DR.

BLYDEN : ACUTE & CHRONIC BRONCHITIS

Dr. Blyden by Dr.Blyden Noah. Copyright : Dr.Blyden Noah , 2020
Expert on Global Health . DR. BLYDEN LIBRARY

DR. BLYDEN
BY DR.
BLYDEN NOAH
DR. Blyden
Noah is a
general
practitioner
living and
working in
Sweden. He is
the author of
the Dr.Blyden
handbooks ,
Dr.Blyden radio
podcasts ,novels
, poems ,
factbooks about
ACUTE & CHRONIC BRONCHITIS African and
Sierra Leonean
DR. BLYDEN NOAH . E-mail : culture and
nas.deen1@gmail.com . WEBSITE : https:// traditional
religions , new
doctorblyden.jimdo.com/ or https:// games , new
independent.academia.edu/BlydenNoah inventions etc .

Dr. Blyden
DR. BLYDEN LIBRARY Noah was born
in Sierra Leone .

E-mail :
nas.deen1@gma
il.com
Dr. Blyden
Website : https://
doctorblyden.jimdo
.com/ or https://
independent.acade
mia.edu/
BlydenNoah

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 BRONCHI AND BRONCHIOLES
These are branches of the trachea (windpipe)

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 WORLDWIDE FACTS ABOUT BRONCHITIS

Bronchitis is an inflammation of the bronchi (bronchitis), the

bronchioles (bronchiolitis) and sometimes the trachea
(tracheitis) . Bronchitis , tracheitis and bronchiolitis almost
always exist together . Bronchitis is a common disease that
affects millions of people all over the world year after year .
Bronchitis affects 150 million people per year globally
according to WHO estimates . Smoking , allergies, exposure
to gas, dust , fumes and air pollution increase the risk of
bronchitis . Millions of people worldwide are exposed to
passive smoking , fumes in their workplace and air pollution
everyday . A study in the USA has shown that prolonged
exposure to nitrogen oxides in car fumes increase the
incidence of acute bronchitis by about 30 percent in young
children . Studies have also shown that people who are
exposed to coal smoke and workers exposed to coal dust for
long periods are more likely to develop chronic bronchitis
than people who are not . Workers in agricultural, textile,
paper, wood, chemical, and food processing industries are
also at risk of developing chronic bronchitis . Chronic
bronchitis is a prolonged , debilitating disease characterized
by cough and sputum production, fatigue , breathing
difficulties etc which can lead to mental strain and reduced
quality of life . The victim’s are sickly and are often on sick
leave . This can lead to serious loss of productivity with
severe consequences for their families , societies , countries
and the world .
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Acute and chronic bronchitis occur in people of all ages
worldwide, from young children to old people . Chronic
bronchitis is more common in people above 45 years of age .

AIR POLLUTION

MOTOR VEHICLE (CAR) POLLUTION

Motor vehicles cause 75 % of carbon monoxide air pollution

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THE ANATOMY OF THE BRONCHI AND THE
BRONCHIOLES

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The bronchial tree is made up of the trachea (windpipe) , the
bronchi and the bronchioles . The bronchial tree stretches
from the larynx (voice box) to the alveoli (air sacs) in the
lungs . The trachea branches into 2 primary bronchi , left and
right . The primary bronchi branch into secondary bronchi .
Secondary bronchi branch into tertiary bronchi . Tertiary
bronchi branch into bronchioles . Bronchioles branch into
lobular bronchioles which branch into terminal bronchioles .
Terminal bronchioles branch into respiratory bronchioles .
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Respiratory bronchioles branch into alveolar ducts which
enter the alveolar sacs (air sacs) .

WHAT IS BRONCHITIS

Bronchitis is an inflammation of the bronchi (bronchitis) ,

the bronchioles (bronchiolitis) and the trachea (tracheitis) .
Bronchitis, bronchiolitis and tracheitis almost always exist
together .

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 WHAT IS ACUTE BRONCHITIS

This is bronchitis that usually last about 6 weeks but can last
up to a maximum of 3 months .

WHAT IS CHRONIC BRONCHITIS

This is bronchitis that usually last three or more months and

recurs year after year.

