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BRONCHITISBronchitis is an inflammation of the trachea and bronchial tree. Bronchitis may be either acute or chronic. Acute bronchitis may be caused by viral or bacterial infections and is often preceded by an upper respiratory tract infection. Acute bronchitis may also result from irritation of the mucous membranes by environmental fumes, acids, solvents, or tobacco smoke. Bronchitis usually begins with a dry, nonproductive cough. After a few hours or days, the cough may become more frequent and produce mucus. A secondary bacterial infection may occur, in which the sputum (bronchial secretions) may contain pus. People whose cough and/or fever continues for more than seven days should visit a medical practitioner. Chronic bronchitis may result from prolonged exposure to bronchial irritants. Cigarette smoking, environmental toxins, and inhaled allergens can all cause chronic irritation of the bronchi. The cells lining the bronchi produce excess mucus in response to the chronic irritation; this excess mucus production can lead to a chronic, productive cough. Bronchitis can be particularly dangerous in the elderly and in people with compromised immune systems. These people should see a doctor if they develop a respiratory infection. Checklist for Bronchitis
What are the symptoms of bronchitis? Acute infectious bronchitis is often preceded by signs of an upper respiratory tract infection: stuffy or runny nose, malaise, chills, fever, muscle pain, and sore throat. The cough is initially dry and does not produce mucus. Later, small amounts of thick green or green-yellow sputum may be coughed up. Chronic bronchitis is characterized by a productive cough that initially occurs only in the morning.  How is it treated? Rest and oral fluids are recommended in the fever stage of acute bronchitis. Antibiotics are used when the sputum becomes dark green or yellow, indicating a bacterial infection. For most adults, tetracycline (Achromycin®, Sumycin®) or ampicillin (Amficot®, Omnipen®, Principen®, Totacillin®) are the antibiotics used first. Alternatively trimethoprim/sulfamethoxazole (Bactrim®, Septra®) may be recommended. Symptomatic treatment of cough may be given to aid sleep, although coughing is important during the day to clear out infected sputum. Antitussives (cough suppressants) include dextromethorphan (e.g., Benylin® DM, Vicks® Formula 44) and codeine. The most commonly used expectorant (drug that stimulates expulsion of bronchial secretions) is guaifenesin (e.g., Guiatuss®, Humibid®, Robitussin®). Treatment of chronic bronchitis includes smoking cessation and a variety of drugs directed at relieving symptoms (e.g., ß2-agonists) or treating superimposed bacterial infections (antibiotics). Dietary changes that may be helpful: Dietary factors may influence both inflammatory activity and antioxidant status in the body. Increased inflammation and decreased antioxidant activity may each lead to an increased incidence of chronic diseases, such as chronic bronchitis. People suffering from chronic bronchitis may experience an improvement in symptoms when consuming a diet high in anti-inflammatory fatty acids, such as those found in fish. In a double-blind study of children with recurrent respiratory tract infections, a daily essential-fatty-acid supplement (containing 855 mg of alpha-linolenic acid and 596 mg of linoleic acid) reduced both the number and the duration of recurrences.1 In people with bronchitis, lipids in the lung tissue may undergo oxidation damage (also called free-radical damage), particularly when the bronchitis is a result of exposure to environmental toxins or cigarette smoke. A diet high in antioxidants may protect against the free radical-damaging effect of these toxins. Studies comparing different populations have shown that increasing fruit and vegetable (and therefore, antioxidant) consumption may reduce the risk of developing chronic bronchitis.2 3 Food and environmental allergies may be triggering factors in some cases of chronic bronchitis.4 Cows’ milk allergy has been associated with bronchitis in children,5 6 7 and some doctors believe that dairy products may increase mucus production and, therefore, that people suffering from either acute or chronic bronchitis should limit their intake of dairy products. Ingestion of simple sugars (such as sucrose or fructose) can lead to suppression of immune function;8 therefore, some doctors believe simple sugars should be avoided during illness. Lifestyle changes that may be helpful: Breast-feeding provides important nutrients to an infant and improves the functioning of the immune system. Studies have shown that breast-feeding prevents the development of lower respiratory tract infections during infancy.9 10 Whether that protective effect persists into adulthood is not known. Exposure to environmental chemicals, including passive smoke, can increase the incidence of respiratory illness among children.11 Chronic bronchitis is frequently associated with smoking and/or environmental exposure to