Acute Bronchitis in Adults

Acute bronchitis is a disease with general and respiratory symptoms of varying intensity, with cough as the leading symptom. It is accompanied by acute inflammatory irritation of the bronchial mucosa, mostly from viral infections, less frequently associated with bacteria.
In acute bronchitis without pre-existing chronic lung disease, there is usually no indication for antimicrobial therapy (1, 2). Guidelines already recommend strategies to avoid unnecessary prescriptions of antimicrobial treatment and refer to conditional (delayed) prescribing and participatory decision-making between patient and physician (2).

From the point of view of Anthroposophic Medicine, acute bronchitis is a disease which manifests in the respiratory organization, a part of the rhythmic system, but whose actual cause does not lie within the rhythmic system. Primarily there is a different imbalance – a dominance of the neurosensory system and a weakened respiratory system (3).

The following recommendations are based on this understanding of the disease.

Symptoms of acute bronchitis

The main symptom of acute bronchitis is coughing.

Other symptoms vary and may include:

• Sputum production
• Malaise (exhaustion)
• Subfebrile or febrile temperatures
• Nasal congestion (“common cold syndrome”)
• Aching limbs, myalgia

It is important to distinguish between acute, chronic and chronic obstructive bronchitis. We can speak of chronic bronchitis when the symptoms of cough and sputum occur over a period of at least 3 months in at least 2 consecutive years.(4) In chronic obstructive pulmonary disease (COPD), there is also a persistent and fixed obstruction of the airways, which cannot be corrected by medication or only partially resolves.(5)

Symptoms of acute bronchitis can be very similar to those of pneumonia. Presence of any of the following symptoms should therefore prompt evaluation by a physician (x-ray, clinical and laboratory diagnosis if necessary):

• Respiratory distress (dyspnea)
• Increased breathing rate (tachypnea)
• Fever, which is persistent/rising
• chills
• coughing blood (hemoptysis)
• chest pain independent of cough
• Circulatory weakness, impaired consciousness
• Change or increase in disease symptoms

Treatment principles of integrative therapy

Acute bronchitis can be treated using the following therapeutic principles:

Warmth: Support and balance body warmth with warm drinks, warming external applications, appropriate clothing and avoidance of air conditioning. Special attention should be paid to warming cooler body regions. Do not suppress fever, avoid antipyretics. 
Breathing: Soothe the stimulus to cough (with substances see below). 
Fluid: Drink warm fluids (a sufficient amount is essential for the function of the mucous membranes in the respiratory tract). 
Nutrition: As appropriate to the general condition (e.g., take in some bitter substances, avoid sweets). 
Protected time, physical rest 
Psychosomatic aspects: Reduce stress if necessary, work to regulate frequent sensory overload (e.g., through digital media). 
Individual aspects: Abstain from nicotine, reduce media time, adapt lifestyle

Sick leave
Sick leave may be necessary to support healing. 

Warmth and external applications

• Chest rubs or compresses, with:
  e.g., Plantago Bronchialbalsam (bronchial balm, oil for external use) WALA ,
  especially for productive cough: thyme oil,
  especially for dry cough and spasms: lavender oil, copper lavender oil DR. HEBERER or beeswax cloth applications.
  For instructions, see: http://www.pflege-vademecum.de/lavendeloel-brustauflage.php
  
  
• Wrapped compresses:
  e.g., Farmer's cheese (quark) compresses. For instructions, see: http://www.pflege-vademecum.de/qbw.php
  or in case of high fever: mustard compresses. For instructions, see: http://www.pflege-vademecum.de/senf-thorax-wickel.php
  or in case of low fever: ginger compresses.
  For instructions, see: http://www.pflege-vademecum.de/itrw.php

Medication

Cough medication for acute bronchitis

• Plantago cough syrup WALA (also available as Plantago Hustensaft or Pulmonium Hustensaft), 1 tsp. 3–5x/d
• Herb & Honey Cough Elixir WELEDA (also available as Hustenelixier), 1 tsp. 3–5x/d
• Ipecacuanha D2 or Pulsatilla vulgaris D3 dilution WELEDA, 1 tsp. 3–5x/d;
  for dry irritable cough, that stimulates the gag reflex, and comes more at night, as an antimicrobial agent
• Sambucus/Teucrium comp. dilution WELEDA, 15 drops 3/d
• Verbascum comp. dilution WELEDA, 15 drops 3x/d;
  for dry, insatiable coughing
• Petasites comp. pill. WALA, 10 pill. 3–4x/d;
  for all kinds of coughs

