Bronchial irritation must be reduced to the minimum possible level. If cigarette smoking is the cause, the patient must be advised to stop smoking, once forever. Change of job or occupation may have also to be advised if smoke-filled and dusty atmosphere be the cause, though it may not be possible due to various family and social factors and compulsions. Other causes and irritants should also be located and eliminated. Major emphasis should be laid on elimination of basic contributory cause, without which even the best suited treatment is not likely to show any favourable outcome.
Treatment to Control Respiratory Infection
Oral Tetracyclin or Ampicillin should be given for 5-10 days, at the rate of 250 mg after every six hours or else a 12 – hourly dose of Cotri-moxazole of 960 mg may be given to affect conversion of purulent sputum to mucus (mucoid state). Here, Davidson maintains that “well-informed, reliable patients can be given a supply of any one of these drugs and be permitted to start a course of treatment on their own initiative when the need arises.”
If, in spite of recourse to the line of treatment, suggested above, the patient does not show any sign of desired improvement and/or when the sputum still remains purulent, bacterial examination of sputum is called for, because Strep-pncumonial or H.influenzae cause bacterial infection in majority of cases suffering from Chronic bronchitis. The said examination is more necessary when change over to another more affective treatment is desired or necssitated. Davidson further opines that on the aforesaid situation “a change of antibiotic, guided by the results of bacterial sensitivity tests, will be indicated.” 1 le further warns that “continuous suppressive antibiotic treatment is not advised as it is apt to promote the emergence of drug-resistant organisms within the respiratory tract.”
Bronchodilators (like Asthalinc inhaler) are said to be more effective in bronchial asthma than in chronic bronchitis.
Supportive measures: I fnproductive nightly cough can be brought under control if the patient wraps himself well with warm coverings and also sleeps in a warm room. Hot beverage (like coffea, tea) or steam inhalation will help to liquefy sputum which becomes easier to cough up. Avoid using any cough suppressant syrup, expectorant or mixture, as it has very negligible effect in reducing viscosity of sputum. To derive quick benefits, resort may be had to oxygen therapy which will exert an all round improvement in overall situation.
General
Keep up general resistance of the body. Prevent cold draughts entry into the room which should have proper ventilation and must be warm also. Meat-soups may also be given, if the patient is not allergic or averse. Keep the patient in recumbent position. Give only hot liquid diet but no cold, spicy or irritating diet should be served.
If there is much problem or sputum is stuck up and difficult to expectorate or even raise up, resort may be had to oxygen and/or sputum expellor, of course, in some hospital or a nursing home.