=Definition.=—A catarrhal inflammation of part or whole of the mucous
membrane of the larynx, trachea and bronchial tubes, or it may extend
into the capillary tubes. This is bilateral, affecting more or less the
bronchial tree in both lungs.
=Osteopathic Etiology= and =Pathology=.—The most common cause of acute
bronchitis is “catching cold.” It is more prevalent in the winter, and
it often succeeds an ordinary cold in the head, coryza or laryngitis,
the inflammation extending downward from the upper air passages. A
case of acute bronchitis always presents a contracted condition of
the muscles on either side of the spine in the upper dorsal region.
The contracted muscles may extend as far down as the middle dorsal or
as high as the entire cervical. Occasionally, the ribs posteriorly
are drawn downward by the extreme contraction of the muscles, and
the upper anterior part of the chest may be somewhat constricted and
limited in its movements by the tensed muscles. Thus, in a few cases
the ribs and upper dorsal vertebræ are actually subdislocated by the
extreme contraction of the muscles. The principal points affected are
the second, third, fourth and fifth dorsal regions. In a few instances
cervical lesions disturbing the vagus and resulting in motor weakness
of the tubes, will be noted. The osteopathic control of the bronchial
vasomotor nerves is in this region (dorsal).
The disease is also associated with measles and it is usually a symptom
of influenza. One attack predisposes to another. It affects either
sex and especially children and the old, in whom it most frequently
involves the smaller bronchi. In adult life it involves the larger
bronchi. Micro-organisms, particularly the pneumococcus, influenza
bacillus, and micrococcus catarrhalis, act as exciting causes.
=Pathologically=, the mucous membrane of the portion of the trachea
and bronchi that are implicated become reddened, congested and more
or less covered with a tough mucus mingled with epithelial cells. The
hyperemia is most marked about the mucous glands. Some of the smaller
bronchial tubes are dilated. In severe cases there is desquamation
of the ciliated epithelium, swelling and edema of the submucosa, and
infiltration of the tissues with leucocytes. The affection involves
chiefly the vasomotor nerves. In cases on the verge of chronicity,
look well to the diet; especially lessen in amount the starchy and
saccharine foods.
=Symptoms.=—The onset of acute bronchitis is accompanied by the
symptoms of a common “cold.” In the beginning the cough is hard and dry
without expectoration; but later it is looser, the secretion becoming
mucopurulent and abundant and finally purulent. The scanty sputum
is at first glairy and mucoid, while later it becomes more abundant
and mucopurulent and contains pus cells and desquamated epithelium.
When the bronchial inflammation becomes fully established, there is a
feeling of tightness and rawness beneath the sternum and a sensation of
oppression in the chest, due to swelling of the mucous membrane and the
presence of secretions which cause stenosis of the bronchial lumina.
There is a slight fever, rarely exceeding 101 degrees F. The disease
lasts from four or five days to three weeks. There is either a complete
recovery or chronic bronchitis is developed.
=Physical Signs.=—There may be no physical signs in slight attacks of
acute bronchitis of the larger tubes. In severer cases the physical
signs are well marked. =Inspection= may recognize increased frequency
of breathing, and when the smaller tubes are involved there is dyspnea.
=Palpation.=—The bronchial fremitus may often be felt, providing there
is sufficient narrowing of the breathing tubes. =Percussion.=—Sounds
are normal as long as the bronchitis is uncomplicated.
=Auscultation.=—In the early stage piping, sibilant rales may be heard
on both sides. These rales are inconstant and appear and disappear with
coughing. There may be harshness of breathing added to these. When
resolution sets in, the rales change and become mucous and bubbling in
quality. Vocal resonance in bronchitis is normal, unless complications
occur.
=Diagnosis.=—This is generally easy. The absence of dullness and
blowing breathing and the bronchial character of the cough and
expectoration are usually sufficient to distinguish it from pneumonia
and pleurisy. If the physical signs are noticed carefully, the
diagnosis is rendered easy and positive in all cases.
=Prognosis.=—In the very young and the very old, the prognosis is
unfavorable, but in a previously healthy adult the most that can
happen to a case of acute bronchitis is to become chronic. Recovery is
the rule; even in the aged and feeble death is rare. If osteopathic
treatment can be instituted from the inception, the disease will
probably be aborted. The treatment almost invariably lessens the
severity and duration of an attack. For capillary bronchitis see
Bronchopneumonia.
=Treatment.=—Complete rest in a warm bed, and a hot foot bath would
cure a large majority of cases in a day or two if the patient would
only submit to such treatment. Most of them wish to be around and out
doors and very likely attending to their usual work, so that a cure in
some cases is hard to perform. They are very liable to take more “cold”
and in a few cases it will take great effort to prevent the bronchitis
from becoming chronic. One thorough treatment per day will usually be
sufficient.
The hyperemic condition of the bronchial tubes is due to a vasomotor
disturbance, generally caused by a severe contraction of the muscles
of the back in the region of the first to fourth dorsal; although the
vasomotor nerves to the mucous membrane of the bronchial tubes may
be affected anywhere from the first to the seventh dorsal inclusive.
Contraction of the muscles over the anterior part of the chest
corresponding to these regions and caused by the same influences
(chiefly atmospherical changes) is of quite common occurrence. In the
majority of cases the contraction of the chest and back muscles is
so severe that the ribs are partly displaced by the tension and thus
is added a complication to the disorder, and from this complication
chronic bronchitis is liable to occur. The ribs or even vertebræ to
the corresponding region oftentimes remain partly dislocated and are
a source of continued and permanent irritation to the innervation of
the bronchial tubes. So it is always necessary in treating any form of
bronchitis to see at each treatment that the ribs and vertebræ from the
first dorsal to the seventh dorsal, inclusive, are anatomically correct.
As has been stated, the disordered muscles or ribs may be affected
anteriorly as well as posteriorly; consequently, the treatment
applied is a thorough relaxation of the chest and back muscles and
the correction of the ribs and vertebræ in order that the vasomotor
disturbance of the bronchial mucosa may be corrected and the
inflammation relieved. An excellent method to release the immobilized
anterior upper chest is to place patient flat upon his back with
pillow beneath upper dorsal. This hyperextends spine, enlarges spinal
foramina, and tends to elevate ribs. Then by use of arms as levers,
moderate inspiration, and employment of one hand over anterior end of
ribs they may be easily released and raised. This treatment effects
circulation, innervation, lymph tissue, and rib bone marrow.
In addition to the dorsal spinal nerves, and the sympathetic, the vagi
are to be considered in the treatment of bronchitis, as all of these
nerves, sympathetic, spinal, and vagi, go to make up the anterior and
posterior pulmonary plexuses from which the bronchial mucosa receives
its innervation. The veins particularly involved in passive hyperemia
of the bronchial tubes are the superior intercostal and azygos
major; so raise and spread the ribs to give greater freedom to these
blood-vessels.
“The blood flow may be diverted from the bronchi to the abdomen by a
slow, deep, inhibitive treatment over it, including pressure over the
solar and hypogastric plexuses.” (Hazzard).
The excretory organs and the diet of the patient should be attended to.
Especially in children, the diet had best be a fluid one, as milk, egg
albumin, meat broths and meat juice. For those who are subject to the
disease an outdoor life is best.