Saturday, December 29, 2012

CHRONIC BRONCHITIS


Chronic inflammation of respiratory tubes (bronchi) with mucus secretion is termed as chronic bronchitis.  Productive cough which persists for at least three months per year in two consecutive years is indicative of chronic bronchitis.  It is classed as a chronic obstructive pulmonary disease (COPD), others being emphysema.
Causes – Smoke and dust are the most common causes of chronic bronchitis.  Smoke may be of tobacco or ovens using woods, cow dung etc. or of some factory smoke polluting air.  Dusts inhaled by mine workers and stone cutters also causes chronic bronchitis.  Allergies cause symptoms similar to chronic bronchitis or asthma.
Signs and symptoms – Common symptoms of chronic bronchitis are cough with phlegm, shortness of breath and wheeze (noisy respiration).  The mucus is often yellow or green or of other color according to type of infection.  Sometimes pain chest and fever occur.  Weakness and malaise often present.
In person suffering from chronic bronchitis acute attacks are not uncommon.  During as acute episode cough and thick mucus accumulation obstructs the passage to causes severe breathing difficulty.  Sometimes chill, fever and malaise are associated with it.   
Diagnosis- Symptoms are indicative.  Noisy breathing (wheezing), prolonged expiration and decreased respiratory sounds on auscultation help to diagnose.
Chest X-ray shows hyperinflation of bronchial tubes.  Collapse and consolidation of lung indicates pneumonia.   In expectoration neutrophils and streptococcus are seen.  Infection is not a cause of chronic bronchitis but it increases neutrophil infiltration at the site which causes increased mucus secretion.  Total white cell count in blood increases with increased C-reactive protein.  Presence of goblet cells in bronchioles is confirmatory of chronic bronchitis.
In case of unresolved diagnosis High resolution Computerized Tomography (HRCT) is done.
Treatment- Conventionally chronic bronchitis is treated with antibiotics and bronchodilators.  Only in 5-10% cases infection could be related as cause of chronic bronchitis. Nicotin in any form especially smoking should be restricted as it paralyses cilia in respiratory tubes which push foreign particles up and clear the bronchi.  The paralysis results in accumulation of mucus.  A self limiting viral infection usually resolves in a few weeks. Oxygen therapy is required if acute attack in not controlled with medicines.
Homoeopathic medicines – The homoeopathic medicines listed below covers symptoms of chronic bronchitis but in homoeopathic prescribing it the man in disease which is important so none of these medicines should be prescribed for chronic bronchitis rather patient should be individualized on the basis of generals, modalities, concomitants etc..
Chronic inflammation of Bronchial tubes – Alumina, Ammonium-carb., Ammonium- caust., Ammonium-iod., Ammonium-mur., Ammoniacum, Antim-ars., Antim-iod., Antim-sulph-aurum., Antim-tart., Arsenicum alb., Arsenic-iod., Bacillinum, Balsamum-peruvianum, Balsamum-tolutanum, Baryta-carb., Baryta-mur, Calcarea carb., Calcarea-iod., Calcarea-sil., Cantharis, Carbo-animalis, Carbo-veg., Ceanothus, Chelidonium, China, Cocus cact., Conium, Copaiva, Cortisonum, Cubeba, Digitalis, Diphtherotoxinum, Drosera, Dulcamara, Eriodyctyon californicum., Eucalyptus, Eupatorium-cannabinum, Grindelia,  Heper sulph., Hydrastis, Hyoscymus, Ichthyolum, Ilex-aquifolium, Iodum, Ipecacuana, Kali-bichromat., Kali-carb., Kali-hypophos., Kali-iod., Kali-sulph., Kreosotum, Lachesis, Lycopodium, Marrubuum-vulg., Medorrhinum, Mercurius sol. ,Morgan bacillus, Muco-toxinum, Myosotis-arvensis, Myosotis-symphytifolia, Myrtus-cheken, Natrum-mur., Natrum-sul., Nitric-ac., Nux-vom., Pertusinum, Phosphorus, Pix liquida, Pneumococcinum, Pulsatilla, Rumex.,  Sabal ser., Sanguinaria, Secale cor., Senega, Sepia, Silicea, Silphium lacinatum, Spongia, Squilla, Stannum met., Stramonium, Strychninum purum, Sulphur, Taxus baccata, Terebinth., Tuberculinum bov., Tuberculinum-denys, Tub-residuum Koch Veratrum alb.

Case - G B      65 yrs.   Female   married   housewife    hindu    vegetarian
Diagnosis – chronic bronchitis.
The patient was suffering from cough for last 10 months.  Cough used to occur every winter but this time it continued beyond the winter. The cough was barking, whistling and sometime rattling aggravated at night, waking patient often. Her trouble also aggravated from fan, air draft, on lying, talking and laughing. Better by sitting up in bed, sometimes relieved after drinking. There were 2-3 coughs in every paroxysm and often excited with feeling mucus in trachea. Expectoration was white. There was a history of patient staying in hospital to nurse her ailing sister but there was no acute cough, cold or fever. 
Appetite was normal increased after exertion but patient was taking meals once a day mostly in afternoon. Thirst less. She had habit of taking coffee twice a day. She was used to wakes for urination at night for 2-3 times. Falls asleep easily and she generally sleeps on right side. Blood pressure was 130/86 mm of Hg. Tongue was thickly coated white.
Hemoglobin 13.2 gm/dl, TLC 10,520, ESR 70. Sputum was not given. X – ray chest showed prominent bronchial marking.
16/10/11 Rx Lachesis         30  twice a day for 3 days.
19/10/11 No change.
               Rx 1. Heper sulph 200 two doses at 10 minutes interval.
                    2. Causticum    200 two doses at 10 minutes interval to take after 1 week if not relieved 
                    3. Rubrum        30   twice a day for 15 days.
05/11/11 Cough relieved 75% after the dose of Heper sulph. So Causticum was not required. Hoarseness of voice and white expectoration not relieved.                        
                   Rx 1. Spongia        30  two doses at 10 minutes interval weekly.
                        2. Rubrum         30  twice a day for 30 days.
05/12/11 No expectoration. Voice became normal. Cough sometimes at night and from cold air.
                   Rx 1. Heper sulph  200   two doses at 10 minutes interval.
                        2. S. L.              200   two doses at 10 minutes interval weekly.
                        3. Rubrum         30     twice a day for 30 days.
Patient reported to be trouble free after the last dose of Heper sulph on 09/01/12.


Dr. M. K. Tyagi
D.H.M.S., Dip. N.I.H.
Research Officer, Sewa Mandir.
Mobile" 09829157926
Email: 1.sewamandir@usa.net, 2.manju_mkt2003@yahoo.co.in

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