Cough with additional symptoms

• Anis-Pyrit tabs. WELEDA, 2 tabs. 4x/d, in case of additional hoarseness
• Archangelica comp. pill. WALA, 10 pill. 4x/d, in case of additional sore throat
• Pyrit/Zinnober tabs. WELEDA, 2 tabs. 3–4x/d, in case of catarrhal symptoms
• Bronchi Plantago pill. or amp. WALA, 10 pill. 3–4x/d or 1 amp. s.c. 1–2x/d,
  in case of tracheobronchitis and/or additional mucus plugging

Composition of the medications: Plantago Bronchialbalsam: D-Campher, Cera flava, Drosera e planta tota ferm 33c dil. D3, Eucalypti aetheroleum, Petasites hybridus e radice ferm 33c dil., Plantago lanceolata e foliis ferm 34c dil., Terebinthina laricina, Thymi aetheroleum. Plantago/Pulmonium Hustensaft: Petasites hybridus e radice ferm 33c dil., Picea abies Summitates, Plantago lanceolata, Folium rec. Sambucus/Teucrium comp.: Berberis, Fructus dil. D6, Phosphorus dil. D6, Sambucus nigra dil. D3, Teucrium scorodonia dil. D4. Verbascum comp.: Cetraria islandica, ethanol. Decoctum, Achillea millefolium, Flos, ethanol. Infusum, Pimpinella anisum, ethanol. Decoctum, Verbascum densiflorum, Fructus immat. dil. D2. Petasitis comp.: Abies alba e summitatibus ferm 33d dil. D2, Petasites hybridus e radice ferm 33c dil. D2, Plantago lanceolata e foliis ferm 34c dil. D2. Anis-Pyrit Tbl.: Anis-Pyrit D2. Archangelica comp.: Angelica archangelica e radice ferm 33c dil. D2, Argentum nitricum dil. D14, Hyoscyamus niger ex herba ferm 33d dil. D3, Pyrit trit. D2, Salvia officinalis e foliis ferm 33d. Pyrit/Zinnober tab.: Pyrit trit. D2, Zinnober trit. D20. Bronchi Plantago: Bronchi bovis Gl dil. D16, Bryonia cretica ferm 33b dil. D7, Eupatorium cannabinum ex herba ferm 33c dil. D7, Larynx bovis Gl dil. D16, Plantago lanceolata e foliis ferm 34c dil. D5, Pyrit dil. D14, Tunica mucosa nasi bovis Gl dil. D13.

Phytotherapy

• Soledum® capsules Casella-med, 2 caps. 3x/d ; mucolytic and antiobstructive (with cineol)
• GeloMytrol® forte capsules Bohl-Borkamp , 1 caps. 3x/d, in case of additional sinusitis (with eucalyptus oil, etc.)
• Bronchicum® capsules Cassella-med (Germany) or Bronchipret® tabs. (Switzerland), 1 caps./tab. 3x/d (with primrose, thyme)

Allopathic cough blockade

• Codein antitussives, e.g., Paracodin® Teofarma S.r.l.,
  20 drops 1x/d; in exceptional cases, e.g., to maintain a good night’s sleep or depending on the situation.
  Do not use as permanent medication.

Medication for general symptoms (significant feeling of illness/fever)

• Infludo® drops WELEDA , 10–15 drops 3–4x/d (adults)
• Infludoron® pill. WELEDA (also available as Ferrum phosphoricum comp. pill.) ,
  5–10 pill. 3–4x/d (children and adults)

Additional: acute bronchitis with spastic component

• Cuprum aceticum D3 or D4 WELEDA,
  3 x 15 drops or 1 amp. s.c. in the evening or at bedtime
• Cuprum aceticum comp. WALA,
  1 am p. s.c. in the evening or at bedtime

Additionally: for older patients, as well as for cardiac co-treatment

• Crataegus ethanol. Digestio dilution 33% WELEDA , 15 drops 3x/d, or 1 tab. 3x/d;
  for heart/circulation, and for the lungs (hypersecretion)
• Cardiodoron® WELEDA , 15 drops 3x/d (note: contraindicated in case of glaucoma)