BRONCHITIS

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 THE CAUSES (ETIOLOGY) OF BRONCHITIS

1/ Virus : About 90 percent of bronchitis infections are

caused by viruses such as :
— Influenza A and B virus (Flu viruses)
— Respiratory syncytial virus (RSV)
— Parainfluenza viruses
— Coronabiruses
— Rhinoviruses
— Adenoviruses

2/ Atypical bacteria :
— Mycoplasma pneumoniae
— Chlamydia pneumoniae (TWAR)
— Legionella pneumophila

3/ Typical bacteria :
— Bordetella pertussis (causes whooping cough)
— Streptococcus pneumoniae
— Hemophilus influenzae
— Moraxella catarrhalis
— Other bacteria

THE RISK FACTORS OF BRONCHITIS

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— Smoking / Exposure to tobacco smoke : Smoking is the
main risk factor for chronic bronchitis , 75 percent of people
who have chronic bronchitis smoke or used to smoke.
— Air pollution
— Exposure to fumes , dust and gases in workplaces
— Exposure to coal smoke and coal dust in an around coal
plants .
— Exposure to a cold and damp enviroment for a long
period .
— Having the genetic disorder alpha-1 antitrypsin deficiency.

DISEASES WHICH ARE SIMILAR TO BRONCHITIS

1/ Asthma

2/ Chronic obstructive pulmonary disease (COPD)

3/ Bronchopneumonia / Pneumonia

4/ Lung cancer / Metastases in the lungs

5/ Pleuritis (Pleurisy)

6/ Pneumothorax

7/ Pulmonary embolism

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8/ Heart failure (Congestive heart failure)/ Pulmonary
edema
9/ Tuberculosis

10/ Cystic fibrosis

THE TYPES OF BRONCHITIS

1/ Based on the duration :

a/ Acute bronchitis : Lasts less than 3 months

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b/ Chronic bronchitis : Lasts more than 3 months

2/ Based on the causative agent (etiology) :

a/ Viral bronchitis : The cause is virus

b/ Bacterial bronchitis : The cause is bacteria

c/ Occupational bronchitis : The causes are fumes , dust ,

smoke etc in the workplace

d/ Industrial bronchitis : The causes are air pollution in an

around industrial plants . The worldwide ban on the use of
asbestos has greatly reduce the incidence of asbestosis .

3/ Based on the underlying disease :

a/ Asthmatic bronchitis : This is recurring bronchitis in a

person with asthma.

4/ Based on the severity :

a/ Mild bronchitis : Bronchitis with mild symptoms

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b/ Severe bronchitis : Bronchitis with severe symptoms

HOW IS BRONCHITIS TRANSMITTED ?

The virus and bacteria causing bronchitis are transmitted

from person to person by :

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1/ Transmission via bodily contact .

2/ Transmission via airborne droplets of water vapor .

3/ Transmission via surface contamination .

4/ Transmission via saliva .

The virus and bacteria multiply fast and are found in great
numbers in the mucous membranes in the nose , the throat ,
the trachea and mouth of an infected person . The vast
amount of active virus and bacteria irritate these mucous
membranes causing itching and the secretion of large
quantities of virus- and bacteria infested mucus . If the
infected person kisses another person the virus and bacteria
are transmitted to that person via saliva . If the infected
person scratches his nose and then shakes the hand of
another person , it is then passed to the other person . When
the infected person coughs, blows his nose or sneezes the
virus and bacteria are expelled in airborne droplets (very tiny
drops of water vapor) which can be inhaled by other persons
and infect them . Large quantities of virus and bacteria are
present on the hands of infected persons because of the
practices of touching the face , nose blowing , coughing into
their hands etc . When infected persons touch frequently
touched objects such as doorknobs, remote controls , stove
buttons , radio buttons , refrigerator handle , computer

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keyboards etc the virus and bacteria are transferred to these
objects where they lie and wait for hours for an uninfected
person to touch them and become infected .
AIRBORNE DROPLETS TRANSMISSION

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 THE SYMPTOMS OF BRONCHITIS

1/ Productive (wet) cough

2/ Overproduction of mucus (phlegm , sputum)

3/ Shortness of breath

4/ Slight fever

5/ Wheezing : High-pitched whistling sound caused by

inflammation and narrowing of the bronchioles , a.k.a
bronchiolitis . The wheezing comes about when a large
volume of air is forced through the narrowed bronchial
tubes.

