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Acute bronchitis

As most cases of acute bronchitis are mild and self limiting (they resolve themselves in seven to ten days), they do not usually require treatment, and the symptoms can be easily managed at home.

Managing symptoms at home

If you have acute bronchitis:

• get plenty of rest


• drink plenty of fluid to prevent dehydration and to thin the mucus in your lungs, making it easier to cough up


• treat headaches, fever and aches and pains with paracetamol or ibuprofen (ibuprofen is not recommended if you have asthma)

There is little evidence that cough medicines work, and coughing enables you to clear the excess phlegm (mucus) from your lungs. Therefore, suppressing your cough may make the infection last longer. A warm drink of honey and lemon may help relieve the discomfort that is caused by coughing.

Stop smoking

If you smoke, stop immediately. Smoking aggravates bronchitis and increases your risk of developing a chronic (long-term) condition. Giving up smoking while you have bronchitis can also be the perfect opportunity to quit altogether.

Antibiotics

Although treatment from a GP for acute bronchitis is rarely necessary, there may be times when you should see your GP (see Chest infection - symptoms for details).

Your GP will not routinely prescribe antibiotic treatment for acute bronchitis for a number of important reasons:

• Most cases of acute bronchitis are caused by viral infections, which means that antibiotics will have no effect.


• You are almost as likely to experience a side effect from taking antibiotics, such as vomiting and diarrhoea, as you are to receive any benefit from the treatment.


• The more antibiotics are used to treat mild conditions, the greater the likelihood that the bacteria will develop resistance to antibiotics and go on to cause more serious infections.

Many experts believe that the reason there are so many dangerous strains of antibiotic-resistant bacteria, such as MRSA and multi-drug resistance tuberculosis (MDR-TB), is because antibiotics have been overused in the past to treat mild conditions.

The use of antibiotics is usually only recommended if it is thought that you have an increased risk of developing a secondary lung infection, such as pneumonia, due to factors such as:

• being over 75 years of age and having a high temperature (fever) of 38C (100.4F) or above


• having long-term problems with your lungs or heart, such as chronic obstructive pulmonary disease (COPD) or heart failure


• having a weakened immune system (immunocompromised) as a result of a condition, such as diabetes or cancer, or due to certain types of medical treatment, such as chemotherapy

If you are prescribed antibiotics for bronchitis, it is likely to be a five-day course of amoxicillin, oxytetracycline or doxycycline. Possible side effects of these medicines include:

• nausea


• vomiting


• diarrhoea

Pneumonia

If you have pneumonia, depending on how serious your condition is, you may be treated at home or at hospital. Your GP will make a detailed assessment based on how ill you are and the likelihood that you will become more seriously ill.

CRB-65 score

Most GPs use a scoring system that is known as the CRB-65 score to assess the potential seriousness of pneumonia. CRB-65 stands for:

• Confusion. Signs of mental confusion may mean that you have a more serious infection.


• Respiratory rate. Your respiratory rate is how many breaths you take in a minute (more than 30 breaths a minute may be a sign that your lungs are not working properly).


• Blood pressure. Low blood pressure can be a sign of a more serious infection.


• 65 refers to whether you are 65 years of age or over. Older people are more vulnerable to the effects of pneumonia

Each one of the above criteria has a score of one, which added together make up the total CRB-65 score.

• A CRB-65 score of zero means that you have a low risk of developing complications and that you can usually be treated at home.


• A CRB-65 score of between one and two means that you have a medium risk of developing complications and that you should have a same-day assessment by an expert in treating pneumonia. Depending on the results of the assessment, you may be able to be treated at home or you may need to be admitted to hospital.


• A CRB-65 score of three or more means that you have a high risk of developing complications and you should be immediately admitted to hospital for treatment.

Treatment at home

If you are being treated at home, you will usually be prescribed a seven-day course of antibiotics, with amoxicillin being the preferred choice. If you are allergic to amoxicillin, alternative antibiotics, such as doxycycline, can be used.

The most common side effects of the antibiotics that are used to treat pneumonia are:

• nausea


• vomiting


• diarrhoea

However, these side effects are usually mild.

Less commonly, doxycycline can make your skin more sensitive to the effects of sunlight. Therefore, minimise your exposure to direct sunlight and avoid using sun lamps and sunbeds if you are taking doxycycline.

If you are prescribed antibiotics, it is important to finish taking your course, even if you are feeling better. Stopping the course too soon could cause the pneumonia to return.

Self care

The steps listed below may help ease your pneumonia symptoms.

• Painkillers, such as paracetamol or ibuprofen, will help relieve pain and reduce a high temperature.


• As with acute bronchitis, cough medicines are not recommended for treating the symptoms of pneumonia. Coughing enables you to clear phlegm (thick mucus) from your lungs, so trying to stop your cough could make the infection last longer. A warm drink of honey and lemon may help relieve the discomfort that is caused by coughing.


• Drink plenty of fluids to avoid becoming dehydrated.


• Get plenty of rest to help your body recover.


• If you smoke, stop. Smoking damages your lungs, so this is a good opportunity to stop smoking altogether.

Treatment at hospital

If your symptoms are moderate, you can usually be treated with antibiotic tablets (oral antibiotics).

If your symptoms are severe, treatment usually involves giving you antibiotics directly into your vein through a drip in your arm (intravenous antibiotics). You may also be given additional fluids to stop you becoming dehydrated and oxygen to help you breathe.

Depending on how well you respond to treatment, it may be possible to switch from intravenous to oral antibiotics after a few days.

Most people who are treated in hospital required a 7-10 day course of antibiotics. How long it will take before you are well enough to return home will depend on your general state of health and whether you experienced any complications.

Follow-up

It is usually recommended that you attend a follow-up examination six weeks after the onset of your symptoms to check that the pneumonia has not caused any serious or permanent damage to your lungs.

The follow-up examination usually involves taking a chest X-ray so the state of your lungs can be assessed