Bronchitis and Pneumonia

Chapter 153 Bronchitis and Pneumonia

image General Considerations

Bronchitis is inflammation of the mucous membranes of the bronchi, the airways that carry airflow from the trachea into the lungs. Pneumonia is inflammation of the lungs. Both acute bronchitis and pneumonia are characterized by the development of a cough with or without the production of sputum. Acute bronchitis often occurs during the course of an acute viral illness such as the common cold or influenza. Viruses cause about 90% of cases of acute bronchitis.

Although pneumonia may appear in healthy individuals, it is usually seen in those who are immune-compromised, particularly drug and alcohol abusers. The growing population of those with chronic lung diseases and other debilitating illnesses and a history of the use of respiratory therapy, immunosuppressive drugs, and other such technologies have contributed to the further increase of nosocomial and opportunistic pneumonias, which have high mortality rates. Acute pneumonia is the seventh leading cause of death in the United States.1 It is particularly dangerous in the elderly.

In healthy individuals, pneumonia most often follows an insult to the host defense mechanisms: viral infection (especially influenza), cigarette smoke and other noxious fumes, impairment of consciousness (which depresses the gag reflex, allowing aspiration), neoplasms, and hospitalization (Table 153-1). In immunocompetent, nonelderly adults, cigarette smoking is the strongest independent risk factor for invasive pneumococcal disease.2

Table 153-1 Etiologies of Common Pneumonias

Type Percentage
Viral (influenza) 20 (3)
Mycoplasmal 10-20
Bacterial 12
Bacterial superimposed on viral 6
Chlamydia 10
Unknown cause (Legionnaires’ disease, toxic) 38

Data from Branch WT Jr. Office practice of medicine. Philadelphia: Saunders, 1982:57-76.

The airway distal to the larynx is normally sterile owing to several protective mechanisms, both mechanical and humoral. The mucus-covered ciliated epithelium that lines the lower respiratory tract propels sputum to the larger bronchi and trachea, evoking the cough reflex. The respiratory secretions contain substances that exert nonspecific antimicrobial actions: alpha1 antitrypsin, lysozyme, and lactoferrin. At the level of the alveoli, potent defense mechanisms are present, including alveolar macrophages, a rich vasculature capable of rapidly delivering lymphocytes and granulocytes, and an efficient lymphatic drainage network.

image Diagnostic Summary: Pneumonia

The diagnosis of pneumonia is usually made by physical examination and confirmed by a chest x-ray. Common physical examination findings include the following:

Examination of the sputum suggestive of infection includes the presence of blood; thick, opaque sputum colored yellow, green, or brown and a positive Gram stain. Sputum culture and sensitivity are not always helpful in identifying the cause of pneumonia due to contamination of the sample with throat or mouth bacteria.

A urine test (Binax NOW, Binax Inc., Scarborough, Maine) can detect Streptococcus pneumonia or Legionella pneumophila antigens within 15 minutes. It may identify up to 77% of pneumonia cases and may rule out the infection in 98% of patients who do not have S. pneumoniae. However, the test is not very useful in diagnosing S. pneumoniae as a cause of pneumonia in children, since the organism is so common in this population whether or not they have pneumonia. L. pneumophila is the bacterium that causes Legionnaires’ disease and sometimes pneumonia.

A chest x-ray is nearly always taken to confirm a diagnosis of pneumonia, but it is not imperative that it be positive to make the clinical diagnosis. A positive chest x-ray for pneumonia may reveal lung infiltrates or complications of pneumonia such as pleural effusions.

Special Considerations with Pneumonia

There are more than 100 types of bacteria, viruses, and fungi known to cause bronchitis or pneumonia. The three most common forms of pneumonia are the viral, mycoplasmal, and pneumococcal types.

image Therapeutic Considerations

Regardless of the form of bronchitis or pneumonia, the basic approach is to use an expectorant, mucolytic, and immune supportive nutrients to help resolve it. Although antibiotics are of limited value in acute bronchitis, they definitely have their place in treating pneumonia.


Botanical expectorants have a long history of use in bronchitis and pneumonia. Because impaired cough reflexes have been thought to play a role in recurrent bronchitis and pneumonia,8 it seems reasonable that these botanicals would be useful in helping relieve this condition and preventing recurrences. Botanical expectorants act to increase the quantity, decrease the viscosity, and promote expulsion of the secretions of the respiratory mucous membranes. Many also have antibacterial and antiviral activity. Some expectorants are also antitussives; however, Lobelia inflata, a commonly used expectorant, actually helps promote the cough reflex.9 Therefore Lobelia may be more effective at clearing the lungs than other expectorants when the cough is productive. Other commonly used expectorants include Glycyrrhiza glabra (licorice), Pelargonium sidoides (South African geranium), Hedera helix (ivy), and wild cherry bark.

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Sep 12, 2016 | Posted by in MANUAL THERAPIST | Comments Off on Bronchitis and Pneumonia

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