6/ Inspiratory stridor : High-pitched wheezing sound heard

on inhalation . This sound is heard without the stethoscope
and is caused by a large volume of air being forced through
the narrowed and inflamed trachea (tracheitis) .

7/ Pain in the chest and thorax

8/ Fatigue

9/ Hoarseness (Dysphonia)

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10/ Chest congestion

DIFFERENCES BETWEEN ACUTE &

CHRONIC BRONCHITIS

Acute bronchitis :
— Lasts from 3 weeks to 3 months
— Fever is common
— Risk factors such as smoking or pollution play a little or no
role in occurence

Chronic bronchitis :
— Lasts more than 3 months
— Fever is not common
— Risk factors such as smoking or pollution play a big role in
occurence

SYMPTOMATIC DIFFERENCES BETWEEN VIRAL AND

BACTERIAL BRONCHITIS

Bacterial bronchitis / Bronchopneumonia

— Orthopnea ( breathing difficulties when lying down)
— High fever (> 40 degrees C )
— Chills
— Coughing up blood (hemoptysis)
— Percussion dullness in the lungs
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Viral bronchitis :
— Orthopnea absent
— High fever absent / Chills absent
— Coughing up blood absent
— Percussion dullness in the lungs absent

DIFFERENCES BETWEEN BRONCHITIS AND

BRONCHOPNEUMONIA

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 Bronchitis : Involves the trachea , bronchi and bronchioles
only . The air sacs (alveoli) are not involved .

Bronchopneumonia : Is bronchitis + pneumonia . The air

sacs (alveoli) are involved .

CRP VALUE AND WHEN TO GIVE ANTIBIOTICS

IN BRONCHITIS

CRP less than 30 mg/L : No antibiotics . Viral infection.

CRP 50-100 mg/L : Give antibiotics if bronchopneumonia is

suspected or confirmed .

CRP 100 mg/L or more than 100 mg/L : Bacterial Infection

. Give antibiotics .

LAB TESTS FOR BRONCHITIS

1/ C-Reactive Protein (CRP)

CRP EQUIPMENT

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2/ Complete blood count (Including WBC count)

3/ White blood cells (WBC) differential count

4/ Temperature

5/ Respiratory rate

6/ Oxygen saturation via pulse oximeter (POX)

7/ Sputum culture

8/ Nasopharyngeal culture

9/ PCR throat swab for mycoplasma and chlamydia

pneumoniae

10/ Blood culture for legionella and other bacteria is done in

hospitals

LUNG FUNCTION TESTS IN BRONCHITIS

1/ PEAK FLOW METER :

The peak flow meter is a hand-held device that measures the

Peak Expiratory Flow Rate (PEFR) , which is the maximum
volume of air that can be blown out of the lungs per minute .
The Peak Flow Meter thus measures lung capacity and lung

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obstruction . The PEFR is lower than normal in patients with
bronchitis because of inflammation and congestion in the
inner linings of the trachea , the bronchi and the bronchioles.

1/ PEAK FLOW METER

PEFR : < 300 liters per minute = Obstruction

PEFR: 300 - 400 liters/min = Risk for Obstruction

PEFR : > 400 liters / min = Normal . No Obstruction.

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2/ SPIROMETER :

Spirometry test (lung function test) : Spirometry is a

measurement of the function and capacity of the lungs with
an instrument called a spirometer . The patient breathes into
a mouthpiece attached to the spirometer . The spirometer
then measures how much air you can exhale, how much air
you can breathe out in 1 second (FEV1) and the amount of
air left in your lungs after a normal exhalation .

