Thursday, 17 May 2012

Thoughts on bronchitis

Good news is that I'm healthy, so this is a random post regarding bronchitis after reading this. Quick thought to pass on then I'm done.

In the last week I've known of two people who've caught bronchitis, one of them a friend of mine, and both were taking antibiotics. Thing is, antibiotics only work when the infections are bacterial-based, not viral. Your run-of-the-mill cold (aka rhinovirus; one of many dozen variations) moves from the upper respiratory tract to the brochi (inside the lungs) and voila, you have bronchitis. Bronchitis is a particularly prodigious cold, probably taking advantage of a weakened organism (i.e. you). Athletes, with their hard breathing are particularly susceptible if over-training themselves. If you caught what looked to be a cold but progressed to more coughing that usual, chances are it's viral. Bacteria infect lungs much less commonly. If bacteria is in your lungs there's a good chance it's pneumonia and far worse than a simple cough/head stuffiness.

So, if you have bronchitis it's probably viral and if you have pneumonia it's probably bacterial. That's how it usually works, as far as I understand.

My own brush with bronchitis was straightforward enough, if not annoying: during the fall of 2009 I caught a cold the day before an 'important' race (too much stress, my own fault). I raced anyway. Next day I was coughing loudly, and it lasted eight weeks with some mild/persistent coughing for another month thereafter. Sucked, but doctors were adamant there was nothing I could do about it; no pill would shorten the stay of infection. This well-meaning doctor also took an Xray of my lungs to confirm bronchitis. She gave me a steroid inhaler, but I knew (and she did too) this was a placebo-based measure. Doing something feels better than nothing, right? Spent about 20$ on the inhaler and I thought of worse reasons that I have opened my wallet.

Taking what I knew into context, even 20$ was a silly amount to pay.  I knew, positively knew there was no chance the inhaler would work. Supposedly the inhaler reduces swelling in the lungs, but you know what really reduces swelling? Rest, which leads to stronger immune system. It's nice to pretend-fight disease, but what puts patients into a positive mindset is good information. This is true whether you're weathering a mild storm or fighting a serious illnesses. Antibiotics were ruled against my case because they would do nothing. Glad my doctor was smart; had she prescribed ABs I probably would have taken them.

What troubles me is the evidence that suggests doctors prescribe antibiotics to bronchitis patients anyway. They're thinking, I suppose, that it's better to be safe than sorry. If a patient might have a bacterial infection they may as well give them a few antibiotics to stave off that 5-10% chance. The short-term downside (for the patient) is small (except for they money wasted and possible side effects), but later the downside is bacterial resistance, which is pretty bad. This JAMA article found unneeded AB prescriptions were especially prevalent in children. The abstract reads
Antibiotic prescribing for children diagnosed as having colds, URIs, and bronchitis, conditions that typically do not benefit from antibiotics, represents a substantial proportion of total antibiotic prescriptions to children in the United States each year.
Such doctors are preparing worse illnesses in the child's adult years. Very worrisome, especially when compounding the AB resistance of many bacterial-based lung infections (i.e. Mycoplasma and Klebsiella) compounding the futility of taking these pills. In a meta study of 15 papers it was found that
There is limited evidence to support the use of antibiotics in acute bronchitis. Antibiotics may have a modest beneficial effect in some patients with acute bronchitis though data on subsets of patients who may benefit more from treatment is lacking. However, the magnitude of this benefit needs to be considered in the broader context of potential side effects, medicalisation for a self limiting condition, increased resistance to respiratory pathogens and cost of antibiotic treatment.
Both these papers are well-cited (a few hundred apiece). All said, I'd estimate an order-of-magnitude 1% chance that taking an AB will cure your bronchitis (a rough guess given a 5-10% initial chance of bacterial infection, among which maybe a < 50% chance of these infections subside with a given pill i.e. Haemophilus and Pneumococcus vs Mycoplasma, Klebsiella. But then not every dose is 100% effective even if the medicine is theoretically effective. Compounding odds against the effectiveness are side effects being worse than the bronchitis itself, so the probability of net usefulness drops even further.

Back to sports: Athletes are -generally speaking- young, young enough to have a long life beyond their competitive years. Ideally those later years should be enjoyed as much as the earlier ones. Unfortunately those taking antibiotics without due consideration run serious risks in their long-term health and for a negligible gain. Athletes are not more at risk for lung-related problems:
Athletes ... tended to have fewer reimbursable medications for asthma and fewer current symptoms for chronic bronchitis...The lifetime occurrence of asthma or other pulmonary diseases is not increased in former elite athletes, and exercise alone, even in a cold environment, did not appear to increase the prevalence of asthma
At least if they take proper care and rest and not overreaching themselves (but try telling that to the sponsors...)

I am not knocking medicine, just its abuse in risk management. You don't risk an operation unless the danger to your health breaches a considerable threshold. Here too athletes will opt for risky procedures to gain mobility. For myself, I decided (after consulting a podiatrist) to wait until serious pain occurs in my bunion before I consider an operation (she set me straight here), but the athlete part of me wants the surgery, like, yesterday. [NB: Major surgery could be an excellent time for antibiotics; imagine wasting that resistance on a bad cold]. Speaking of tradeoffs, watch the scene in Hoop Dreams where William Gates undergoes knee surgery to salvage his high school basketball career. The doctor says he'll recover for next year, but in his post college years he'll probably have the knees of a senior citizen.

There, I'm done.


  1. The question is “ is bronchitis contagious “ So chronic bronchitis isn't contagious, but it's a severe health issue that needs a doctor's concern. Acute Bronchitis is contagious, which can last for 1 to 3 weeks? It's usually caused by cold or flu viruses. Since these viruses are contagious, acute bronchitis usually is, too.

  2. Thanks for sharing this extremely informative article on bronchitis. I recently read about what is bronchitis on website called I found it extremely helpful.

  3. Most symptoms of bronchitis and pneumonia can develop from other cold illness like flu and a common cold. To get a proper diagnosis, you must consult with your physician, as only they will be able to determine the proper course of treatment.

    Do you know Is Bronchitis Contagious And How Does It Spread?
    To prevent this, try to cease contact with others while you have bronchitis, as both bronchitis and the flu can be contagious.