Bronchitis is also apt to be very severe when it occurs in persons who are addicted to intemperance. Again, in those who suffer from any disease affecting directly or indirectly the respiratory functions, such as consumption or heart disease, the supervention of an attack of acute bronchitis is an alarming complication, increasing, as it necessarily does, the embarrassment of breathing. The same remark is applicable to those numerous instances of its occurrence in children who are or have been suffering from such diseases as have always associated with them a certain degree of bronchial irritation, such as measles and whooping-cough.
One other source of danger of a special character in bronchitis remains to be mentioned, viz. collapse of the lung. Occasionally a branch of a bronchial tube becomes plugged up with secretion, so that 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 escapes, but no fresh air enters, and the part collapses and becomes of solid consistence. Increased difficulty of breathing is the result, and where a large portion of lung is affected by the plugging up of a large bronchus, a fatal result may rapidly follow, the danger being specially great in the case of children. Fortunately, the obstruction may sometimes be removed by vigorous coughing, and relief is then obtained.
With respect to the treatment of acute bronchitis, in those mild cases which are more of the nature of a simple catarrh, little else will be found necessary than confinement in a warm room, or in bed, for a few days, and the use of light diet, together with warm diluent drinks. Additional measures are however called for when the disease is more markedly developed. Medicines to allay fever and promote perspiration are highly serviceable in the earlier stages. Later, with the view of soothing the pain of the cough, and favouring expectoration, mixtures of tolu, with the addition of some opiate, such as the ordinary paregorics, may be advantageously employed. The use of opium, however, in any form should not be resorted to in the case of young children without medical advice, since its action on them is much more potent and less under control than it is in adults. Not a few of the so-called "soothing mixtures" have been found to contain opium in quantity sufficient to prove dangerous when administered to children, and caution is necessary in using them.
From the outset of the attack the employment of fomentations, or especially a turpentine stupe, gives great relief, and occasionally in the non-specific form this treatment, combined with a good dose of calomel and salts, may render the attack abortive. Some relief is always obtained by inhalations, and theoretically, an acute specific bronchitis should be successfully treated by inhalation of antiseptic and soothing remedies. In practice, however, it is found that the strength cannot be sufficiently strong to destroy the bacteria in the bronchial tubes. However, much relief is obtained from the use of steam atomizers filled with an aqueous solution of compound tincture of benzoin, creosote or guaiacol. A still more practicable means of introducing volatile antiseptic oils is the globe nebulizer, which throws oleaginous solutions in the form of a fine fog, that can be deeply inhaled. Menthol, eucalyptol and white pine extract are some of the remedies that may be tried dissolved in benzoinol, to which cocaine or opium may be added if the cough is troublesome.
When the bronchitis is of the capillary form, the great object is to maintain the patient's strength, and to endeavour to secure the expulsion of the morbid secretion from the fine bronchi. In addition to the remedies already alluded to, stimulants are called for from the first; and should the cough be ineffectual in relieving the bronchial tubes, the administration of an emetic dose of sulphate of zinc may produce a good effect.
During the whole course of any attack of bronchitis attention must be paid to the due nourishment of the patient; and during the subsequent convalescence, which, particularly in elderly persons, is apt to be slow, tonics and stimulants may have to be prescribed.
Chronic bronchitis may arise as the result of repeated attacks of the acute form, or it may exist altogether independently. It occurs more frequently among persons advanced in life than among the young, although no age is exempt from it. The usual history of this form of bronchitis is that of a cough recurring during the colder seasons of the year, and in its earlier stages, departing entirely in summer, so that it is frequently called "winter cough." In many persons subject to it, however, attacks are apt to be excited at any time by very slight causes, such as changes in the weather; and in advanced cases of the disease the cough is seldom altogether absent. The symptoms and auscultatory signs of chronic bronchitis are on the whole similar to those pertaining to the acute form, except that the febrile disturbance and pain are much less marked. The cough is usually more troublesome in the morning than during the day. There is usually free and copious expectoration, and occasionally this is so abundant as to constitute what is termed bronchorrhoea.
Chronic bronchitis leads to alterations of structure in the affected bronchial tubes, their mucous membrane becoming thickened or even ulcerated, while occasionally permanent dilatation of the bronchi takes place, often accompanied with profuse foetid expectoration. In long-standing cases of chronic bronchitis the nutrition of the lungs becomes impaired, and dilatation of the air-tubes (emphysema) and other complications result, giving rise to more or less constant breathlessness.
Chronic bronchitis may arise secondarily to some other ailment. This is especially the case in Bright's disease of the kidneys and in heart disease, of both of which maladies it often proves a serious complication, also in gout and syphilis. The influence of occupation is seen in the frequency in which persons following certain employments suffer from chronic bronchitis. Hirt has shown that 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 presence or absence of complications. Attention to the general health is a matter of prime importance in all cases of the disease, more particularly among persons whose avocations entail exposure, and tonics with cod-liver oil will be found highly advantageous. The use of a respirator in very cold or damp weather is a valuable means of protection. In those aggravated forms of chronic bronchitis, where the slightest exposure to cold air brings on fresh attacks, it may become necessary, where circumstances permit, to enjoin confinement to a warm room or removal to a more genial climate during the winter months.