BRONCHITIS, the name given to inflammation of the mucous membrane of the bronchial tubes (see RESPIRATORY SYS TEM). Two main varieties occur, specific and non-specific. The bronchitis met with in typhoid fever and diphtheria, influenza, measles, pneumonia, due to the micro-organisms causing these diseases, is specific ; that which results from extension from above, or from chemical or mechanical irritation, is non-specific. It is convenient to describe it, however, under the clinical divisions of acute and chronic bronchitis.
Acute bronchitis generally arises as the result of exposure to cold, particularly if accompanied with damp, or of sudden change from a heated to a cool atmosphere. The symptoms vary accord ing to the severity of the attack, i.e., according to the extent to which the inflammatory action spreads in the bronchial tubes. The disease usually manifests itself at first as a common cold with feverishness and general constitutional disturbance. A short, painful, dry cough, rapid and wheezing respiration, a feel ing of rawness and pain in the throat and behind the breast bone, and of oppression or tightness throughout the chest, mark the early stages of the disease. If the smaller bronchi are involved extensively, dyspnoea is severe.
After a few days expectoration accompanies the cough, at first scanty and viscid or frothy, but soon becoming copious and muco purulent. In general, after free expectoration has been established the more urgent and painful symptoms abate ; and though the cough may persist for three or four weeks, the patient is ulti mately restored to health.
The case is very different when the inflammation spreads into, or primarily affects, the minute ramifications of the bronchial tubes in immediate relation to the air-cells of the lungs, giving rise to capillary bronchitis or broncho-pneurnonia (see RESPIRA TORY SYSTEM and PNEUMONIA) . When this takes place the symp toms already detailed are greatly intensified, and the patient's life is in danger. The feverishness and restlessness increase, the cough becomes incessant, the respiration extremely rapid and laboured. the nostrils dilating with each effort, and evidence of impending suffocation appears. The surface of the body is pale or dusky, the lips are livid, while breathing becomes increasingly difficult, and is attended with suffocative paroxysms which render the recumbent posture impossible. Unless speedy relief is obtained somnolence and delirium set in and death ensues.
Acute bronchitis must at all times be looked upon as a serious ailment. It is pre-eminently dangerous at the extremes of life, and it is one of the most fatal diseases of those periods.
Bronchitis is often very severe in alcoholic persons, in those who suffer from any disease affecting directly or indirectly the respiratory functions, such as consumption or heart disease, and in children who are or have been suffering from measles and whooping-cough.
One source of danger in bronchitis is collapse of the lung. Occasionally a branch of a bronchial tube becomes plugged with secretion, and the area of the lung to which this branch conducts ceases to be inflated on inspiration. The small quantity of air imprisoned in the portion of lung gradually is absorbed, but no fresh air enters, and the part collapses and becomes solid. In creased difficulty of breathing is the result, and where a large portion of lung is affected by the plugging of a large bronchus, a fatal result may rapidly follow, especially in children.
Treatment.—In mild cases warmth, light diet and diluent drinks alone are necessary. In severer cases expectorants, per haps with the addition of a little opiate if pain be severe, may be required. In children, however, opium must be given with the greatest caution because of their extreme sensitiveness to this drug. Not a few "soothing mixtures" contain opium in quantity sufficient to be dangerous when administered to children. In addition fomentations and inhalations are often of use.
When the bronchitis is of the capillary form, the great object is to maintain the patient's strength, and secure expulsion of the morbid secretion from the fine bronchi. In addition to other remedies stimulants are called for from the first, and should the cough be ineffectual in relieving the bronchial tubes, the adminis tration of an emetic dose of sulphate of zinc may produce a good effect. It may be necessary to administer oxygen.
During the whole course of any attack of bronchitis attention must be paid to nourishment of the patient ; and during the sub sequent convalescence, particularly in elderly persons, tonics and stimulants may have to be prescribed.
Chronic bronchitis leads to alterations of structure in the affected bronchial tubes, their mucous membrane becoming thick ened or even ulcerated, while occasionally permanent dilatation o the bronchi takes place, often accompanied with profuse foetid expectoration. In long-standing cases the nutrition of the lungs becomes impaired, and dilatation of the air-tubes (emphysema) and other complications result, giving rise to breathlessness.
Chronic bronchitis may arise secondarily to some other ail ment, especially Bright's disease and heart disease. The influence of occupation is seen in the frequency in which persons follow ing certain employments suffer from chronic bronchitis. The inhalation of vegetable dust is very liable to produce bronchitis through the irritation produced by the dust particles and the growth of organisms carried in with the dust. Consequently, millers and grain-shovellers are especially liable to it, while next in order come weavers and workers in cotton factories.
The treatment to be adopted in chronic bronchitis depends upon the severity of the case, the age of the patient and the pres ence or absence of complications. Tonics with cod-liver oil will be found advantageous. In those aggravated forms where the slightest exposure to cold air brings on fresh attacks, confinement to a warm room or removal to a more genial climate during the winter months is indicated.