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Spirometry is used to measure the degree of lung obstruction
in bronchitis . The Forced Expiratory Volume in one second
(FEV1) and FEV1 divided by the Forced Vital Capacity
(FEV1/FVC) values are lower than normal in bronchitis .
Forced Vital Capacity is maximum amount of air a patient
can blow out from his lungs after a maximum inhalation.
Spirometry is also used to diagnose asthma , COPD (chronic
obstructive pulmonary disease) and other conditions .
The flow-volume curve is concave (obstructive) in bronchitis

OBSTRUCTIVE (CONCAVE) CURVE

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 CHEST X -RAY FINDINGS OF BRONCHITIS

1/ Peribronchial infiltrates (Peribronchial cuffing) :

These are patchy opacities along the distribution of the
bronchi and the bronchioles . These opacities are caused by
the mucus and liquids (infiltrates) which are clogging the
airways of the bronchi and the bronchioles.

2/ Atelectasis : This is closure or collapse of small portions

of the lung due to the clogging and blockage of the bronchi
and bronchioles supplying these portions with air .

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Atelectasis is reversible and the lung returns to it's normal
function when the patient is well .

3/ Chest X-Ray may be normal

HOW BRONCHITIS IS DIAGNOSED

1/ Symtptoms of bronchitis : Present . See above

2/ General condition : Tired looking patient . Rapid ,

shallow breathing . Coughing .

3/ Lung auscultation with stethoscope : Wheezing .

Inspiratory stridor .

4/ Some laboratory findings of bronchitis :

a/ C-Reactive Protein (CRP) : Normal or slightly elevated.

b/ White blood cells (WBC , Leucocytes ) : Slightly elevated .

c/ Respiratory rate : Increased or normal .

d/ Temperature : Normal or slightly elevated.

e/ Oxygen saturation (Pulse oximetry) : Decreased or normal

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f/ Sputum culture : Positive , identifying the bacteria

g/ Nasopharyngeal culture : Positive , identifying the

bacteria

h/ PCR throat swab for mycoplasma and chlamydia

pneumoniae : Positive , identifying the bacteria.

5/ X-ray findings of bronchitis : See x-ray findings above

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 HOW TO PREVENT BRONCHITIS

1/ Cough and sneeze in your elbow , not in your hands. This

is to prevent infecting other people.

2/ Or cover your mouth and nose with a tissue when you

cough or sneeze .

3/ Wash your hands with soap and water or use alcohol-

based hand sanitizers regularly .

4/ Stop smoking / Avoid passive smoking

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5/ Use disposable paper towels if someone in the household
has an infectious disease

6/ Avoid longtime exposure to cold winds and draught

7/ Live a healthy life by exercising , eating lots of vegetables

and fruits and drinking a lot of water regularly.

8/ Wear a face mask when necessary

9/ Avoid contact with air pollutants

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 THE COMPLICATIONS OF BRONCHITIS

Bronchitis can lead to complications such as :

1/ Bronchopneumonia

2/ Pneumonia

3/ Pleuritis (Pleurisy)

4/ Atelectasis (Collapse of a portion of the lung)

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4/ Chronic obstructive pulmonary disease (COPD)

5/ Exacerbation (worsening) of asthma

HOW VIRAL BRONCHITIS IS TREATED

1/ COUGH SYRUPS : Cough suppressant syrups reduce

coughing by blocking the body’s cough reflex .

a/ Cocillana-Etyfin syrup (Ethylmorphine)

b/ Dextromethorphan syrup

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2/ MUCOLYTICS / EXPECTORANTS : These medicines thin
and remove thick mucus from the airways .
- Acetylcysteine , 200 mg effervescent tablets , 1 tablet in a
glass of water 3 times daily for 8 days .
- Guaifenesin (glyceryl guaiacolate)

3/ PARACETAMOL : Paracetamol is given to reduce fever

and alleviate pain .
500 mg Paracetamol tablets , 1-2 tablets 4 times daily .

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4/ INHALED BRONCHODILATORS : Bronchodilators widens
the airways and facilitates breathing . These medicines are
usually used in the treatment of asthma .

- Terbutaline inhaler (Bricanyl turbohaler)

- Salbutamol inhaler (Ventolin inhaler)

5/ WATER / LIQUIDS :
Bronchitis causes the overproduction of mucus which leads
to dehydration of the body . The patient should drink lots of
water or other liquids .