Composition of the medications: Infludo: Eisenhut D3, Zaunrübe D2, Eucalyptus D2, Wasserdost D2, Phosphor D4, Sabadill D3. Infludoron: Eisenhut D4, Eisenphosphat D6, Zaunrübe D1, Eucalyptus D1, Wasserdost D1, Sabadill D1. Cuprum aceticum comp.: Cuprum aceticum dil. D5, Nicotiana tabacum e foliis ferm 33b dil. D9, Renes bovis Gl dil. D5. Crataegus ethanol. Digestio: Aurum metallicum praeparatum dil. D15, Cactus grandiflorus, ethanol. Digestio dil. D4, ethanol. Digestio (1:3,1) aus Onopordum acanthium, Flos rec., ethanol. Digestio (1:3,1) aus Primula veris, Flos rec., Cor bovis dil. D6, Crataegus, ethanol. Digestio dil. D3. Cardiodoron: Onopordum acanthium, flos recens, Hyoscyamus niger, herba recens, Primula veris, flos recens.

Additionally: inhalation or teas

• Table salt inhalation (NaCl 0.9%) via an ultrasound nebulizer (2ml), with Cuprum aceticum D4, 1 amp. a 1 ml, if needed; for mild obstructive bronchitis
• Steam inhalation with chamomile flowers, thyme tea
• Metered-dose aerosol inhalation or Beta 2-mimetics inhalation: Salbutamol ready-to-use inhalation via ultrasound nebulizer; for moderately severe to severe obstructive bronchitis
• Drink warm teas: e.g., with thyme, elderberry blossoms, lime blossoms, sage (possibly with honey and lemon)

Physiology

The human respiratory organization is part of the rhythmic system. It mediates between the polar aspects of the neurosensory system and the motor-metabolic system. The physiological processes of respiration are related to soul processes in human beings. Healthy respiration can be seen as an expression of the capacity for soul balance (emotional coherence). The respiratory organization is divided into the upper, middle and lower respiratory tracts. The bronchi occupy a central position and, from this viewpoint, serve especially the rhythmic processes of respiration. The lower airways, on the other hand, have a more intensive relationship to metabolic processes and the blood.

Pathophysiology

Acute inflammation of the airways is a reaction to an imbalance of forces between the neurosensory and motor-metabolic systems. When the neurosensory processes have too strong an effect on the respiratory organization, a compensatory inflammatory response develops. The primary cause of the disorder is the neurosensory system, which weakens the respiratory organization (3).

There are a variety of general behavioral recommendations and therapeutic possibilities to strengthen the powers of the respiratory organization.

These include

• Healthy nutrition
• Abstaining from nicotine
• Regular exercise (in nature)
• Warmth regulation
• Avoidance of distress
• Rhythmic structuring of the day
• Eurythmy therapy or art therapy
• Therapeutic speech formation

1. Albert RH. Diagnosis and treatment of acute bronchitis. American Family Physician 2010;82(11):1345–1350.
2. Höffken G, Lorenz J, Kern W, Welte T, Bauer T, Dalhoff K, Dietrich E, Ewig S, Gastmeier P, Grabein B, Halle E, Kolditz M, Marre R, Sitter H (ed.). S3-Leitlinien zu Epidemiologie, Diagnostik, antimikrobieller Therapie und Management von erwachsenen Patienten mit ambulant erworbenen tiefen Atemwegsinfektionen. Kurzfassung. 2nd ed. Stuttgart: Thieme Verlag KG; 2009.
3. Steiner R. Geisteswissenschaftliche Gesichtspunkte zur Therapie. GA 313. 5th ed. Dornach: Rudolf Steiner Verlag; 2001, p. 149. English translation: Steiner R. Illness and therapy. Spiritual-scientific aspects of healing. London: Rudolf Steiner Press; 2013.
4. Practical Approach to Lung Health: Manual on Initiating PAL Implementation. Geneva: World Health Organization (WHO); 2008, p. 33.
5. Global initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. GOLD Report 2019. Available at : https://goldcopd.org/wp-content/uploads/2018/11/GOLD-2019-POCKET-GUIDE-FINAL_WMS.pdf (25.07.2019)