Friday, September 23, 2016

Bell's Palsy: Cause, Symptoms, and Treatment

Bell's palsy is a type of facial paralysis that involve the cranial nerve VII (Facial nerve) resulting in loss of control of facial muscles on the affected side or ,rarely, both sides resulting in total facial paralysis. The paralysis is of the infranuclear/lower motor neuron type. The nerve that controls muscles on one side of the face damaged by inflammation or compression. This facial condition is common to occur in people between 15 and 60 years of age, but people outside this age group can also have Bell's palsy. They can affect men and women equally. Facial nerve
Facial nerve's nuclei are from the brainstem. Inflammation of the facial nerve within its bony canal (fallopian canal) will block in transmitting neural signals or even damage the nerve. The interruption in the messages the brain sends to the facial muscles results in facial weakness or paralysis. Because of that interruption, one may lose the ability to control over eye blinking, closing of the eyes, frowning, raising eyebrows, smiling, salivation, and lacrimation (production of tears). Facial nerve also supply the taste sensation in the anterior two-thirds of the tongue, via the chorda tympani nerve. Again, damage to this nerve will affect the taste sensation in the anterior two-third of the tongue on the affected side. Additionally, the facial nerve carries nerve impulses to the lacrimal glands, the saliva glands, and the muscles of a small bone in the middle of the ear called the stapes.


Causes


Like many other diseases, the exact cause of Bell's palsy is unknown. Studies suggest that this medical condition could be triggered by:
  • Herpes Simplex that causes cold sores and genital herpes.
  • Herpes zoster virus that causes chickenpox and shingles. They are less common cause of Bell's palsy compared to herpes simplex.
  • Epstein-Barr virus that causes mononshingles.
  • Brain tumors. An abnormal tissue growth.
  • Meningitis that causes meninges inflammation.
  • Sarcoidosis that causes organ inflammation.
  • HIV that attack the immune system.
  • Stroke.
  • Diabetes mellitus.
  • Ramsay Hunt syndrome from varicella-zoster virus.
  • Lyme disease. A bacterial infection caused by ticks.
  • Head trauma from an accident.
  • An accident from surgery.
  • Congenital facial palsy.

Symptoms Symptoms can vary from mild to severe and typically come on over 48 hours. They usually appear abruptly, and you will just notice drooping of your face on the affected side or when you have difficulty eating or drinking. In most cases of Bell's palsy, improvement seen within two to three weeks and full recovery expected within nine months. Common symptoms include:
  • Headache.
  • Sudden weakness or total paralysis of the facial muscles that causes your face to droop
  • Drooping of the eyelid which causes difficulty in closing the eyelid.
  • Drooling from the mouth on the affected side.
  • Loss of ability to taste.
  • Difficulty in eating and drinking.
  • Inability to make facial expressions.
  • Impaired speech.
  • Pain around the ear on the affected side.
  • Dry eye from inability to blink the eye.
  • Increased tear production.
  • Increased sensitivity to sound (hyperacusis).
  • Numbness on the affected side of the face.
Risk factors

  • More likely to occur in pregnant women than in nonpregnant women.
  • More likely to occur in diabetic people.
  • Familial inheritance.
  • Recent upper respiratory tract infection.
  • Viral infection that results in swelling.
Differential diagnosis

Here are some medical conditions that produce facial paralysis and are mistaken as Bell's palsy.

  • Stroke. They are accompanied by weakness in the arms and legs. Also has control in the upper part of the face, like wrinkling of the forehead.
  • Infection with herpes zoster virus. Presence of small blisters on the external ear and hearing disturbance.
  • Lyme disease, caused by ticks, produce facial paralysis.

Diagnosis

There is no routine laboratory or imaging tests required to make the diagnosis of Bell's palsy. Diagnosis is usually done by eliminating the other reasonable possibilities.

  • A physical examination conducted by your doctor to include all questions about the symptoms.
  • A neurologic examination to check the facial nerve integrity.
  • Imaging test like CT scan or MRI to check the facial nerve.
  • Blood test can check the presence of bacterial or viral infection.
  • Electromyography (EMG) can confirm the presence of nerve damage and to determine the severity and extent of nerve involvement.
  • The degree of nerve damage assessment, using the House-Brackmann Facial Nerve Grading System.