chemicals or allergens. These exposures should be avoided to allow the cells of the bronchi to recover from chronic irritation and to decrease the burden on the immune system. Nutritional supplements that may be helpful: In a double-blind study of elderly patients hospitalized with acute bronchitis, those who were given 200 mg per day of vitamin C improved to a significantly greater extent than those who were given a placebo.12 The common cold may lead to bronchitis in susceptible people, and numerous controlled studies, some double-blind, have shown that vitamin C supplements can decrease the severity and duration of the common cold in otherwise healthy people.13 Vitamin C and vitamin E may prevent oxidative damage to the lung lipids by environmental pollution and cigarette smoke exposure. It has been suggested that amounts in excess of the RDA (recommended dietary allowance) are necessary to protect against the air pollution levels currently present in North America,14 although it is not known how much vitamin E is needed to produce that protective effect. A review of 39 clinical trials of N-acetyl cysteine (NAC) found that 400 to 600 mg per day was a safe and effective treatment for chronic bronchitis.15 NAC supplementation was found to reduce the number of aggravations of the illness in almost 50% of people taking the supplement, compared with only 31% of those taking placebo. Smokers have also been found to benefit from taking NAC.16 In addition to helping break up mucus, NAC may reduce the elevated bacterial counts that are often seen in the lungs of smokers with chronic bronchitis.17 In another double-blind study, people with chronic bronchitis who took NAC showed an improved ability to expectorate and a reduction in cough severity.18 These benefits may result from NAC’s capacity to reduce the viscosity (thickness) of sputum.19 Vitamin A levels are low in children with measles,20 an infection that can result in pneumonia or other respiratory complications. A number of studies have shown that supplementation with vitamin A decreased complications and deaths from measles in children living in developing countries where deficiencies of vitamin A are common.21 However, little to no positive effect, and even slight adverse effects, have resulted from giving vitamin A supplements to prevent or treat infections in people living in countries where most people consume adequate amounts of vitamin A.22 23 24 25 26 27 Therefore, vitamin A supplements may only be useful for people with bronchial infections who are known to be deficient in vitamin A. The thymus gland plays a number of important roles in the functioning of the immune system. Thymus extract from calves, known as Thymomodulin®, has been found, in a double-blind study, to decrease the frequency of respiratory infections in children who were prone to such infections.28 The amount of Thymomodulin used in that study was 3 mg per kg of body weight per day. Herbs that may be helpful: Several types of herbs may help people with bronchitis, either by treating underlying infection, by relieving inflammation, or by relieving symptoms such as cough. For clarity, the table below summarizes which herbs are in each category of action. Some herbs have more than one action. Herbs listed in the table have not necessarily been proven to be effective. The herbs are discussed in more detail following the table.
Expectorant herbs help loosen bronchial secretions and make elimination of mucus easier. Numerous herbs are traditionally considered expectorants, though most of these have not been proven to have this effect in clinical trials. Anise contains a volatile oil that is high in the chemical constituent anethole and acts as an expectorant.29 Horehound has expectorant properties, possibly due to the presence of a diterpene lactone in the plant, which is known as marrubiin.30 Mullein has been used traditionally as a remedy for the respiratory tract, including bronchitis. The saponins in mullein may be responsible for its expectorant actions.31 Pleurisy root is an expectorant and is thought to be helpful against all types of respiratory infections. It is traditionally employed as an expectorant for bronchitis. However, owing to the cardiac glycosides it contains, pleurisy root may not be safe to use if one is taking (heart medications.32 This herb should not be used by pregnant women. Anti-inflammatory herbs may help people with bronchitis. Often these herbs contain complex polysaccharides and have a soothing effect; they are also known as demulcents. Plantain is a demulcent that has been documented in two preliminary trials conducted in Bulgaria to help people with chronic bronchitis.33 34 Other demulcents traditionally used for people with bronchitis include mullein, marshmallow, and slippery elm. Because demulcents can provoke production of more mucus in the lungs, they tend to be used more often in people with dry coughs.35 Elecampane is a demulcent that has been used to treat coughs associated with bronchitis, asthma, and whooping cough. Although there have been no