Acute bronchitis

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Classification according to ICD-10
J20 Acute bronchitis
ICD-10 online (WHO version 2019)

As acute bronchitis is a newly formed is inflammation of the - of the larger branched respiratory bronchi - with cough , phlegm production, fever and other systemic symptoms referred. If - as is often the case - the windpipe is also affected, it is called acute tracheobronchitis .

Summary

The diagnosis of bronchitis is one of the most common diagnoses made by general practitioners, although the definition and pathophysiology are often ambiguous. The diagnosis of acute respiratory tract infection would usually be better , since not only the bronchi but also other parts of the airways are usually affected.

Epidemiology

One reason for the frequent diagnosis is the unreflected summary of various clinical pictures under this term. Since there are no clear disease-specific symptoms or laboratory parameters that point the way to the future, every cough caused by infections of the upper airways, allergic syndromes or even sinusitis is often referred to as bronchitis; it is one of the most frequent consultation occasions in a general medical practice.

In a study it was already occupied that patients with acute bronchitis to 6.5-fold increased morbidity (the prevalence ) of bronchial asthma in its history had and a nine-fold increased risk had been subsequently the diagnosis of bronchial asthma to to get. This is an indication of hypersensitivity of the respiratory tract ( bronchial hyperreactivity ) underlying both clinical pictures .

etiology

The data on the percentage of cases with a viral, bacterial or fungal infection of the bronchi or non-infectious causes is poor, especially when one considers the frequency and economic importance of this disease.

The coding of diseases in the German health care system in the DRG system differentiates between several different pathogen-related forms of acute bronchitis. The diagnosis with evidence of germs is also better paid for. It would therefore be expected that increasingly better statements about the individual pathogens of acute bronchitis can be made. However, the data on this is rarely published or even viewed critically.

Symptoms and Findings

Cough and obstructive symptoms such as the often present stridor are caused by the inflammation of the bronchial mucosa, which causes swelling and mucus production. The cough is usually dry at first, as the swelling of the mucous membranes precedes the production of mucus due to the increased blood flow caused by the infection ( hyperemia ). With its formation, the cough becomes productive. The sputum - called sputum in medical terminology - is viscous or thin. With viral inflammation it is usually clear to grayish, with bacterial inflammation, on the other hand, it tends to be yellow-green in color, but this can only give a tendency towards the underlying etiology.

In obstructive bronchitis (previously also spastic bronchitis), the spasmodic muscle contraction of the bronchi can cause rattling and whistling, also humming and wheezing, breathing noises, especially when exhaling, and make it difficult to cough up sputum. The lung function assessed by spirometry shows values ​​similar to those of mild bronchial asthma in around 60 percent of the patients . Since this can develop with recurring acute bronchitis caused by chlamydia , patients should undergo a check-up after the acute symptoms have subsided.

diagnosis

The physical examination, the laying confirm the respiratory tract, but more important is the history : a nocturnal cough may be the only symptom of acute bronchitis. Routine sputum examinations either give no results or are not cost effective. In 25 percent of the cases in which those affected suffer from a cough that lasts longer than four weeks, a whooping cough serology and other further examinations should be arranged to rule out more serious diseases such as B. Lung cancer or systemic diseases. Pioneering examinations include blood values, an X-ray of the lungs and ultrasound examinations.

Differential diagnosis

therapy

Antibiotics

The administration of an antibiotic is only indicated in the case of a bacterial infection, but not in the case of a purely viral infection.

Herbal medicines

For acute bronchitis, plant substances such as mustard oils from nasturtiums and horseradish can also be used, the effectiveness and tolerability of which has been proven by clinical studies. Numerous in-vitro studies show that the plant substances act against viruses, against bacteria - including the most common pathogens causing bacterial respiratory infections and also have anti-inflammatory effects.

Cough suppressants

The administration of an antitussive (a cough-relieving agent) can be counterproductive as the sputum produced should be coughed up. When complaining about disturbed sleep, reflux esophagitis or heart failure must be considered, both of which can cause significantly more symptoms when lying down.