Treatment

Usually, the condition gets better by itself with normal or near-normal function. Signs of improvement will show within two weeks, with complete recovery within six to nine months.

Corticosteroids medicines, such prednisone, have been found to improve outcomes and are thus recommended. They work best if taken within 3 days after symptoms start. Corticosteroid works on reducing inflammation.

Antiviral medications, when added in steroids, is of a small added benefit in the treatment. One review found antivirals alone are ineffective in improving recovery from Bell's palsy. They are usually prescribed if Bell's palsy caused by a virus.

Mild pain relieved by some over-the-counter pain medications, such as ibuprofen or acetaminophen.

Dry eye protection from drying up by using eye drops or an eye patch.

Surgery is generally not recommended, but may improve the outcome for those who have not recovered from severe facial nerve paralysis.

Physical therapy

  • A series of facial exercises will promote muscle re-education. These exercises will strengthen your facial muscles and promote faster recovery.
  • Applying heat can help reduce pain. An infrared radiation applied to the affected side of the face or a warm, moist towel placed over the face will help relieve pain.
  • Electrical stimulation to stimulate the facial nerve, but there is no concrete evidence to support its efficiency.
  • Soft tissue mobilization or massaging your face will promote relaxation and increase circulation.
Promote mouth care. Food may stick in the mouth that may cause gum problems or tooth decay. Brushing or using dental floss will help prevent these problems.

Swallowing problems, prevention by eating slowly and chewing your food well. A soft diet will also help you.

Acupuncture is given, but the efficiency of using this alternative medicine remains unknown.



Prognosis

The prognosis is generally very good. Most people with Bell's palsy start to regain normal facial function in as early as 3 weeks, even without treatment. Studies show complete recovery achieved in at least 1 year.



Complications

Most people recover from Bell's palsy without complication. However, complications are possible for severe cases of Bell's palsy. These may include:

  • Chronic loss of taste (ageusia).
  • Chronic facial spasm.
  • Facial pain.
  • Persistent facial weakness.
  • Reduced sense of taste.
  • Incomplete or faulty regeneration of facial nerve, such as synkinesis.
  • Difficulties in speech, eating, and drinking.
  • Twitching of facial muscles.
  • Eye problems, such as corneal infections


Monday, September 5, 2016

Shin Splints: Causes, Symptoms, and Treatment

Shin Splints, medically known as Medial Tibial Stress Syndrome, refers to a pain along  long bone in the lower leg (Tibia). This condition is a physical activity-related problem that is usually common to athletes(runners), dancers, and military recruits. We often experience this pain, even on a simple activity such as morning jog, brisk walking, or even catching a bus to take a ride to work.

Causes:

Shin splints develop after a vigorous, repetitive physical activity, compromising the bones, muscles, and tendons in the lower leg. As a result of overworked, pain and inflammation will soon be experienced. This condition is common to anyone who just started an activity or a sudden change in the level of activity. A sudden change and/or increase in the frequency, duration, and intensity of an activity will likely cause shin splints. 





Symptoms:

The most common complaint is a dull, throbbing pain and tenderness along the border of the tibia. Pain usually occurs during and after exercise. Mild swelling will also occur in the lower leg.

Risk Factors:

Anyone will likely have shin splints if:

  • You are wearing an improper or a worn-out shoes during an activity or exercise.
  • You have some foot deformities, such as flat feet and high arches.
  • You are a new participant in a sports activity.
  • You suddenly increase the frequency, duration, or intensity of an activity.
  • You are into military training.

Diagnosis:

We often do home remedies to manage shin splints. If the symptoms continue to persist, it would be better to see your doctor. 

The doctor usually does physical examination and patient interview on symptoms and medical history. X-rays will also be done to rule out other problems that cause the pain, such as stress fractures.




Treatment:

We often do home remedies to manage shin splints. If the symptoms continue to persist, it would be better to see your doctor. 

