A doctor’s advice on beating bronchitis

I’ve put in quite a bit of time working in an urgent care near my home during bronchitis season which is closely tied to flu season. It’s fairly common to have a run in with bronchitis following a bout of flu.

Unfortunately I have to explain to a lot of patients why antibiotics aren’t necessary for their viral infection. It’s not always what they want to hear, but my job is to do right by them.

Because antibiotics will only help a small number of patients with bronchitis, let’s look at other better bronchitis treatments — and how to treat an even more common and lingering condition known as post-viral cough.

Fight the virus directly

When prepared, your own body can fight off viral infections better than any antibiotic can. To fight viral respiratory infections such as bronchitis, you will need a well-hydrated body and optimal nutrition to help bolster your immune system.

Here are my recommendations to knock out a respiratory virus:

Sleep as much as possible: This focuses your energy and your immune system to healing your body from the effects of the virus.

Hydrating tea: To make fresh ginger tea, cut off 6-8 coin-size chunks of fresh garlic root into 2 cups water, bring to a boil, and then cool. Add Stevia or honey for taste, and sip this over 2 hours. Also, herbal teas containing cats claw, ginseng, and ginger root fight viral infections. Peppermint and/or chamomile helps nausea and keep you hydrated.

High dose Vitamin C at 9,000 mg in three divided doses each day until you have recovered: In a study of 252 students ages 18 to 30 years, those who received mega doses of Vitamin C reported flu and cold symptoms 85% less than those of the student control group who received pain relievers and decongestants. Physicians have reported this effect from such high doses, but there are no scientific studies reported on www.pubmed.com.

High dose vitamin D at 100,000-200,000 IU daily for just 3 days has been proven to cause a powerful antimicrobial response.  In 1948 researchers first reported near miraculous effects of high dose vitamin D’s effects on influenza and viral pneumonia. Vitamin D in later studies, mega doses of vitamin D was observed to naturally release antimicrobial peptides against infectious agents including bacteria, viruses, fungi, and parasites. The safety of mega doses up to 500,000 IU of vitamin D3 once a month in the elderly has been proven.

Avoid refined sugar: This sweet stuff sours your health. For starters, it suppresses immunity.  As subtle as it may seem, consuming refined sugar during a cold or flu prolongs your sickness. It also slows healing time from injury and actually acidifies the already acidic tissues in these illness states. Also, sugar reduces your defense against bacterial infection.

Garlic is the superfood that picks up where antibiotics fail. It is known to reduce your risk of getting a viral respiratory infection. A 2001 study done in the UK reported on the use of just one capsule daily of a garlic supplement containing allicin during the winter season by 146 volunteers.Compared to study subjects who received no medicine (placebo group), those who took garlic suffered 63% fewer common cold infections.  And those among the garlic group who did get sick with a cold only suffered symptoms for 1.52 days (on average) compared to 5.01 days for the placebo group.  A number of other studies prove garlic’s effects on viruses.  Be sure it contains allicin. You can safely take 4 to 8 times the bottle’s recommended dose.

Cimetidine (Tagamet^®) at 800 mg daily has been shown to boost immune function by reducing T-suppressor cells — particularly effective against certain viruses.It also can increase natural killer cell activity and the inherent immune stimulants interleukin-2 and gamma interferon.

DHEA has been shown to boost immune response. In one study, doses of 50 mg daily measurably increased seven different immune markers by 20% to 62%. You could take a high dose (e.g. 200 mg) each morning until symptoms resolve.

Lactoferrin is an immune booster found naturally in mother’s milk, and sold at health food stores. It has been shown to potentiate the immune system and block viral attachment to cells.  Once could effectively take 1200 mg daily until symptoms stop.

Echinacea is a potent remedy, and contains several immune stimulant compounds. The German government has approved Echinacea for the treatment of viral flu-like symptoms.

Easing your symptoms

There are a few medications I can recommend to relieve your worst symptoms…

Expectorant: When the thick sputum of bronchitis sticks in your airways and makes you feel short of breath from it, then use the expectorant (mucus thinner) called guaifenesin. The most common brand name for this is called Mucinex. For some of you, Mucinex will liquefy your bronchial secretions well, but could also induce more coughing.

