As regards the treatment of such cases we shall only consider the dietetic part. The first and essential thing is to remove the excess of adipose tissue, and to relieve the lungs of the work of carbo-hydrate excretion which has been beyond their powers. It may be taken for granted, without making any objectionable inquiries, that too much food is being taken, and that the excess has been in the form of carbo-hydrates and fats. They must be mercilessly cut down, and a diet consisting largely of protein material must be substituted. Three meals a day may be ordered, to be selected from the following : beef or mutton plainly cooked, chops, steak, fish, game, fowl, kidneys, tongue and veal. These are to form the main part of the dietary, and must be partaken of in moderation, so as to avoid the evils of an excessive amount of nitrogenous food. If signs of indigestion or gastric discomfort appear, the patient has probably been taking too much. In addition to the above, there may be allowed at each meal two small pieces of dry toast, or two breakfast biscuits, or two tablespoonfuls of dinner biscuits; at one meal a tablespoonful of spinach or other green vegetable, and at another meal a raw apple. One cup of tea or coffee, or one claret glassful of water (with 1/2 oz. of brandy or whisky if desired) represents the amount of fluid allowed with meals. This may be called the rigid dietary, which is modified according to the progress of the patient. While the amount of fluid taken at meals is strictly limited, the patient may be encouraged to drink at other times from 1-2 pints or more daily. Plain water is as good as any other, but soda or potash water may be taken if preferred, and Contrexeville water will be found useful if the urine contains much uratic deposit. The excretory organs will carry off the superfluous tissues more rapidly if supplied with plenty of plain fluid.
As a result of this treatment the patient should lose in weight from 2-3 lb. per week. He will also in a short time report the disappearance of the chronic wheeze, and of the shortness of breath on exertion, and an increased power of walking up an incline. He or his friends may become anxious as to the effects of this diet on his gout, for many of these patients are gouty, or are believed to be so. As a matter of clinical experience it will be found that "gouty bronchitis" in a fat subject usually turns out to be fatty bronchitis in a gouty subject. The diet, however, is both digestible and nourishing, and will not affect a gouty tendency unless indulged in immoderately. More urgent will be the patient's cry for his wine, the champagne or port which had been ordered him as "strengthening." He may be assured that his diet is a sufficiently strengthening and stimulating one, and that alcohol will only increase the tendency to pulmonary catarrh. The severe protein regimen does not require to be continued for the rest of the patient's life. When he has been sufficiently reduced in bulk, as shown by the amelioration of the symptoms, a gradual return may be made to an ordinary diet. What must be insisted on is that his meals in future should be moderate in amount, and that the carbo-hydrate element especially should not be in excess.
The addition of some animal fat to the diet in the form of milk, cream, butter, etc., is useful in all forms of chronic bronchitis, provided that the digestion is not overtaxed. The patient who has bronchitis every winter will probably benefit more from cod-liver oil taken throughout the cold months than from any other therapeutic measure.
In the chronic bronchitis of elderly people, which may be described as that due to cardiac weakness and respiratory difficulty, a more stimulating form of treatment may be called for. The employment of small and frequent meals of nourishing food will be found beneficial generally, and will not cause indigestion and flatulence. Alcohol may be used more freely in this form than we have felt justified in recommending at the earlier periods of life. The cardiac and respiratory centres will benefit from the stimulation which alcohol supplies. Two to three ounces of brandy, or a couple of glasses of port or Burgundy may be taken daily.
In infancy bronchitis is for the most part associated with rickets, and is often of a most acute kind. In the acute stage the diet is that of a feverish attack, but afterwards much may be effected by diet both in the prevention of further acute attacks and in the cure of chronic bronchitis. Rickets is a disease which leads directly to a catarrhal condition of the bronchial tubes. The tendency is still further increased by the fact that the preceding diet has usually been one containing an excessive amount of carbo-hydrate material. An excessive carbo-hydrate diet throws extra work on the pulmonary powers of excretion, and produces an excessive amount of flabby adipose tissue which interferes with the circulation through the lungs. These conditions must be altered by the adoption of a full anti-rachitic diet (see Rickets).
The leading measures are to reduce the carbo-hydrate intake, and to increase the amount of animal fat and proteins.