  • Rest. If would be best if you take some time off from an activity or exercise that causes the pain. This will promote faster recovery. Instead, try to engage in low-impact activities that don't give too much stress on your lower leg such as swimming.
  • Ice. Never apply ice directly over the skin. Wrap around the ice with layers of towelling.
  • Apply icing for 20 minutes, four to six times a day for several days. This will help in reducing pain and swelling.
  • Ultrasound, iontophoresis, phonophoresis, and electrical stimulation  can help reduce pain and inflammation.
  • Elastic compression bandage will help against swelling.
  • Take some over-the-counter pain reliever to reduce pain and swelling, such ibuprofen, Aspirin, Naproxen, or Acetaminophen.
  • Range of motion and flexibility exercises to the lower leg muscles helps a lot. See your physical therapist to help you with pain management and your return to sports. Here are some exercises you can do at home.
  • Wear shoes with good cushioning to reduce stress on the lower leg.
  • Orthotic shoe insert provides foot alignment and stability of your foot and ankle.
  • Surgical treatment done in very severe cases. 

Here are some exercises you can do at home.

Toe Curls.

  • Standing. Spread the towel in front of you. Place your one foot at the edge of the towel. Slowly bring or pull the towel towards you using your toes. Repeat this procedure with the other foot.

Calf Stretching

  • Long sitting on the floor. Loop a towel or resistance band at the bottom of your one foot. Gently pull them towards you into dorsiflexion. Hold it for a few seconds and repeat three times on each leg. Do the same stretching on the other leg.

Shin Resistance Exercise

  • Sitting on the floor. Loop a resistance band around the front of your one foot while the other end of the resistance band looped around a stationary object like a table. Dorsiflex the foot against the resistance band. Do this with 10 to 15 reps. Progress with heavier band later on.


    Prevention:


    • Start a new exercise or activity slowly. Gradually increase the frequency, duration, and intensity as you go along with your exercise or activity. Don't rush.
    • Start an exercise with warm up and light stretching to prepare your muscles.
    • Stop an exercise the moment you feel pain in your shinbone.
    • Try to develop strength in your lower leg before going into high-impact activities.
    • Cross training is effective in improving fitness and performance. Incorporate low-impact activities such as jogging and swimming, with your main activity or sports.
    • Avoid overdoing an exercise or an activity.
    • Wear the right shoes that give comfort and safety.

    Friday, September 2, 2016

    Frozen Shoulder: Causes, Symptoms, Treatments - All About Physical Therapy

    Frozen shoulder, otherwise known as adhesive capsulitis, is a condition in the shoulder characterized by stiffness, pain, and limitation of motion. It is typical in frozen shoulder to involve only one, although, few cases affect both shoulders. 

    Causes:

    Frozen shoulder usually happen after a recent injury or after a medical procedure or from, a medical condition such as stroke, diabetes, or mastectomy. The inability of moving the shoulder into its full range of motion because of pain results in stiffness of the tissues around the joint. Later on, shoulder movement becomes more difficult and painful.




    Symptoms:

    This shoulder condition usually develops gradually, becomes worse over time and then slowly resolve over the course of 1 year up to 3 years. Persistent pain and limitation of motion from joint stiffness are the most obvious symptoms seen in people with frozen shoulder. This condition develops in 3 stages and each stage can last up to several months.

    Freezing Stage 
    • The painful stage. More and more pain is experienced when you do any movement of the shoulder. Limitation of motion starts to become limited.
    Frozen Stage
    • Pain begins to diminish at this stage, but the stiffness still remain making shoulder movement difficult affecting daily activities.
    Thawing Stage
    • Shoulder movement slowly improves at this stage.

    Risk Factors:
    • Age. Common to people aged 40 to 70 years
    • Gender.More often to women than in men
    • After surgical procedure 
    • Recent injury such as fracture
    • Medical problems such as stroke, hyperthyroidism, hypothyroidism, diabetes, Parkinson's disease, or cardiac disease

    Diagnosis and Test:
    • Medical History to include a detailed description of the symptoms, present and past medical conditions, and medications and/or supplements taken.
    • Physical Examination to include testing the range of motion of both shoulder joints. The affected shoulder will show limited motion, both active and passive.
    • Imaging Test
    • X-rays, which shows a clear image of the bone, help find other problems in the shoulder.
    • Ultrasound and MRI give a better view of the soft tissues to rule out other problems.

    Treatment

    The aim of treatment for frozen shoulder is to ease pain and keep the mobility and flexibility of the shoulder. Here are some of the recommended treatment approaches of frozen shoulder.