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6/ OXYGEN TREATMENT :
Normal value of oxygen saturation via pulse oximetry is
95-100 % . Give oxygen 4 liters/min via a nasal cannula or
6-10 liters/min via oxygen mask when oxygen saturation is
< 90 % .

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 HOW BACTERIAL BRONCHITIS/ BRONCHOPNEUMONIA
IS TREATED

1/ Symptomatic treatment : Same as treatment for viral

bronchitis above.

2/ Antibiotic treatment :
Antibiotics are medicines that destroy bacteria and prevent
their spread . Common antibiotics used in the treatment of
bacterial bronchitis and bronchopneumonia are penicillins ,
macrolides and tetracyclines .

a/ Penicillins :

- Penicillin V (phenoxymethylpenicillin , penicillin VK) , 1 g

tablets, 1 tablet 3 times daily for 7-10 days . Penicillin V is
effective against streptococcal bacteria.

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 - Amoxicillin , 750 mg tablets or capsules , 1 tablet 2 times
daily for 7-10 days . Amoxicillin is effective against
streptococcal bacteria and hemophilus Influenzae bacteria .

b/ TETRACYCLINES : Doxycycline (Doxyferm) 100 mg

tablets , 1 tablet 2 times daily for 10 days . Tetracyclines are
effective against mycoplasma and chlamydia bacteria
(Taiwan acute respiratory agent a.k.a TWAR) . Doxycycline is
also given when there is allergy to penicillins .

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c/ MACROLIDES :
- Erythromycin (Ery-Max) 250 mg capsules or tablets , 2
capsules 2 times daily for 10 days . Macrolides are effective
against mycoplasma and chlamydia bacteria (Taiwan acute
respiratory agent a.k.a TWAR) . Erythromycin is also given
when there is allergy to penicillins .

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 WHAT YOU YOURSELF SHOULD DO TO PREVENT
BRONCHITIS

1/ See 'How to prevent bronchitis' above .

2/ Wear a face mask when necessary ( especially when there

is a viral or bacterial epidemic ) .

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 WHAT GOVERNMENTS (LOCAL AND NATIONAL)
SHOULD DO TO PREVENT BRONCHITIS

1/ Governments should enact legislations banning dangerous

pollutants and reducing air pollution caused by cars and
industry .

2/ Governments and community leaders should run

bronchitis and smoking risks awareness campaigns
countrywide now and then . These campaigns should
comprise radio , TV and internet ads , posters , SMS , e-mail
ads , booklets etc so that the majority of the populace would
be reached by them . The ads should emphasize the health
risks of bronchitis emphasizing that it is a treatable disease .

3/ Governments should make sure that medicines used to

treat bronchitis are always available, affordable and of good
quality . It is the duty and obligation of national and local
governments to prevent fake and substandard medicines
from reaching the populace. Such medicines harm and kill
people . Governments should establish special departments
which controll and check all medicines entering and leaving
their countries .

4/ Governments should establish well-equipped primary

health care centers in all communities and well-equipped
diagnostic hospitals in all regions in their countries . This
helps to prevent bronchitis and epidemics .
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5/ Governments should establish more medical schools ,
nurses's schools , psychotherapy schools , physiotherapy
schools etc so that more doctors , nurses etc can be trained to
help in the fight against bronchitis and other diseases .
Governments should also encourage and promote the
establishment of home-grown pharmaceutical companies that
do research on local ingredients and produce medicines to
treat bronchitis and other diseases .

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 WHAT THE WHO AND UNICEF SHOULD DO TO
PREVENT BRONCHITIS WORLDWIDE

1/ The World Health Organisation (WHO) and United

Nations International Children's Fund (UNICEF) should put
forward advisories on the need to reduce pollutants and air
pollution worldwide because of the health risks to humanity.

2/ The World Health Organisation (WHO) and United Nations

International Children's Fund (UNICEF) should run bronchitis
awareness campaigns worldwide now and then . I salute these
noble organisations for their worlwide actions on health and I
urge them to do more .