modern clinical studies with this herb, its use for these indications is based on its high content of soothing mucilage in the forms of inulin and alantalactone.36 However, the German Commission E monograph for elecampane does not approve the herb for bronchitis.37 Ivy leaf is approved in the German Commission E monograph for use against chronic inflammatory bronchial conditions.38 One double-blind human trial found ivy leaf to be as effective as the drug ambroxol for chronic bronchitis.39 Ivy leaf is a non-demulcent anti-inflammatory. Chinese scullcap might be useful for bronchitis as an anti-inflammatory. However, the research on this herb is generally of low quality.40 Antimicrobial and immune stimulating herbs may also potentially benefit people with bronchitis. Echinacea is widely used by herbalists for people with acute respiratory infections. This herb stimulates the immune system in several different ways, including enhancing macrophage function and increasing T-cell response.41 Therefore, echinacea may be useful for preventing a cold, flu, or viral bronchitis from progressing to a secondary bacterial infection. Thyme contains an essential oil (thymol) and certain flavonoids. This plant has antispasmodic, expectorant, and antibacterial actions, and it is considered helpful in cases of bronchitis.42 One preliminary trial found that a mixture containing volatile oils of thyme, mint, clove, cinnamon, and lavender diluted in alcohol, in the amount of 20 drops three times daily, reduced the number of recurrent infections in people with chronic bronchitis.43 Horseradish contains substances similar to mustard, such as glucosinolates and allyl isothiocynate.44 In addition to providing possible antibacterial actions, these substances may also have expectorant properties that are supportive for persons with bronchitis. Eucalyptus leaf tea is used to treat bronchitis and inflammation of the throat,45 and is considered antimicrobial. In traditional herbal medicine, eucalyptus tea or volatile oil is often used internally as well as externally over the chest; both uses are approved for people with bronchitis by the German Commission E.46 Lobelia contains many active alkaloids, of which lobeline is considered the most active. Very small amounts of this herb are considered helpful as an antispasmodic and antitussive agent (a substance that helps suppress or ease coughs). Anti-inflammatory properties of the herb have been demonstrated, which may be useful, since bronchitis is associated with inflammation in the bronchi.47 Lobelia should be used cautiously, as it may cause nausea and vomiting. References:  1. Venuto A, Spano C, Laudizi L, Bettelli F. Essential fatty acids: the effects of dietary supplementation among children with recurrent respiratory infections. J Intl Med Res 1996;24:325–30. 2. La Vecchia C, Decarli A, Pagano R. Vegetable consumption and risk of chronic disease. Epidemiology 1998;9:208–10. 3. Rautalahti M, Virtamo J, Haukka J, et al. The effect of alpha-tocopherol and beta-carotene supplementation on COPD symptoms. Am J Respir Crit Care Med 1997;156:1447–52. 4. Rowe AH, Rowe A. Food Allergy: its role in emphysema and chronic bronchitis. Dis Chest 1965;48:609–12. 5. Hill DJ, Duke AM, Hosking CS, Hudson IL. Clinical manifestations of cows’ milk allergy in childhood. II. The diagnostic value of skin tests and RAST. Clin Allergy 1988;18:481–90. 6. Cohen GA, Hartman G, Hamburger RN, O’Connor RD. Severe anemia and chronic bronchitis associated with a markedly elevated specific IgG to cow’s milk protein. Ann Allergy 1985;55:38–40. 7. Hide DW, Guyer BM. Clinical manifestations of allergy related to breast and cows’ milk feeding. Arch Dis Child 1981;56:172–5. 8. Sanchez A, Reeser JL, Lau HS, et al. Role of sugars in human neutrophilic phagocytosis. Am J Clin Nutr 1973;26:1180–4. 9. Pisacane A, Graziano L, Zona G, et al. Breast feeding and acute lower respiratory infection. Acta Paediatr 1994;83:714–8. 10. Kerr AA. Lower respiratory tract illness in Polynesian infants. New Zealand Med J 1981;93:333–5. 11. Jin C, Rossignol AM. Effects of passive smoking on respiratory illness from birth to age eighteen months, in Shanghai, People’s Republic of China. J Pediatr 1993;123:553–8. 12. Hunt C, Chakravorty NK, Annan G, et al. The clinical effects of vitamin C supplementation in elderly hospitalised patients with acute respiratory infections. Int J Vitam Nutr Res 1994;64:212–9. 13. Hemilä H. Does vitamin C alleviate the symptoms of the common cold?—A review of current evidence. Scand J Infect Dis 1994;26:1–6. 14. Menzel DB. Antioxidant vitamins and prevention of lung disease.Ann N Y Acad Sci 1992;669:141–55. 15. Stey C, Steurer J, Bachmann S, et al. The effect of oral N-acetylcysteine in chronic bronchitis: a quantitative systematic review. Eur Respir J 2000;16:253–62 [review]. 16. Boman G, Backer U, Larsson S, et al. Oral acetylcysteine reduces exacerbation rate in chronic bronchitis: report of a trial organized by the Swedish Society for Pulmonary Diseases. Eur J Respir Dis 1983;64:405–15. 