    • Medications. Over the counter pain-relieving and antiinflammatory drugs, such as aspirin and ibuprofen to cut pain and swelling.
    • Heat application followed by gentle stretching to increase range of motion.
    • Range of motion exercises, given by a physical therapist, to recover shoulder joint mobility.
    • Ice and corticosteroid injection will help reduce pain and swelling.
    • Transcutaneous Electrical Nerve Stimulation (TENS) give pain relief by blocking pain fiber that carries pain impulses.
    • Joint Distention. A sterile water is injected into a joint to stretch the tissue so that movement is easier
    • Shoulder Manipulation under anesthesia. You will receive general anesthesia and the doctor do manipulation to break adhesion.
    • Shoulder Arthroscopy. This procedure is rarely done. The doctor uses a lighted, tubular instrument inserted into a small incision around the joint to remove scar tissue and adhesions.

    Saturday, August 27, 2016

    Plantar Fasciitis: All About Physical Therapy

    Plantar fasciitis is an overuse injury involving the plantar fascia, a strong, thick band of tissue that runs from the heel(calcaneum) up to the toes. An overstretched or overused injury of the plantar fascia will lead to pain and inflammation at the bottom of the foot which makes walking more difficult. This band of tissue provides arch support as well as a shock-absorber of your foot. Plantar fasciitis affect both men and women, but more to active men aged 40 to 70. The involvement can either be one foot or both.




    Possible Causes and Risk Factors:

    This foot condition develops as the result of repeated small tears in the plantar fascia resulting to inflammation and degeneration of the connective tissues in the fascia. Plantar fasciitis is more likely to develop if you have:

    • Flat feet and high arches of the foot.
    • Certain occupations that requires prolonged standing.
    • Obesity or a sudden weight gain.
    • Engaged in long distance running and other intense activities or exercise.
    • Tight TA will raise the arches of the foot.
    • Incorrect shoe fitting that doesn't support the arch of the foot because this puts more stress on heel.
    • A sedentary lifestyle and you do lots running, walking, and jumping.
    • Certain type of arthritis, particularly among the elderly people.


    Symptoms:

    Anyone with plantar fasciitis will likely experience:

    • Pain and tenderness at the bottom of the heel with the first step in the morning or even after standing/sitting for a while.
    • Limited ankle dorsiflexion secondary to tight TA.
    • Mild swelling or redness of the foot.
    • Limping or may attempt toe walking to decrease pain which might also develop foot, knee, hip or back problems later on.
    • Painful with barefoot walking on hard surface or even stair climbing.
    • Pain after an intense activity such as running, jumping, and other related activities that repeatedly put stress or pressure on the tissues.


    Diagnosis:

    • Physical examination should include patient interview.
    • An x-ray may be taken to rule out other problems.
    • An ultrasound scan usually shows thickening and swelling of the fascia.


    Treatment:

    Start your treatment as early as possible before it gets worse. Go and see your doctor. Here are some recommended treatment approach if you have plantar fasciitis.

    • Take time to rest your feet , at least for a week. Limiting or even stopping an exercise or activity allows better healing of the tissues
    • Apply ice for 15 minutes, at least twice a day, to relieve pain and inflammation.
    • Avoid any form of the heating your foot during the first 2 to 3 days.
    • Flexibility and strengthening exercises to ankle and calf muscles.


    1. Standing with both hands touching the wall at shoulder level. Feet slightly apart, with one foot in front of the other foot.Begin by bending your front knee while keeping your back knee in a straight position and then move forward by leaning on the wall. Hold it for a few seconds and then release. This exercise will stretch your calf muscles. Do this again by switching the position of the two feet to stretch the other calf muscles.
    2. Long sitting on the floor. Loop a towel around the ball of your one foot. Pull the toes towards you while keeping your knee straight. Hold this for a few seconds. Do this exercise with the other foot.
    3. While sitting on a chair, place a water bottle, a tennis ball, or a drink can under the arch of your foot. Slowly roll the bottle from the ball of the foot to the heel. The massage effect helps reduce pain in the bottom of your foot.


