Bronchitis, an inflammation or infection of the bronchial airways, and pneumonia, a more widespread inflammation or infection of the lungs, are common lower respiratory infections in adults, especially in the winter months. Smokers and the elderly are at highest risk, but the illnesses can strike adults of any age.
Lower respiratory infections usually are caused by viruses and therefore won’t respond to antibiotics. Fortunately, however, the infections usually clear up on their own after a few days of bed rest.
Acute bronchitis can occur in otherwise healthy persons of any age. It is characterized by a cough, often one that produces sputum. A sore throat or laryngitis may be present as well. Most cases, including those that accompany the common cold, are caused by a virus. These will not respond to antibiotics. Fortunately, most cases clear up on their own with rest. Medication to relieve pain and fever can help ease discomfort.
In some, targeted antiviral therapy may be useful. For example, over 90 percent of people stricken with influenza A will have acute bronchitis. In these cases, an early course of the antiviral drugs amantadine or rimantadine can reduce the severity of the disease detoxic tablete. In the elderly, the antiviral drug acyclovir may be used if a lower respiratory infection with herpes simplex virus is suspected. These infections can be very serious in older people, sometimes requiring hospitalization.
Only about ten percent of cases of acute bronchitis will respond to antibiotics. These cases are generally caused by such unusual organisms as Bordetella pertussis, which causes whooping cough, Mycoplasma pneumoniae or chlamydia. If acute bronchitis persists for more than seven days, one of these organisms should be considered. Antibiotics effective against these organisms include the tetracyclines and macrolides (erythromycin, clarithromycin) or azalides (azithromycin). The choice of antibiotic will depend on cost, the individual’s allergy history and potential drug interactions.
Chronic bronchitis is present when sputum production persists for at least three months out of the year for at least two years in a row. In the United States, about 90 percent of chronic bronchitis cases occur in smokers. The longer and more heavily a person smokes, the greater the risk of developing this chronic illness.
Acute exacerbation of chronic bronchitis (AECB) occurs when the quantity and viscosity, or thickness, of sputum increase; the sputum changes in color from clear to yellow or green; and the presence of a low-grade fever and worsened respiratory status. Hospitalization is required to manage some AECB episodes. Most cases of AECB are infectious and caused by common bacteria such as Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. However, some cases are related to allergies. These can be easily identified by evaluating sputum under a microscope. When an allergic cause has been ruled out, most
physicians recommend antibiotics such as Biaxin. The usual length of therapy is seven to ten days.
Community-acquired pneumonia (CAP) afflicts approximately 3 million Americans each year, leading to about 500,000 hospitalizations. Severity ranges from mild to life-threatening. When mild, symptoms may mimic bronchitis. Severe cases can lead to severe respiratory difficulties or septicemia, a potentially serious illness in which infectious organisms multiply in the bloodstream. Death rates for hospitalized patients with CAP are as high as 20 percent among older groups.
Among young, otherwise healthy persons, many cases are due to unusual organisms such as Mycoplasma pneumoniae and Chlamydia pneumoniae which are likely to respond to antibiotics such as Biaxin. Symptoms in younger persons often include complaints of chest pain, shortness of breath and cough. Among the elderly, the major CAP invaders are common bacteria such as Streptococcus pneumoniae, Haemophilus influenzae and Legionella pneumophila. Symptoms in older persons may be subtle, consisting primarily of confusion or fatigue detoxic vaistinese. Fever may be absent thus complicating diagnosis. Most elderly people with CAP will require hospitalization. Treatment often consists initially of intravenous antibiotics. Those who respond favorably can conclude their antibiotic therapy with oral antibiotics, generally for a total course of ten to 14 days.
Obviously, preventing lower respiratory infections is desirable. Quitting smoking is the most effective way to do this. Getting an annual influenza vaccine is also worthwhile. A pneumococcal vaccine to prevent pneumonia is available as well. Usually a single pneumococcal vaccine is given, but some people may benefit from a second immunization five to seven years after the first.
Immunization should be strongly considered for the elderly, those with underlying cardiopulmonary disease and others in whom pneumococcal pneumonia or viral influenza could be dangerous or cause a significant absence from work. More widespread use of these safe, well-tolerated vaccines could prevent many lower respiratory infections, especially in the elderly. More widespread use of these safe, well-tolerated vaccines could prevent many lower respiratory infections, especially in the elderly