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To Your Health

Dr. Roger Hicks

 Late fall and winter not only bring us cooler temperatures with rain, snow and the end of fire season, but also colds, flu and bronchitis. Bronchitis is one of the most common reasons for seeing a doctor, accounting for about 10 percent of all doctor visits in the U.S., or about 100 million per year. Most people will suffer mild symptoms that may last a few days or a couple of weeks, but sometimes the problem is more serious. So, what is it really?

Acute bronchitis is characterized by a cough lasting at least 5 days caused by inflammation of the airways, or bronchial tree. Think of your lungs as an upside-down tree, with your windpipe, or trachea, being the trunk of the tree. The trunk splits into large branches, the bronchi, then smaller branches and finally out to the leaves, the air sacs where oxygen exchange takes place. Bronchitis involves the branches, while pneumonia, a more serious illness, is in the leaves.

The vast majority of acute bronchitis is caused by infections, and more than 90 percent of those infections are viral. Unfortunately, it’s one of the most common reasons for unnecessary use of antibiotics. It is sometimes caused by bacterial infections, but even in those cases, antibiotics are usually not recommended because they won’t help you get better faster. Unusual causes are fungal infections, irritation from smoke or chemical fumes, and stomach acid that gets into the airways in people with GERD (gastroesophageal reflux disease). 

The inflammation makes the airways narrow due to increased mucous and swelling of their linings. In addition, the muscles that wrap small airways can go into spasm, making the air passages even smaller. All of this makes it hard to breathe and causes the typical bronchitis symptoms of chest congestion, fatigue, coughing, wheezing and sometimes shortness of breath. Acute bronchitis often follows an upper respiratory infection (a.k.a., the common cold). Symptoms can overlap, with runny nose, sore throat and headache of the cold initially, and those of bronchitis developing later as the infection goes down into the chest. 

Acute bronchitis usually goes away on its own in one to three weeks, and antibiotics – which work only on bacteria – rarely are of any help. What does help is plenty of rest, extra fluids, steam from the shower or a bowl of hot water, over the counter cough lozenges or syrups, and remedies to boost the immune system.

Reducing antibiotic use for acute bronchitis has become a national and international health care priority. Using antibiotics when they aren’t needed can do more harm than good, both on a personal and societal level. Unintended consequences of antibiotics include side effects, like rash and diarrhea, as well as more serious consequences, such as an increased risk for an antibiotic-resistant infection or Clostridium difficile infection, a sometimes deadly diarrhea.

There are exceptions when antibiotics are needed, of course, such as bronchitis caused by pertussis (whooping cough), or bronchitis in someone with a compromised immune system. Bronchitis caused by the influenza virus can be helped by an antiviral medication if caught early. But most of the time, they aren’t needed. 

However, if you have a fever over 100.4, cough up bloody mucous, have wheezing, shortness of breath or chest pain, or if the cough lasts more than 3 weeks or keeps coming back, you should visit an urgent care facility or your primary care physician. Any of those things mean it could be something more serious, such as asthma or pneumonia. 

People who suffer from a recurring cough that lasts months may have chronic bronchitis, which is a different problem. Chronic bronchitis is more serious and is a type of lung disease often associated with COPD (chronic obstructive pulmonary disease) in which a cough lasts more than 3 months in two consecutive years. 

Of course, prevention is always the best (and cheapest) medicine. So, cover your nose and mouth when coughing or sneezing, wash your hands often, stay away from people who are sick when possible, don’t smoke and avoid second-hand smoke, and stay up to date with recommended vaccines to protect yourself from developing bronchitis. 

Winter and respiratory infections seem to go together, just like winter and snow. If you have a cough with any of the warning signs above, consider a visit to your doctor or an urgent care center to make sure you don’t have a serious problem. Once you are clear, getting some regular exercise is a wonderful way to improve overall health.

A director of the Urgent Care Association of America from 2011 to 2017, Dr. Roger Hicks served as the Association’s treasurer and then secretary. He is a founder and current board member of the Urgent Care Assurance Company, a malpractice company specializing in urgent care. He is the founding President of the California Urgent Care Association. He is also the founding president of the South Yuba River Citizens League and served on SYRCL’s Board of Directors for 30 years.