    • Athletic shoes or shoe with a well-cushioned sole are usually good choices.
    • Heel cups or shoes inserts give added cushion and comfort to your foot.
    • Resting night splint may be used to stretch the TA while sleeping.
    • Try to reduce weight. Enrolling in a weight-reduction program helps a lot.
    • Acetaminophen and Ibuprofen will help reduce pain and inflammation.
    • Extracorporeal shock-wave therapy. Better discuss this procedure with you doctor.
    • Foot surgery may be needed if all nonsurgical treatment didn't work out.


    Preventive Measures:

    • Do stretching prior to any activities or exercises.
    • Avoid doing exercises on hard surfaces.
    • Try to lose some weight if you are obese.
    • Change your type of sport. Go into low-impact sports like swimming instead of running or jogging.
    • Always check your shoe physical condition. Don't wear worn out shoes.

    Saturday, August 20, 2016

    Morton's Neuroma

    Morton's neuroma, also known as Morton's metatarsalgia or interdigital neuroma, is a painful foot condition affecting the nerve passing under the ligament that connect the metatarsals. This foot condition often affects the third and fourth toes, may sometimes develop in the second and third toes. Also, it either affects one foot or both feet. A constant irritation or an excessive pressure on those areas of the foot or both feet develops a thickening of the tissues that surround the nerves leading to the toes. As a result, one may experience a sharp, burning pain at the ball of the foot. The sensation is feeling like as if you are walking on a pebble, a common description of this foot condition. Although it can occur at any age, the condition is more notable in runners and in middle-aged women who loves to wear high-heeled shoes. Besides, the incidence is higher in women than in men.




    Causes

    Although the exact cause remained unclear, many experts believed that Morton's neuroma is usually associated with irritation or pressure of the nerves between the toes. Aside from wearing high-heeled shoes and participating in high-impact sports like running, anyone with foot deformities such hammertoes and flat feet will also have this foot condition.






    Symptoms

    A sharp, burning pain felt at the ball of the foot often worsen with activity and wearing tight shoes.
    Unpleasant tingling sensation at the toe.
    Pain increases over time.

    Diagnosis

    Examination may show a palpable mass at the toes, which is tender when pressed.
    X-ray may help to rule out bone fracture.
    A test on the range of motion to find any arthritic or an inflammatory condition of the joints.
    Ultrasound and Magnetic Resonance Imaging are both good in visualizing the soft tissues, though quite expensive.

    Treatment

    The treatment is towards the symptoms. A conservative treatment is the first approach before going into an invasive intervention.

    Wearing a orthotic device, those with foot deformities, will help relieve pressure on the toes.
    Shoe change will help reduce pressure on the nerves, particularly the athletes.
    Avoid high-heeled and tight shoes as well.
    Foot massage provides pain relief.
    Placing an ice pack at the sole provides pain relief.
    Weight reduction  for obese persons to reduce strain on the feet.
    Over the counter pain relievers and injections of steroids may help ease the pain and inflammation.
    Surgical removal of the thickened tissues deemed necessary if all conservative treatments haven't worked. Although the surgery is successful in most cases, one may still experience the permanent sensation of numbness but not painful.

    Friday, August 19, 2016

    R.I.C.E Therapy

    For the benefits of those who still have no idea on to how handle recent soft-tissue injuries, let me share with you the advantage of RICE therapy and how it promote faster recovery. Anyone, particularly the athletes and other physically active people, can have muscle strain, ligament sprain, bruise, and other soft-tissue injuries. RICE therapy is recommended on acute cases, usually the first 24 to 48 hours after injury. It doesn't mean RICE therapy is already enough, especially serious injuries. Better see your doctor for proper evaluation and management, like drug prescription and physical therapy. RICE, which stands for rest, ice, compression, and elevation, help reduce pain and swelling.


    Rest
    Right after the injury, take some time off from your activities. Stopping or limiting an activity promote faster soft-tissue healing. Remember, continued stress on the injured part will lead to further damage. If the injury is on the leg or ankle, crutches will help you move around without putting pressure on the injured part.
    Ice
    This treatment approach help control pain and inflammation. Icing works on reducing the size of the blood vessels, thereby decreasing the bleeding, the swelling, and easing pain. Never apply ice directly over the skin on the injured part, instead, wrap it around with a towel or any clothes. Commercially, there are cold packs available in medical shops. Apply icing for 15 to 20 minutes and repeat the procedure as long as you want. Icing works best during the first 24 to 48 hours after injury.
    Compression
    Compression,using a bandage, help reduce swelling as well as support to the injured part. Just remember not to wrap too tight to avoid cutting off blood supply to the injured area as well as more swelling below the affected area.
    Elevation
    While applying the ice, like sitting or lying, elevate the injured part above the heart level to help reduce swelling.

