By Dr. Hillel Z. Harris, MD
With winter arriving in full effect here in South Florida, a common problem we are seeing in our patients is bronchitis. Symptoms include coughing (either dry or productive), difficulty breathing, and generalized weakness or lightheadedness. A low grade fever my be associated with the cough.
For some, this can lead to severe respiratory problems, such as in those with asthma or COPD (chronic obstructive pulmonary disease). For these patients, bronchitis can precipitate an attack of their underlying lung disease and cause respiratory distress, which is extremely dangerous and life threatening.
For others, the symptoms of coughing and shortness of breath may last for weeks without improvement. For those who smoke, the symptoms can be more severe and last even longer. Infection with influenza or other viruses commonly cause the symptoms of bronchitis.
So when should you visit the Urgent Care or ER?
If you are a young and otherwise healthy non-smoker, you may not need to be seen by a health-care professional if your only symptom is a cough. If you have any of the other symptoms mentioned above, you need to be evaluated, particularly if your symptoms are persistent.
If your symptoms are severe and you think you may need to be admitted, go to a hospital’s Emergency Room. If your symptoms are mild to moderate and you feel that with treatment you will be able to go home, you can go to an Urgent Care Center.
Urgent Care Physicians, Physician Assistants, and Nurse Practicioners are excellent at listening to you lungs to see if you are wheezing or having poor air exchange. They are able to hear sounds that can suggest pneumonia, or hear crackles that may fluid in the lungs.
The lung examination is typically more important that having an x-ray, although both should be done to rule out small pneumonias that can be missed by auscultation, as well as other life-threatening pulmonary emergencies such as a pneumothorax, or a dropped lung. Additionally, there are many life threatening conditions that can cause shortness of breath, including a heart attack or a blood clot.
The other important piece of the evaluation is oxygen saturation, or the percentage of oxygen in your blood. The pulse oximeter has become a standard addition to the vital signs, such as blood pressure and heart rate. It measures the amount of oxygen in your blood using an infra-red sensor through the nail of your finger.
In fact, pulse oximeters are now sold in most drug stores for home use. A reading below 94% is considered low, and typically treatment is aimed at increasing your oxygen percentage. Often the profound weakness accompanying bronchitis is due to low oxygen saturation, whereby even minimal exertion such as walking across the room may cause one to feel lightheaded.
Cold weather, or a change in the temperature outside, may cause breathing attacks in those with asthma or COPD. Athletes who have asthma are especially prone to attacks due to exercising outdoors when the temperature drops.
Bronchitis causes 3 main problems in the lungs:
1. Inflammation, whereby the lungs become swollen and inflamed.
2. Increased secretions, which narrow the airways making breathing difficult.
3. Spasm, thereby worsening the narrowing and obstructing breathing even more.
The goal of treatment is to alleviate all 3 symptoms. Bronchitis manifests clinically with diminished air entry and wheezing. These symptoms are treated most effectively with bronchodilators (medicines that dilate the airways), such as with inhalers or nebulizers. The addition of steroids has been shown to greatly improve patients’ symptoms as well. Steroids decrease inflammation of the airways. They also decrease secretions, or mucous, thereby improving breathing. Steroids can be given intravenously, or taken orally. Inhaled steroids, however, do not help in the acute treatment phase of bronchitis; these are rather used as maintenance daily therapy for those with asthma or COPD.
Staying hydrated is another important component to treatment. Hydration helps to limit secretions by diluting the mucous that builds up in the lungs, thereby making it less viscous and easier to clear. Water, electrolytes, and soup are great for hydration.
A common question is what role antibiotics play in treating bronchitis. Most causes are viral, so simple cases will not benefit from antibiotics. However, smokers and those with underlying lung diseases can often start with a viral bronchitis and can develop a superimposed bacterial infection. In these patients, antibiotics are indicated.
This winter, don’t let bronchitis sideline you by trying to tough it out by yourself. Seek help from qualified healthcare professionals who can help you feel better by tailoring their treatments for each person. Let’s get you back to feeling like yourself, and breathing well again.
Dr. Hillel Z. Harris, MD, is a board-certified emergency physician at the Sports ER and Urgent Care Center, Inc., in Delray Beach, Florida. He specializes in the care of athletes, sports rehabilitation, and general urgent care. He has been practicing emergency medicine in Atlantis, Florida at JFK Medical Center since 2009.