Chronic bronchitis - What medicine to use?

Chronic bronchitis is characterized by cough and phlegm... at least 3 months a year (may not be continuous), lasting at least 2 years (but not due to tuberculosis, lung fungus, abscess, bronchiectasis).

There are acute episodes leading to bronchiectasis, bronchial obstruction (called chronic obstructive bronchitis) causing reduced ventilation, alveolar dilation, respiratory failure, and chronic cor pulmonale.

The main cause of bronchial hypersecretion is due to viruses and bacteria. However, bacteria from infections in the upper respiratory tract, teeth, mouth, and sinuses can cause secondary infections, creating secondary complications of an acute bronchial hypersecretion episode of chronic bronchitis.

Treatment may include symptomatic medications and antiviral and antibacterial drugs.

Symptomatic drugs

Expectorants: Secretions stagnant in the bronchi cause obstruction in the airways. Expectorants facilitate the cough reflex to expel secretions to clear the airways. If the secretions are small but thick and difficult to expel, use secretion thinning agents such as sodium benzoate and terpin hydrate. If the secretions are large and thick, thinning will increase the volume and make ventilation difficult, use sulfur-containing reducing agents such as acetylstein and carboxystein.

These substances act on the gel phase of secretions, breaking the disulfide bonds of glycoproteins, changing the structure and destroying the secretions. Cough suppressants can be used, but at appropriate doses. Do not use too high a dose to stop the cough immediately, because too high a dose will completely eliminate the cough reflex, meaning that the expulsion of secretions will be hindered.

Treatment for patients with bronchitis

Anti-inflammatory drugs: Inflammation causes difficulty in breathing. Use oral, inhaled or inhaled corticosteroids, in severe cases use injections to reduce inflammation. Note: with oral and injectable forms, only use a dose that is effective for a short period of time (no more than 10 days) to avoid systemic side effects (causing water retention, reduced resistance). Inhaled forms rarely cause systemic side effects and can be used for a longer period of time. However, prolonged use can cause fungal infections, so after each use, rinse your mouth and throat thoroughly.

Anti-obstructive bronchodilators: Use bronchodilators to reduce airway obstruction such as theophylline, beta 2 agonists (short-acting drugs such as salbutamol, terbutaline, fenoterol and long-acting drugs such as salmeterol, formoterol).

Theophylline has the effect of dilating the bronchi, thus reducing difficulty breathing. The drug is diuretic, causes rapid heartbeat, and stimulates the nerves. Using a sufficient therapeutic dose will take advantage of the main effect, using a high dose will cause side effects. The interval between the effective dose and the toxic dose is short, if used incorrectly, it is easy to be poisoned.

For adults, the drug is difficult to tolerate, slowly excreted, less toxic, and only needs to be used twice a day. While for children, the drug is easily tolerated, quickly excreted, and easily toxic, and needs to be used 4-5 times a day. Most drugs are metabolized in the liver and excreted through urine, so people with liver or kidney failure or children whose liver detoxification ability is not strong enough should not use it. Drugs secreted in milk should not be used by breastfeeding mothers. If the mother needs to use it, she should give her child supplementary milk.

Beta-2 agonists stimulate beta-2 adrenergic receptors, leading to smooth muscle relaxation, antispasmodic bronchial spasm, and airway clearance. Depending on the degree of bronchial obstruction (long or short), choose the appropriate drug. Use inhaled form through the nose and mouth (fast effect, timely relief of bronchial obstruction). This group has side effects: increased oxygen consumption at rest, causing tachycardia at rest, arrhythmia, hand tremors, hypokalemia. Oral use is not recommended because of slow absorption, late onset of effect (not timely response to relieve bronchial obstruction), higher doses are required, and can easily cause cardiovascular stimulation, agitation, muscle tremors, and headaches.

Anticholinergics and beta 2 agonists both cause tolerance (higher doses are required to achieve the same effect). They should not be used long term but should be used intermittently.

Antiviral and antibacterial drugs

Antiviral: Antiviral drugs are used to fight the cause of chronic bronchitis. Commonly used drugs are antiviral drugs against influenza A.

Antibacterial resistance: Depending on the danger level and severity of the bacterial strain, you can use common antibiotics or strong antibiotics, use one antibiotic or a combination of two or more antibiotics. Each course of treatment lasts 8-15 days if mild, and 4-6 weeks if severe. Some antibiotics that can be used are: benzylpenicillin, ceftriazone, augmentin...

Chronic bronchitis is quite dangerous, especially when it is infected, and needs to be treated actively. The use of symptomatic drugs and antibiotics must be specifically prescribed by a doctor regarding dosage and duration of use. Patients should not take medicine on their own.

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