3/ The World Health Organisation (WHO) and United Nations

International Children's Fund (UNICEF) should speak up more
against corruption , advocate more for affordable medicines and
medical equipment , and for more investment in medical and
other health care institutions in countries all over the globe .
Corruption and stealing of state resources by heads of countries ,
politicians , bureaucrats and other civil servants are depriving
people in most countries in the world of their right to quality
health care .

4/ The World Health Organisation (WHO) should increase it’s

worldwide campaigns against fake (counterfeit) and
substandard drugs . Fake drugs kill 1 million people every year
worldwide . The United Nations (UN) should establish a
regulatory agency with the power to make spot checks of
pharmaceutical products and to issue or revoke licences to sell

44
and export medicines and medical products. Those who are
found guilty of producing fake and substandard drugs should
lose their licence to sell and export their products and be fined.
People should report all fake and counterfeit medicines to their
National Medicines Regulatory Authority or to WHO Global
Surveillance and Monitoring System .

CASE STUDY : CHRONIC VIRAL BRONCHITIS

56 year old woman comes to the Health Center. She is a non-

smoker but her husband smokes . She is exposed to passive
smoking in her home everyday since many, many years . She
is suffering from productive cough , overproduction of mucus

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, shortness of breath , wheezing, chest congestion and fatigue
since 6 months . She denies fever. She does not know if she
has an allergic disease but she suspects she is allergic to cats.
She denies heredity for asthma. She is not taking any
medications at the moment .

1/ General condition : Good . Inspiratory stridor can be

heard without the stethoscope (Sign of tracheitis)

- Respiratory rate : 20/min (8-25/min)

- Oxygen saturation in pulse oximeter : 92 % (95-100 %)

2/ Lung auscultation :

- Sounds of mucus congestion .

- Wheezing is heard at the base of the left lung (Sign of

bronchitis and bronchiolitis)

3/ Lab tests :

a/ CRP : <5 mg/L (<5 mg/L)

b/ Complete blood count :

- Hemoglobin (Hb) : 140 (117 - 153) g/L
- White Blood Cells (WBCs , Leucocytes ) : 10 (3.5 - 8.8)
10 9/L
- Red Blood Cells (RBCs , Erythrocytes ) : 4.5 (3.94 - 5.16)
10 12/L .
- Thrombocytes (Blood platelets) : 360 (165 - 387) 10 9/L
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- Other complete blood count components: Normal

c/ Allergy screening tests :

- Immunoglobulin E (IgE) test : Negative
- Phadiatop allergens test : Negative .
Phadiatop is a mixture of common respiratory allergens
(birch- timothy- mugwort pollen , mites, cat, dog, horse,
mold) . The negative test means the patient is not allergic to
any of these allergens .

4/ Temperature : 37.7 deg C (36.0 – 37.8 deg C)

5/ Sputum culture : Negative for bacteria.

6/ Nasopharyngeal culture : Negative for bacteria.

7/ PCR throat swab for mycoplasma and chlamydia

pneumoniae : Negative for bacteria .

8/ Chest X-ray findings : Peribronchial infiltrates can be

seen along the distribution of the bronchi and the
bronchioles .

9/ Blood pressure : 130/85

10/ Spirometry with Spirare 3 software :

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- FEV1 Reversibility test with 4 inhalations of salbutamol
(ventolin) , 0.2 mg/dose : 1 %
- FEV1/FVC : 83.6 %
- Slight obstructive curve

Summary and treatment : Chest x-ray shows peribronchial

infiltrates confirming bronchitis. Spirometry has not shown
signs of asthma or COPD . The bacterial cultures are
negative. The allergy tests are negative . The patient has
symptoms of bronchitis .
She was diagnosed with chronic viral bronchitis.
She was advised to make efforts to avoid passive smoking .
She was put on Cocillana Etyfin cough syrup , Acetylcystein
effervescent tablets and Salbutamol (Ventolin) inhaler with
good results .

DR. BLYDEN LIBRARY :

https://sites.google.com/view/docblyden/home

DR. BLYDEN NOAH . E-mail : nas.deen1@gmail.com .

WEBSITE : https://doctorblyden.jimdo.com/ or https://
independent.academia.edu/BlydenNoah

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