Horehound has been used for catarrh of the respiratory tract, especially bronchitis, for over 2000 years . As a herbal expectorant, the medicinal plant horehound was voted " Medicinal Plant of the Year 2018" by scientists from the University of Würzburg due to its outstanding historical importance and the extensive documentation of its effects .

Otherwise, there is hardly any data available on the sensible use of antitussives or cough-relieving agents ( expectorants ).

Bronchospasmolytics

Substances that dilate the bronchial system ( bronchospasmolytics ) can be useful if the air supply is restricted. However, this possible effect is only weakly supported by data (2015 overview) and should be weighed against the possible adverse effects.

Course of disease

Acute bronchitis usually heals without treatment after several days or sometimes weeks without complications. The symptoms usually last for no more than ten days. In rare cases, the cough can last for several months, with whooping cough, bronchial or cardiac asthma , tumor formation or chronic pneumonia should be considered.

See also

literature

  • Klaus Holldack, Klaus Gahl: Auscultation and percussion. Inspection and palpation. Thieme, Stuttgart 1955; 10th, revised edition, ibid. 1986, ISBN 3-13-352410-0 , pp. 85-87 ( diseases with exudation in the bronchial lumen ).

Web links

Individual evidence

  1. ↑ According to W. Fink, G. Haidinger: The frequency of health disorders in 10 years of general practice. In: ZFA - Journal for General Medicine. 83, 2007, pp. 102-108, doi : 10.1055 / s-2007-968157 . Quoted from What family doctors mainly deal with , MMW-Fortschr. Med. No. 16/2007 (149th year)
  2. ↑ Glucosinolates against bacterial infections. In: Deutsche Apotheker Zeitung , No. 25, June 2010, pp. 105-107.
  3. ↑ Werner Stingl: Fight Influenza Viruses with Phytotherapy. In: Ärzte Zeitung , December 16, 2010
  4. ^ Conrad, A. et al: In-vitro studies on the antibacterial effectiveness of a combination of nasturtium herb (tropaeoli majoris Herba) and horseradish root (Armoraciae rusticanae radix), Drug Res 56/12: 842-849 (2006)
  5. ↑ Conrad, A. et al .: Broad spectrum antibacterial activity of a mixture of isothiocyanates from nasturtium (Tropaeoli majoris herba) and horseradish (Armoraciae rusticanae radix). Drug Res 63: 65-68 (2013)
  6. ↑ Dufour, V. et al .: The antibacterial properties of isothiocyanates. Microbiology 161: 229-243 (2015)
  7. ↑ Borges, A. et al .: Antibacterial activity and mode of action of selected glucosinolates hydrolysis products against bacterial pathogens. J Food Sci Technol 52 (8): 4737-48 (2015)
  8. ↑ Marzocco, A. et al .: Anti-inflammatory activity of horseradisch (Armoracia rusticana) root extracts in LPS-stimulated macrophages. Food Func. 6 (12): 3778-88 (2015)
  9. ↑ Tran, H. et al .: Nasturtium (Indian cress, Tropaeolum majus nanum) dually blocks the COX an LOX pathway in primary human immune cells. Phytomedicine 23: 611-620 (2016)
  10. ↑ Lee, ML et al .: Benzyl isothiocyanate exhibits anti-inflammatory effects in murine macrophages and in mouse skin. J Mol Med 87: 1251-1261 (2009)
  11. ↑ Committee on Herbal Medicinal Products : Community herbal monograph and assessment report on Marrubium vulgare L., herba. European Medicines Agency (EMA) 604273/2012 (2012)
  12. ↑ Medicinal Plant of the Year 2018: Horehound - Marrubium vulgare. World Heritage Monastery Medicine, September 21, 2017.
  13. ↑ LA Becker, J. Hom, M. Villasis-Keever, JC van der Wouden: Beta2-agonists for acute cough or a clinical diagnosis of acute bronchitis. In: The Cochrane database of systematic reviews. Number 9, September 2015, S. CD001726, doi : 10.1002 / 14651858.CD001726.pub5 , PMID 26333656 (Review).