How does acute bronchitis occur?
- Начало как обычная простуда: насморк, боль в горле, невысокая температура.
- Через 2–3 дня появляется кашель, сначала сухой и надсадный.
- Кашель становится влажным, отходит светлая или желтоватая мокрота.
- Постепенное стихание: к концу 2–3-й недели кашель проходит.
Жёлтая или зеленоватая мокрота НЕ означает бактериальную инфекцию и не является показанием к антибиотику. Цвет придают иммунные клетки, и при обычном вирусном бронхите мокрота тоже меняет цвет.
When is an antibiotic still needed?
- Suspicion of pneumonia: high fever for more than 3 days, shortness of breath, chest pain, local changes on auscultation
- Exacerbation of COPD with increased shortness of breath and purulent sputum
- Whooping cough (confirmed or clinically probable)
- Severe concomitant diseases and immunodeficiency
- Old age with deterioration of general condition
In all other cases, the antibiotic does not reduce the duration of the cough, but gives side effects and contributes to the resistance of bacteria.
What really helps
- Drinking plenty of warm fluids thins mucus better than most drugs
- Indoor air humidification up to 40–60% and ventilation
- Quitting smoking, including passive smoking - smoking prolongs the cough significantly
- Honey (for adults and children over one year old) reduces night cough
- Expectorants and mucolytics - can facilitate the discharge of sputum; effect is moderate
- Antitussives - only for painful DRY cough and for a short course; they are contraindicated for wet coughs
- Bronchodilators - in the presence of wheezing and obstruction
- Antipyretic for fever and feeling unwell
Нельзя одновременно принимать средства, подавляющие кашель, и отхаркивающие: мокрота будет образовываться, но не будет откашливаться, что способствует застою и пневмонии.
Chronic cough: what to look for
If the cough lasts longer than 3-4 weeks, we are no longer talking about simple acute bronchitis, and we need to look for the cause.
- Post-infectious cough - the most common option, goes away on its own, but can last up to 8 weeks
- Cough variant of bronchial asthma - spirometry is needed
- Gastroesophageal reflux - cough worsens while lying down and after eating
- Postnasal drip syndrome due to rhinosinusitis
- Whooping cough is a paroxysmal cough with repeated episodes, often in adolescents and adults
- Taking ACE inhibitors for blood pressure is a typical and often overlooked cause of dry cough.
- Tuberculosis, lung cancer - must be excluded if cough lasts longer than 8 weeks, hemoptysis and weight loss
Chronic bronchitis
The diagnosis is made if a cough with sputum continues for at least 3 months a year for two years in a row. It is almost always associated with smoking and is part of or a precursor to COPD.
- Spirometry is mandatory to detect obstruction
- Quitting smoking is the main treatment
- Vaccination against influenza and pneumococcus
- Treatment of exacerbations and, if obstruction is detected, continuous inhalation therapy