    Saturday, August 13, 2016

    Transcutaneous Electrical Nerve Stimulator (TENS)

    Transcutaneous electrical nerve stimulation (TENS) is a nonpharmacologic and noninvasive treatment for pain from a variety of painful conditions. A small, portable, battery-powered device that has leads connected to electrodes. Electrodes (sticky patches) are placed on your skin using self-adhesive pads. 
    The TENS unit sends painless electrical impulses through the electrodes to the nerves under your skin, which you feel as a tingling sensation. The electrical impulses can block or reduce the pain signals going to the spinal cord and brain, which can help reduce or relieve pain or muscle spasm. TENS devices also help stimulate your body to produce higher levels of its own natural painkillers, called "Endorphins".
    For most people, TENS is a safe treatment with little or no associated side effects. It is available for home use. You should always follow the manufacturer's specific instructions to be safe. Have your physical therapist or doctor to show you the proper way to use the machine, and follow the instructions carefully.

    Types of TENS:

    1. Conventional(High frequency stimulation) - This high rate and most common mode of TENS can be applied during the acute or chronic phase pain. Onset of pain relief is relatively fast but lasts only for a shorter period of time. Tolerable to most patient. Duration of treatment is 20-60 minutes.
    2. Acupuncture-like(Low-frequency stimulation) - A strong low rate TENS can be applied during the chronic phase of pain. Duration of treatment is 30-40 minutes and duration of pain relief is long-lasting(an hour or more). More uncomfortable and less tolerable type.
    3. Burst Intense(Pulse burst) - A combined characteristic of both high and low rate TENS but more tolerable than low rate TENS. Onset of pain relief is similar to low rate TENS. Duration of treatment is 20-30 minutes. Duration of pain relief is long-lasting(hours).
    4. Brief Intense(High-intensity) - This mode provide rapid onset, short-term pain relief during painful procedures(wound debridement, deep friction massage, joint mobilization or passive stretching). Duration of treatment is usually 15 minutes.         
    Electrode Placement:
    • Over the painful area
    • Over the nerve supplying the painful area
    • Acupuncture sites
    • Proximal or distal to pain site, or even on the opposite side of the body
    • Segmentally related myotomes
    • Trigger points
    Indications:
    • Postoperative pain
    • Chronic pain
    • Arthritis
    • Sports injuries -  bone fractures
    • Period pain
    • Acute pain relief during labor and delivery
    • Phantom pain





    Contraindications:
    • Cardiac pacemaker or another type of implanted electrical device fitted
    • Epilepsy or a heart rhythm disorder(consult your doctor)
    • During first trimester of pregnancy
    • Allergic reaction to the electrodes (it's possible to get hypoallergenic electrodes)
    • Broken skin, varicose veins, recent scarring in the area, or over areas of reduced sensation
    • While driving or operating machinery
    • Near water, such as in the bath or shower
    • Over lower abdominal/uterus during pregnancy
    • Over the anterior transcervical area - the front or side of your neck
    • Cause of pain is not known or is not diagnosed.
    • In the mouth, close to the eyes, or temple area
    Procedure:
    • Check the area to be treated for contraindications and precautions.
    • Check the unit - batteries, knobs, electrodes.
    • Turn the control knobs to the off position before you start.
    • Use rubbing alcohol to clean the skin where the electrodes will be placed. Let your skin dry.
    • Position the self-adhesive pads either side of the painful area, at least 2-3 cm apart.
    • Switch on the machine slowly and turn it up gradually until you feel a tingling sensation.
    • TENS machines are designed so that you can move around with them working.
    • At the end of the session turn the machine off and disconnect the electrodes from the machine.
    • Check the area being treated for irritations; clean the area with soap and water.
    • Clean the rubber electrodes with soap and water to remove the gel; Do not wash the self-adhesive type of pad.
    • Remove the battery from the TENS and replace it with a charged battery. Charge the battery so that it will be ready for another treatment.
    • You can use TENS throughout the day for as long as you like provided you do the same process as mentioned above

