-your-attention kind of cough, but a harsh, sometimes hurtful hacking from deep within your chest. This one's loud and raucous, something like a hound grown hoarse while chasing a hare.

If you're coughing up foul-looking phlegm, maybe producing a curious wheeze from your chest, have chills and possibly a low-grade fever or are experiencing a bit of breathlessness, chances are you've got bronchitis. Despite its serious-sounding name, battles with bronchitis are common enough. An estimated 18 million episodes of it are treated each year in the United States alone. While experts don't know how many of these involve women, they do know that women with bronchitis are keeping doctors busy. And why? Because more women are smoking now than ever before, according to Sally Wenzel, M.D., assistant professor of medicine at the National Jewish Center for Immunology and Respiratory Medicine in Denver.

Just what is this "barking" disease? Picture an upside-down tree and imagine the trunk as your trachea, or windpipe, leading to your lungs. The trunk divides into branches (the bronchi or main airways), the branches into twigs (the bronchioles) and the twigs into leaves (air sacs). When viruses or bacteria enter the trunk through your throat, they make their way into the various branches, twigs and leaves. These nasty little bugs invade and injure cells, causing inflammation and narrowing of the membranes that line the passages. But the body is too smart to allow this irritation to go unchecked: It makes secretions to coat and protect these airways from further damage. That's why you're compelled to cough, sputter and produce phlegm.

So now that you know you've got it, what's next? "Everyone can get acute bronchitis from upper respiratory infections a few times in their life," says Anne L. Davis, M.D., associate professor of clinical medicine at New York University and an attending physician at Bellevue Hospital, both in New York City. "But you must find out which kind you're experiencing--acute or chronic." The differences are significant. And you'll need a doctor's diagnosis.

When It's Acute

This type comes on quite suddenly, announcing itself with what's called a "productive" cough--one that brings up clear or discolored, thin or thick sputum, occasionally mixed with blood. You might feel achy, experience some shortness of breath and run a fever ranging around 101° or 102°. Acute bronchitis often follows on the heels of a simple upper respiratory infection.

"If you've got a cold, it can kick into the bronchial tubes," explains Charles Goodrich, M.D., an internist in New York City. "The usual route is first a cold, then sinus problems, followed by pus dripping into the bronchial tubes and ultimately bronchitis. But some women will get bronchitis first, then the cold kicks in." If your cough persists and the fever lasts longer than three to five days, it's important to see a doctor.

How do you pick up acute bronchitis? Most respiratory infections are transmitted person to person, often by hand contact or sharing food with an infected friend rather than from the sneezing, coughing woman standing beside you in the subway or at the mall. So avoiding them is tricky. But don't be too alarmed--experts say if you have no history of respiratory disease and don't smoke, the usual bout lasts about a week, maybe two. "Acute symptoms last about five to seven days," says Dr. Wenzel, "and you may be left with a cough that lingers for as long as four weeks."

One caveat: "If your cough worsens and if you develop a fever and chest pains, you should see a doctor," counsels Dr. Davis. "Acute bronchitis can go into pneumonia--they sometimes overlap. Be on the safe side and check it out."

When It's Chronic

Unlike its fairly benign, time-limited counterpart, chronic bronchitis can lead to serious complications unless you move to stop it. Chronic bronchitis often emerges just when you think your winter cold has been cured. That's when you notice that all your cold symptoms have disappeared--except that cough and that awful mucus. In time, the coughing and mucus production become second nature; without any true awareness, you're coughing before, during and after colds, all year round.

Since those most affected are smokers, and since most smokers dismiss their morning hack as "just a smoker's cough," it's critical to retire that comment and take the symptom seriously. As a rule, if you have experienced a mucus-producing cough most days of the month, three months of the year, for two successive years without any other underlying causes, you may have chronic bronchitis.

Does this mean you're now immune to acute bronchitis? No such luck. "It's not unusual for women with chronic bronchitis to also have episodes of acute bronchitis," explains Dr. Davis. "You might already have some chronic bronchial impairment, and that makes you more vulnerable to acute infections."

What Causes It?

Either a virus or bacteria--or both--can trigger bronchitis. The underlying causes of this uncontrollable cough aren't too complex. Since latent viruses are always lingering within your cells, it follows that when you're under a lot of stress and pressure, the immune system becomes embattled, your resistance to disease takes a dive, and those viruses are free to take over. "We're not dealing with something unknown and terrifying," explains Dr. Goodrich, "we're talking about super stress--a powerful force in the biology of women today."

