Health News • Is It Bronchitis or Asthma?

The cool nights of autumn are a welcome relief to most of us who are tired of the long hot summer. But for the asthmatic patient that cool air is a warning for the next few months ahead. In many cases, this warning also applies to the patient with occasional bronchitis.

If bronchitis is an infection of the bronchial tubes and asthma is reversible bronchoconstriction of these tubes, then the approach in treating these phenomena would be the same. Yes, these two entities might well be the same disease in a spectrum. Is it a wheezing bronchitis or a coughing variant of asthma?

Generally, these patients tend to suffer more during the fall and spring. This disease is often technically referred to as hyper-reactive airway disease meaning that there seems to be a trigger that causes the airways to constrict in a pathological manner in an attempt to close the airway to the offending trigger. This trigger can be an allergen (pollen, mold, etc) or cold air or exacerbated by an inflammation of the airway. Sometimes the airways are so “twitchy” that even taking a deep breath while laughing irritates the airway causing uncontrollable coughing.

To better understand asthma, the anatomy of the lungs needs to be considered. The airways open from the nose and the mouth into the throat and into the windpipe (trachea). This then divides into two mainstem bronchi, then into narrower tubes called bronchioles, until they open into the tiniest air spaces called alveoli (air sacs surrounded by capillaries). It is here in the alveolar sacs that we exchange oxygen for carbon dioxide with every breath we take in.

The classic asthma attack occurs when the asthmatic cannot get adequate amounts of air because the bore of his airway becomes too narrow. The creates a need for the patient to compensate to satisfy his air hunger by breathing harder and faster. The patient becomes more anxious and agitated.

This breathing is characterized by a tight whistle-like sound called a wheeze. The patient breathes in very quickly but has difficulty breathing out. Air becomes trapped in different parts of the lungs, creating dead spaces and mismatched ventilation. Sometimes an asthmatic’s chest is barrel shaped, retracting as the patient uses the neck, stomach and rib muscles to augment breathing.

The lungs do everything possible to keep themselves sterile. A very sophisticated mucus and ciliary system works to keep out foreign particles such as smoke, dust, bacteria, viruses, allergens & even cold air. The muscles surrounding the bronchial tubes tighten in a spasm in an effort to keep the foreign body out of the lung. This is often the case with particles such as smoke, pollen or other forms of air pollution. Hence the fall or spring pollens often trigger an asthma attack. Also cool air can be bothersome to a sensitized respiratory tract. Sometimes even extra effort during strenuous exercise can trigger an attack. Often in the case of an acute viral bronchitis, certain toxic chemicals produced by the virus set off an attack.

Mucus production is important because it provides a washout mechanism for beating cilia to sweep out these foreign particles. It known that some viruses actually destroy the respiratory cells’ capacity for properly functioning cilia and thus cause severe bronchitis in both children and adults. This is especially true for respiratory syncytial virus (RSV). These viruses appear seasonally during fall and winter. Because people are in closer contact with one another, these viruses are highly infectious via droplets spread in coughing and sneezing.

Therapy, therefore, is directed at these three areas. Bronchodilators are used to relax the muscles around the bronchial tube so that the cilia can do their job and hence are also called rescue medications. The most commonly used drug for this job is albuterol, which is a quick relief or rescue medication. A newer version of this drug in a more purified form called Xopenex causes less of the jittery side effects of generic albuterol. Longer acting bronchodilators include formoderol and salmederol. Aminophylline is sometimes used in severe asthmatics by intravenous injection in the hospital. Adrenalin is used in the case of an emergency by subcutaneous injection.

Hydration helps this the mucus secretions making the job for the cilia easier. Decongestants are used to slow the swelling in the upper respiratory system thereby making for more efficient clearing of the lungs of whatever is attacking the mucus lining. Sometimes, too much secretions occur and the doctor may opt to us ipratropium (atrovent) via nebulizer along with a bronchodilator for the “juicy” asthmatic.

Steroids are considered to be the front line of therapy as these drugs reduce the inflammatory nature of asthma. These drugs slow down the ongoing pathological reaction of these cells against allergenic invaders, be they pollen or infectious agents. Steroids should be used as a controller medication to slow down the inflammatory reaction within the respiratory epithelium.

These steroids are inhaled via a nebulizer or metered dose inhaler on a daily basis, especially in the “peak season”. Probably, the best of these is budesonide (Pulmicort). But sometimes other more potent steroids are necessary to use such as fluticazone or beclomethazone. Currently combinations of steroids and long acting bronchodilators are available in inhaler form. Another class of controllers include the leukotriene inhibitors such as monoleucast (Singulair) which are taken orally. All controller medications must be used regularly in order to be effective.

If an asthmatic is in serious trouble, the doctor may opt to administer a “burst” of steroids, i.e. 3-5 days, to slow down the severe pathological response of an asthma attack. A burst of steroids is usually well to-lerated but sometimes a prolonged systemic course of steroids is necessary to control the asthma. Hence, it is important that the patient get close follow-up with the doctor so that complications of steroids will not occur and if they occur that these complications will be minimized. This is especially true when such a treated patient comes in contact with certain viruses such as chickenpox.

Antibiotics are used only when there is a superimposed bacterial infection such as pneumonia, otitis or sinusitis sets in. A cough suppressant should be avoided as should an antihistamine because these would hinder the clearing of the mucus but could be considered at night when the post nasal drip disturbs sleep.

With asthma on the rise, treatment and education have become more aggressive and sophisticated. Your doctor will want to classify your child as to the severity of his asthma and provide an asthma action plan. Please review on this web-site the asthma action plan. Your doctor will test your child in the office at each visit with either a peak flow meter or a spirometry to help access the severity of his asthma so that you or your child can recognize the symptoms of asthma and its degree of severity and respond appro-priately to your child’s needs.

Of course, this cannot be done all at one visit and so your education in how to handle your child’s asthma will be an on going process at each office visit, whether or not, your child is having an actual attack. A running journal of peak flows and spirometry should be part of the patient’s records so that when the patient is beginning to suffer respiratory obstruction, it can be recognized and the asthma action plan can be put into place.

Other studies that your doctor may need include a chest X-ray and complete blood count to help determine if antibiotics are needed or if there is some other anatomical reason for the recurrent cough.

Most asthmatics are also atopic, meaning that they are prone to allergies and thus an allergy work-up may be necessary to find out which allergen is his trigger. Hence you will know which allergens(i.e.trigger) your child should avoid to help prevent further attacks. Electrostatic air filters on heat pumps and a smoke free environment keep the air clean for the asthmatic.

Sometimes the identification of an allergen may necessitate the removal of the family cat or dog or even cockroaches. Cleaning the home environment of house dust mites and molds is also helpful if these are the offending allergen(s). For inhalant allergens, such as pollen and molds, allergy shots for desensitizing has been proven to be efficacious.

Although bronchial asthma can be debilitating, a great deal can be done to alleviate the symptoms and especially the emotionally and financial toll of this devastating disease. If properly controlled, asthma sufferers need not be afraid to breath that crisp, cool fall air with its molds and ragweed pollen nor of the fresh spring air with its pollens either.