Bronchodilator: The inhalers that contain albuterol (Proventil, Pro-air) can be very helpful to rapidly open the small to medium-sized airways and stop wheezing. This will also allow sputum to be coughed up and out, and should race your heart (that’s how you know it is working).

Cough suppressants: You’ll discover that most all over-the-counter cough syrups contain “DM” which stands for dextromethorphan. These combination cough and cold formulas contain multiple ingredients, so when you increase the dose of the dextromethorphan, you’ll also increase the other ingredients, such as acetaminophen (Tylenol), pseudoephedrine (Sudafed), diphenhydramine (Benadryl), or guaifenesin (Mucinex). That’s why instead, I recommend the long-acting dextromethorphan as an only ingredient (Delsym). Two prescription cough suppressants I offer are benzonotate (Tessalon Perles), which is non-sedating like Delsym; and promethazine with codeine, a sedating cough suppressant for nighttime.  Honey is also an effective cough suppressant.

Post-viral cough

What do you do when your cough just won’t let up after you have fought off the virus? When your appetite has returned, your energy is back, your fever, chills or sweats have resolved, and you continue with a tickling, irritating, persistent cough, you have post-viral cough syndrome. It can persist for weeks or months.

First-line therapy is knock out the cough and continue with nutrient-rich foods and modest exercise. Use the medicines listed above to block the cough. Your doctor may need to provide you with a prescription for a codeine or hydrocodone-containing cough syrup so you can sleep.

If these don’t effectively block your cough, a last-resort medication known to work is a corticosteroid medication such as prednisone for 1-3 weeks. Very high doses, initially at 80 mg daily may be required to be effective.

Sources:

1. Gorton HC, Jarvis K. The effectiveness of vitamin C in preventing and relieving the symptoms of virus-induced respiratory infections. J Manipulative Physiol Ther. 1999 Oct;22(8):530-3.

2. Liu PT, Stenger S, Li H, Wenzel L, et al.  Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science 2006 Mar 24;311(5768):1770-3.

3. Miley GP, Christensen JA. Ultraviolet blood irradiation therapy in acute virus-like infections. Review of Gastroenterology 1948:15;271-277.

4. Gombart AF, Borregaard N, Koeffler HP. Human cathelicidin antimicrobial peptide (CAMP) gene is a direct target of the vitamin D receptor and is strongly up-regulated in myeloid cells by 1,25-dihydroxyvitamin D3. FASEB J. 2005 Jul;19(9):1067-77.

5. Pekkarinen T, Välimäki VV, Aarum S, Turpeinen U, Hämäläinen E, Löyttyniemi E, Välimäki MJ. The same annual dose of 292000 IU of vitamin D (cholecalciferol) on either daily or four monthly basis for elderly women: 1-year comparative study of the effects on serum 25(OH)D concentrations and renal function. Clin Endocrinol (Oxf). 2010 Apr;72(4):455-61.

6. Bacon CJ, Gamble GD, Horne AM, Scott MA, Reid IR. High-dose oral vitamin D3 supplementation in the elderly. Osteoporos Int. 2009 Aug;20(8):1407-15.

7. Josling P. Preventing the common cold with a garlic supplement: a double-blind, placebo-controlled survey. Adv Ther. 2001 Jul-Aug;18(4):189-93.

8. Antiviral Res. 2004 Feb;61(2):125-8; Adv Ther. 2001 Jul-Aug;18(4):189-93; Nutr Cancer. 2000;38(1):98-105; Chin Med J (Engl). 1993 Feb;106(2):93-6; Planta Med. 1992 Oct;58(5):417-23; J Nutr. 2001 Mar;131(3s):1075S-9S.

9. Mitsuishi T, Iida K, Kawana S. Cimetidine treatment for viral warts enhances IL-2 and IFN-gamma expression but not IL-18 expression in lesional skin. Eur J Dermatol. 2003 Sep-Oct;13(5):445-8.

10. Bourinbaiar AS, Fruhstorfer EC.  The effect of histamine type 2 receptor antagonists on human immunodeficiency virus (HIV) replication: identification of a new class of antiviral agents. Life Sci. 1996;59(23):PL 365-70.

11. Waarts BL, Aneke OJ, Smit JM, Kimata K, Bittman R, Meijer DK, Wilschut J.

    Antiviral activity of human lactoferrin: inhibition of alphavirus interaction with heparan sulfate. Virology. 2005 Mar 15;333(2):284-92