Is it Chronic Bronchitis, Bronchitis, or a viral infection?

Bronchitis is swelling and inflammation in the airways of the lungs.  Symptoms can include cough with mucus, chest discomfort, fever, and/or extreme tiredness.  It is often, but not always, caused by an infection, which can be due to bacteria or a virus.  An antibiotic is taken if bacteria are causing the bronchitis.  Generally an antibiotic is not prescribed if a virus is causing the bronchitis.  This is because an antibiotic is not effective against a viral infection.  When a virus is the cause it’s a matter of time until the bronchitis clears on its own.

Chronic bronchitis is a cough with mucus that lasts for at least 3 months in a row 2 years in a row.  Your chest x-ray and spirometry may be normal with chronic bronchitis.  Spirometry is a simple breathing test that measures how your lungs are working.  Most instances of chronic bronchitis are due to cigarette smoking.  However people who have not smoked may get chronic bronchitis from repeated exposure to high air pollution or from work exposures, especially when there is a family history of chronic obstructive pulmonary disease (COPD).  This is a combination of chronic bronchitis and emphysema.  A thorough exam by a doctor should reveal if chronic bronchitis is your problem.  If chronic bronchitis is the problem, using inhaled medicine should help.

People with sinus problems or postnasal drip may have a cough with phlegm that can act like that seen with chronic bronchitis.  Postnasal drip is drainage from the nose and sinuses dripping down the back of the throat.  There could be several reasons for this drainage.  One reason is an allergy.  A second reason is a non-allergic, non-infectious inflammation in the sinuses that can linger after a cold.  A third reason is chronic sinusitis.  Postnasal drip can cause coughing as a result of irritation of the throat and lungs.  You may experience the postnasal drip as a feeling of phlegm at the back of your throat.  Typically this is worse at night when you lay down to sleep.  Generally this irritation feels the worst when you wake up and gets better as the day goes on.  The phlegm may "sit" there, especially when it is thick, and become dark in color.  When it does move you may cough up “clumps”.

The fat content in dairy products can thicken phlegm.  Generally eating dairy products with less fat content is helpful.  Drinking plenty of water will help to thin the phlegm so that it moves more easily.  As long as you are not on a fluid restriction you should be drinking 6 to 8 8-ounce glasses of non-caffeine non-alcoholic fluid daily.  Clearing your throat can irritate your throat and make it sore.  When you feel the need to clear your throat sip some water to clear the phlegm.

An antihistamine can dry up the postnasal drip.  However, it may make the phlegm thicker and more difficult to move.  A decongestant like Sudafed® (pseudoephedrine) can thin the postnasal drip and decrease the swelling so it drains easier.  A combination antihistamine-decongestant will do both.  Check with your doctor to see which would help you more.  Often an antihistamine and decongestant are taken only when the postnasal drip gets bad.  It may be more helpful to take the antihistamine and decongestant on a regular basis.

A nasal wash helps remove phlegm and germs from your nose and sinuses.  This can temporarily decrease the postnasal drip and lessen coughing.  It is most helpful when done daily before using any nasal spray.  A prescription nasal steroid spray decreases phlegm production by decreasing the inflammation of the nose and sinuses.  This may prevent the postnasal drip and coughing.  A nasal steroid spray does not provide immediate relief of symptoms.  It may require several weeks of routine use to become effective.  Sometimes it takes the antihistamine, the decongestant, and the nasal wash followed by the nasal steroid spray ALL used routinely to keep the postnasal drip from bothering you.  Please read our Nasal Wash MedFact at http://www.nationaljewish.org/medfacts/nasal.html for more information about this technique.  Share this information with your doctor to see if you would benefit from this daily treatment.

Gastroesophageal reflux disease (GERD) is the back flow of stomach contents, including digestive juices, into the esophagus or food tube.  This is most commonly called acid reflux or heartburn.  Your symptoms could be caused by esophageal spasm from acid reflux.  Also this reflux can come all the way up into the mouth and nose.  When this happens the material can be aspirated, dribbling into the windpipe and lungs.  This could explain your symptoms, including the bronchitis.

Acid reflux can cause the following symptoms:
· Heartburn or a sour taste in the mouth;
· Pain occurring in the middle of the chest;
· Coughing and/or choking while lying down;
· Increased trouble breathing while asleep; and
· Even no symptoms at all.  This is called “silent reflux” and it is common.

You will need to check with your doctor to know for sure what is causing your symptoms.  A pH probe is the best test to find out if you truly have acid reflux.  This test measures the acid in your esophagus to see if digestive juices are coming up from your stomach.  Please read our Gastroesophageal Reflux Disease MedFact at http://www.nationaljewish.org/medfacts/reflux.html for more information about things to do to lessen acid reflux.  A gastroenterologist is the type of specialist to let you know if further testing is needed to identify acid reflux and the best treatment.

When done routinely, aerobic exercise conditions the entire body so that the muscles are working as efficiently as possible.  Over time this helps to keep you healthy.  Talk with your doctor about exercising again.