    Wednesday, August 10, 2016

    Bronchitis - Acute and Chronic

    Bronchitis is a respiratory disease characterized by an inflammation of the lining of your bronchial tubes. These tubes are large and delicate  that carry air in the tiny branches and smaller cells of the lungs after this air has passed through the mouth, nasal passages, and trachea and then back out from the lungs. Breathing is more difficult  when the bronchi become swollen due to irritants or infections. Bronchitis sufferers also tend to have much more mucus and phlegm. People with asthma may also have asthmatic bronchitis, inflammation of the lining of the bronchial tubes.

    The two main types of bronchitis are Acute (lasting from one to three weeks) and Chronic (lasting at least 3 months of the year for two years in a row).
        
                                                                               




    ACUTE BRONCHITIS

    Acute bronchitis is a type of bronchitis that is short-lived, usually lasts about two weeks. However, coughing may still be experienced for a few weeks even if the infection is gone. Most people recover with no permanent damage to the bronchial tree. Lung irritants or infections may cause acute bronchitis. Infections can be viral or bacterial in origin, but viral origin account in most cases. Influenza, Respiratory Syncytial Virus (RSV), and Rhinoviruses are among the viruses that causes acute bronchitis, while Mycoplasma and Pneumococcus bacterial agents also causes to develop acute bronchitis.

    Cause
    • Acute bronchitis is generally caused by infections or lung irritants. In most cases, it is viral in origin while others are from bacterial infection. A short-term, high-level exposure to chemical irritants or substances like inhaling or exposing to cigarette smoke (including secondhand smoke), dust, inhaling solvents, or industrial air pollution may lead to acute bronchitis.






    CHRONIC BRONCHITIS

    Chronic bronchitis is an ongoing, serious long-term condition characterized by an inflammation of the lining of the bronchial tube secondary to constant irritation. This condition often requires regular medical attention. A productive cough  that produces a slimy mucus is usually present for 3 months during two consecutive years. Chronic bronchitis is one of the conditions included in chronic obstructive pulmonary disease (COPD) that the majority of people diagnosed with the disease is 45 years of age or older. Patients with chronic bronchitis are often called "blue bloaters".

    Cause
    • The most common cause of chronic bronchitis is heavy, long-term cigarette smoking.


    SIGN and SYMPTOMS of Acute Bronchitis or Chronic Bronchitis
    • Persistent cough which may last up to 20 days. A cough may produce a clear, slimy mucus (sputum). A green or yellowish mucus may indicate bacterial infection. In most cases, the infection is viral in origin. Coughing lingers for several weeks after the inflammation of bronchial tube resolves
    • Wheezing is a high-pitched whistling sound made while you breath. The sound is most obvious when you breath out (exhale)
    • Slight fever may include sore throat, stuffy or runny nose, vomiting, and headaches
    • Chills and malaise
    • Chest discomfort
    • Shortness of breath (Dyspnea) especially with physical exertion.

    RISK FACTORS
    • Acute bronchitis are at higher risk for older adults, infants, and young children may be because of low resistance
    • Cigarette smoking, second-hand cigarette smoke, and having an existing lung disease greatly increases the risk for bronchitis.
    • Repeated exposure or contact with dust, chemical fumes, and vapors from certain  occupations
    • Air pollution, infections, and allergies can worsen the symptoms of chronic bronchitis
    • History and repeated bouts of acute bronchitis
    • Women are more than twice as likely as men to be diagnosed with chronic bronchitis.
    • It occurs more often in people who are older than 45 although anyone can have the disease. Also, many adults who develop chronic bronchitis are smokers.