17. Riise GC, Larsson S, Larsson P, et al. The intrabronchial microbial flora in chronic bronchitis patients: a target for N-acetylcysteine therapy? Eur Respir J 1994;7:94–101. 18. Jackson IM, Barnes J, Cooksey P. Efficacy and tolerability of oral acetylcysteine (Fabrol) in chronic bronchitis: a double-blind placebo controlled study. J Int Med Res 1984;12:198–206. 19. Tattersall AB, Bridgman KM, Huitson A. Acetylcysteine (Fabrol) in chronic bronchitis—a study in general practice. J Int Med Res 1983;11:279–84. 20. Arrieta AC, Zaleska M, Stutman HR, Marks MI. Vitamin A levels in children with measles in Long Beach, California. J Pediatr 1992;121:75–8. 21. Fawzi WW, Chalmers TC, Herrera MG, Mosteller F. Vitamin A supplementation and child mortality. A meta-analysis. JAMA 1993;269:898–903. 22. Stephensen CB, Franchi LM, Hernandez H, et al. Adverse effects of high-dose vitamin A supplements in children hospitalized with pneumonia. Pediatrics 1998;101(5):E3 [abstract]. 23. Bresee JS, Fischer M, Dowell SF, et al. Vitamin A therapy for children with respiratory syncytial virus infection: a multicenter trial in the United States. Pediatr Infect Dis J 1996;15:777–82. 24. Quinlan KP, Hayani KC. Vitamin A and respiratory syncytial virus infection. Serum levels and supplementation trial. Arch Pediatr Adolesc Med 1996;150:25–30. 25. Kjolhede CL, Chew FJ, Gadomski AM, et al. Clinical trial of vitamin A as adjuvant treatment for lower respiratory tract infections. J Pediatr 1995;126:807–12. 26. Pinnock CB, Douglas RM, Badcock NR. Vitamin A status in children who are prone to respiratory tract infections. Aust Paediatr J 1986;22:95–9. 27. Murphy S, West KP Jr, Greenough WB 3d, et al. Impact of vitamin A supplementation on the incidence of infection in elderly nursing-home residents: a randomized controlled trial. Age Ageing 1992;21:435–9. 28. Fiocchi A, Borella E, Riva E, et al. Double-blind clinical trial for the evaluation of the therapeutical effectiveness of a calf thymus derivative (Thymomodulin) in children with recurrent respiratory infections. Thymus 1986;8:331–9. 29. Schulz V, Hänsel R, Tyler VE. Rational Phytotherapy: A Physicians’ Guide to Herbal Medicine. Berlin: Springer-Verlag, 1998, 159–60. 30. Leung AY, Foster S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs, and Cosmetics, 2d ed. New York: John Wiley, 1996, 303. 31. Foster S, Tyler VE. Tyler’s Honest Herbal. New York: Haworth Press, 1999, 2265–6. 32. Newall CA, Anderson LA, Phillipson JD. Herbal Medicine: A Guide for Health-Care Professionals. London: Pharmaceutical Press, 1996, 213–4. 33. Koichev A. Complex evaluation of the therapeutic effect of a preparation from Plantago major in chronic bronchitis. Probl Vatr Med 1983;11:61–9 [in Bulgarian]. 34. Matev M, Angelova I, Koichev A, et al. Clinical trial of Plantago major preparation in the treatment of chronic bronchitis. Vutr Boles 1982;21:133–7 [in Bulgarian]. 35. Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Edinburgh: Churchill Livingstone, 2000, 209. 36. Wichtl M. Herbal Drugs and Phytopharmaceuticals. Boca Raton, FL: CRC Press, 1994, 254–6. 37. Blumenthal M, Busse WR, Goldberg A, et al, eds. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Newton, MA: Integrative Medicine Communications, 1998, 328–9. 38. Blumenthal M, Busse WR, Goldberg A, et al, eds. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, MA: Integrative Medicine Communications, 1998, 153. 39. Meyer-Wegner J. Ivy versus ambroxol in chronic bronchitis. Zeits Allegemeinmed 1993;69:61–6 [in German]. 40. Bone K, Morgan M. Clinical Applications of Ayurvedic and Chinese Herbs: Monographs for the Western Herbal Practitioner. Warwick, Australia: 1996. 41. See DM, Broumand N, Sahl L, Tilles JG. In vitro effects of echinacea and ginseng on natural killer and antibody-dependent cell cytotoxicity in healthy subjects and chronic fatigue syndrome or acquired immunodeficiency syndrome patients. Immunopharmacol 1997;35:229–35. 42. Blumenthal M, Busse WR, Goldberg A, et al. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Newton, MA: Integrative Medicine Communications, 1998, 219–20. 43. Ferley JP, et al. Prophylactic aromatherapy for supervening infections in patients with chronic bronchitis. Phytother Res 1989;3:97–9. 44. Blumenthal M, Goldberg A, Brinkman J, eds. Herbal Medicine: The Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications, 2000, 205–7. 45. Wichtl M. Herbal Drugs and Phytopharmaceuticals. Boca Raton, FL: CRC press, 1994,192–4. 46. Blumenthal M, Busse WR, Goldberg A, et al, eds. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Newton, MA: Integrative Medicine Communications, 1998, 126–8. 47. Philipov S, Istatkova R, Ivanovska N, et al. Phytochemical study and antiinflammatory properties of Lobelia laxiflora L. Z Naturforsch (C) 1998;53:311–7. | ||||||||||||||||||||||||||||||||||||
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Reliable and relatively consistent scientific data showing a substantial health benefit.
Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.
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