bubble_chart Overview

Acute bronchitis or acute tracheobronchitis is more common and severe in infants and young children, often complicating or secondary to upper and lower respiratory tract infections, and is a clinical manifestation of measles, whooping cough, cold-damage disease, and other acute pestilential diseases. When bronchitis occurs, the trachea is mostly inflamed at the same time. If the bronchioles are involved, the pathology and symptoms resemble those of pneumonia.

bubble_chart Etiology

The pathogens are viruses, Mycoplasma pneumoniae, or bacteria, or a combination of these infections. Among viral infections, influenza, adenovirus, parainfluenza type 3, and respiratory syncytial virus are the most common, with Mycoplasma pneumoniae also being frequently observed. Any virus capable of causing upper respiratory infections can become the causative agent of bronchitis. On the basis of viral infection, secondary bacterial infections may occur. The more common bacteria include pneumococci, group A β-hemolytic streptococci, staphylococci, and Haemophilus influenzae, and occasionally Bordetella pertussis, Salmonella, or Corynebacterium diphtheriae. Malnutrition, rickets, allergic reactions, as well as chronic rhinitis and pharyngitis can all serve as predisposing factors for this disease.

bubble_chart Clinical Manifestations

The onset can be acute or gradual. Most cases begin with symptoms of upper respiratory tract infection, but may also suddenly present with frequent and deep dry cough, followed by the gradual appearance of bronchial secretions. Dry and wet rales can be heard in the chest, mainly medium bubble sounds, and occasionally limited to one side. Infants and young children cannot expectorate sputum and mostly swallow it through the throat. Mild cases show no obvious signs of illness, while severe cases may present with fever of 38–39°C, occasionally reaching 40°C, which usually subsides within 2–3 days. Patients may feel fatigued, experience sleep and appetite disturbances, and may even develop gastrointestinal symptoms such as vomiting, diarrhea, and abdominal pain. Older children may complain of headache and chest pain. Cough generally lasts 7–10 days, sometimes lingering for 2–3 weeks or recurring. Without proper treatment, pneumonia may develop. White blood cell counts may be normal or slightly low; elevated counts may indicate secondary bacterial infection.

Robust children rarely experience complications, but those with malnutrition, weakened immune function, congenital respiratory tract abnormalities, chronic nasopharyngitis, or rickets are not only more susceptible to bronchitis but also prone to complications such as pneumonia, otitis media, laryngitis, and sinusitis.

bubble_chart Diagnosis

Chest rales can be coarse or fine, mostly medium moist rales, mainly scattered in the lower chest. After coughing up secretions, the rales may temporarily decrease. Occasionally, due to excessive mucus accumulation in the bronchi, breath sounds may diminish, but they return to normal after expectoration. Severe bronchitis is difficult to distinguish from early-stage pneumonia. If deeper rales or crackles are heard, and the rales do not significantly decrease after coughing, pneumonia should be considered, and a chest X-ray should be performed for confirmation.

bubble_chart Treatment Measures

1. General Treatment Regarding rest, diet, adjustment of indoor temperature and humidity, etc., please refer to "Upper Respiratory Tract Infection." Infants should frequently change their lying position to facilitate the discharge of respiratory secretions. When frequent coughing interferes with rest, antitussives may be administered, but excessive dosage should be avoided to prevent suppression of the cough reflex needed to expel secretions. When acute bronchitis causes spasms leading to dyspnea, mild cases can be managed with reference to the following Chinese medicine therapy for "excessive heat panting," while severe cases should be treated with reference to bronchiolitis and bronchial asthma.

2. Chinese Medicine Therapy In Chinese medicine, this condition is referred to as "cough due to external contraction." Depending on the pathogenic factors, it is clinically classified into wind-cold cough, wind-heat cough, and excessive heat panting. The treatment principles focus on dispersing wind and dissipating cold, clearing heat and ventilating the lungs, and reducing heat to calm panting. Clinical differentiation and treatment should be combined.

(1) Wind-Cold Cough: Characterized by sudden coughing, frequent and urgent cough sounds, thin sputum, stuffy nose, clear nasal discharge, itchy throat, or accompanied by headache, aversion to cold, or absence of fever, slightly white tongue coating, and floating pulse. Treatment aims to release the exterior with pungent-warm herbs and dissipate cold to relieve cough. Commonly used formulas include Apricot Kernel and Perilla Powder with modifications.

Example Prescription: Bitter Apricot Seed 6g, Cultivated Purple Perilla Leaf 3g, Peucedanum 9g, Pinellia Tuber 6g, Great Burdock Achene 6g, Fresh Ginger Rhizome 3 slices.

(2) Wind-Heat Cough: Characterized by unproductive coughing, thick yellow sputum, red throat, dry mouth, stuffy nose with yellow nasal discharge, or accompanied by fever, sweating, slightly yellow-white tongue coating, and rapid floating pulse. Treatment aims to release the exterior with pungent-cool herbs, ventilate the lungs, and relieve cough. Commonly used formulas include Mulberry Leaf and Chrysanthemum Decoction with modifications.

(3) Excessive Heat Panting: In addition to the above symptoms, the child has a higher fever accompanied by wheezing and breathlessness. Treatment aims to ventilate the lungs and resolve phlegm, downbear counterflow, and relieve panting. Commonly used formulas include Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction with modifications.

Example Prescription: Ephedra 3g, Bitter Apricot Seed 6g, Raw Gypsum 15g, Liquorice Root 3g, Indigo 3g, Cultivated Purple Perilla Fruit 6g, Radish Seed 9g. Additional herbs (1–2) may be selected based on symptoms: ① For severe exterior pathogens: add Chrysanthemum Flower 9g, Fresh Reed Rhizome 15g. ② For severe heat: add Skullcap Root 6g, Lonicera 9g, Forsythia 9g. ③ For severe cough: add Peucedanum 9g or Stemona Root 9g. ④ For severe panting: add Curcuma Root 6g, Ginkgo 9g, or Raw Hematite 15g. ⑤ For excessive phlegm: add Pepperweed Seed 9g, Trichosanthes Seed 9g.

3. Other Treatments Sometimes, an appropriate dose of ipecac syrup is needed. For infants, 2–15 drops per dose; for older children, 1–2ml per dose, 4–6 times daily, to facilitate expectoration. A 10% ammonium chloride solution has a similar effect, with a dose of 0.1–0.2ml/kg per dose. For bacterial infections, appropriate antibiotics may be selected. Additionally, for prolonged bronchitis, ultrashort wave or ultraviolet radiation therapy may be used.