    DIAGNOSIS

    Medical History
    • Presence of symptom - How long been coughing, presence of mucus, breathing problems, chest discomfort, sleeping or work problem, wheezing sound, and fever
    • Smoking - Daily consumption  and period of time been smoking
    • Ask for another medical condition
    • Type of job that constantly irritate the lungs
    • Drugs and supplements currently using
    • Records of vaccination against pneumonia or annual flu shot
    Physical Examination
    • A stethoscope is used to hear wheezes, and a prolonged exhalation which are signs of airflow obstruction
    Test
    • Pulmonary function test - A spirometer is used to measure the amount of air inspired and expired by the lungs
    • Blood test (CBC)
    • Chest X-ray help rule out other lung problems (pneumonia and bronchial obstructions).
    • CT scans of the chest
    • Measurement of arterial blood gas
    • Sputum Culture

    MANAGEMENT

    Early diagnosis and treatment, combined with avoidable risk factors such as quit smoking and avoiding secondhand smoke, provide a favorable prognosis. The main goals of treatment are to relieve symptoms and make breathing easier.

    Get enough rest, drink plenty of fluids, and aspirin or acetaminophen for fever if you have acute bronchitis. The antibiotic may not work if you have a viral infection. 

    Bronchodilator
    • This medicine relaxes the smooth muscles that encircle the bronchi, which allows the inner airways to expand making it easier to breathe. It is usually inhaled using an inhaler, but is also available in pill form.
    Theophylline
    • This medicine relaxes and open the airways to help you breathe better
    • Indicated for shortness of breath, wheezing and chest discomfort for patients with chronic bronchitis and for other COPD. They are available in tablet, capsule, solution or in syrup.
    Steroids Medication
    • Works to reduce the inflammation which in turn decreases the bronchial swelling and secretions, making improve air flow. You can take steroids either with an inhaler or in pill form.
    Antibiotics
    • As a whole, antibiotics cannot help chronic bronchitis while others prescribed antibiotics during acute exacerbation of chronic bronchitis. May be prescribed if it is from a bacterial infection, but not from a viral origin.
    Supplemental Oxygen Therapy
    • This will help to get more oxygen supply needed to breathe better. Usually prescribed for severe chronic bronchitis and if the medicine doesn't show improvements. A small fingeoximeter for monitoring blood oxygen levels at rest and with activity is helpful.
    Exercise
    • A regular strengthening exercise help improve strength and general body endurance. Begin with light exercise and slowly progress over time. An exercise frequency of at least 3 times a week is usually recommended. Start with slow walking  and progress the duration and speed later. Consult your doctor or a physical therapist for the appropriate exercise program.

    Breathing Techniques

    1. Pursed-lip breathing
    • This technique will also help to feel better from shortness of breathing. This is done by taking a deep breath (inhale) and then breath out slowly (exhale) through the mouth with pucker lips. Stay relaxed and exhale normally. No holding of breath.
    2. Diaphragmatic breathing
    • This technique uses the primary muscle of respiration, the diaphragm. To do this, lie down on your back with both knees flexed and supported. Place the hands on the abdomen and notice the marked expansion of the abdomen rather than the chest when breathing.
    Over-the-counter (OTC) cough suppressants
    • Drugs like Dextromethorphan  and Guaifenesin may be helpful in reducing cough symptoms.
    Alternative Remedies
    • It is advisable to consult a health care professional before using any of these products.

    Medical Complications
    • Dyspnea is a medical term to describe shortness of breath
    • Respiratory failure will happen if there is not enough oxygen that passes from the lungs into the blood
    • Pneumonia is an infection that causes inflammation of the air sacs in one or both lungs.
    • Cor pulmonale is an abnormal enlargement and weakness of right heart ventricle due to lung disease
    • Pneumothorax is an abnormal collection of air or gas in the pleural cavity of the lung causing lung collapse
    • Polycythemia is an abnormally increased concentration of red blood cells needed to carry oxygen),
    • COPD (Chronic Obstructive Pulmonary Disease) is a lung disease characterized by chronic obstruction of lung airflow that affect normal breathing and is not fully reversible. These diseases include the emphysema and the chronic bronchitis. Tobacco smoking is the most common cause of COPD.
    • High mortality rate 
    Preventive Measures:
    • Do not smoke and avoid second-hand smoke
    • Vaccination - Flu shot every year and pneumococcal vaccination every 5 or 6 years
    • Wear an appropriate mask to high-risk areas to limit exposure to chemical fumes, dust, second-hand smoke, and pollution
    • Wash your hands to limit viral and bacterial infections
    • Maintain a physically active lifestyle and eat a balance diet