Bacterial infections are very different from viral ones. These cruel little bugs arrive uninvited from outside the system, light in your throat and work their way down to the lungs. But even if your bronchitis is viral, a secondary bacterial infection may have entered the equation. "If you notice yellow or green pus in the phlegm, bacteria may be feeding on the raw surface of the virally inflamed bronchial tube," explains Dr. Goodrich.

The distinction between a virus and bacteria is significant when it comes to treatment. Again, you'll need a doctor for this. For instance, "treating viral infections with antibiotics won't help," says Dr. Wenzel. But it's crucial that you see a doctor to rule out bacterial infections--they can be treated with antibiotics. And treatments vary, depending on what types of medication you can tolerate and have found to be most effective.

What can you do when you're battling bronchitis?

Get to a doctor. The only way to discern whether you have acute or chronic, viral or bacterial bronchitis is to let your doctor place a stethoscope on your chest. She'll want to find out if fluids have entered your air sacs, and if they have, send you for a chest x-ray. "You want to make certain you've ruled out a bacterial infection or pneumonia," explains Dr. Goodrich, "and if the results prove it's bacterial, your doctor will prescribe the appropriate antibiotic."

Say good-bye to cigarettes. Smoke is an irritant to the lungs and airways. "It not only causes hypersecretion of mucus and disruption in the lining of the airways," says Dr. Wenzel, "smoking makes you very susceptible to further irritant exposure leading to a chronic cough." If you're a smoker, the least you can do for now is give your lungs a rest; the best you can do is give up the habit entirely. "By smoking, you're chronically poisoning your inner bronchial tubes," says Dr. Goodrich.

Get the vaporizer going. To keep your air passages moist and the secretions loose, turn on a warm steam vaporizer. For a viral infection, steam is the most healing treatment you can provide for those raw, inflamed surfaces inside the bronchial tubes (for a bacterial infection, it's second only to antibiotics), says Dr. Goodrich.

More good advice: Every hour on the hour that you're awake, heat a pot of water, place a towel over your head and breathe in the steam for four or five minutes, he says. But make sure the water is hot, not boiling, and do not put your face too close. Allow the towel to vent, so you protect your face from a burn.

If you're a smoker and are continually assaulting your lungs, steam is a great treatment.

Flood yourself with fluids. Since bronchitis commonly flares up during the winter months when the air is dry, guzzling plenty of liquids will help to thin out that thick mucus and keep fluids circulating through your system. "Drink eight to ten glasses of any fluids a day," suggests Dr. Goodrich. But stay away from coffee or cola with caffeine and dehydrating libations--wine, beer or any kind of booze--because they can cause further dehydration.

Relieve that cough. To minimize that hateful hack--the handmaiden of bronchitis--you might try an over-the-counter cough medicine straight from the pharmacy. It won't cure you, but it will provide a bit of TLC, especially when you're craving sleep.

"Look for a cough medicine that contains dextromethorphan," advises Dr. Goodrich. "It's the equivalent of nonprescription codeine." If this medication fails to do the job, and you're still sitting up with a vicious hack at 4:00 a.m., you may continue coughing till the cows come home unless you ask your doctor for something stronger--a prescription cough medicine with codeine.

Get your nutrients. Of course, you'll want to reduce your fever, relieve your aches and simultaneously build up your system. If your stomach can tolerate it, "take two aspirin and 500 milligrams of vitamin C four times a day," suggests Dr. Goodrich. Foods, too, can help the system-strengthening process. "Start with the fluids," Dr. Goodrich advises, "and gradually add simple re-energizing proteins to your meal plans, such as foods like meat, fish, chicken and tofu--but no dairy products. Then add fruits, vegetables and whole grains."

Take a sabbatical. This is no time to show off your superwoman stamina! Get under the covers and rest for a few days. Inhale steam, drink water and juice and read a page-turner book. When you start feeling better, you can begin building yourself up with a few stretches--and then return to bed. "Once you've regained your strength and your body says 'Go!'--then, and only then, return to work," counsels Dr. Goodrich.

Reassess your stress. If stress plays such a large part in your daily life that it's almost your middle name, it's best to take an inventory and find out what can be done to alleviate or manage it. Stress can lower your resistance, making you more vulnerable to respiratory infections, and these days, women are under a lot of diverse pressures. While most of us only laugh when advised to change our lifestyles, you might consider a few "doable" alterations.