Bronchitis acute J20.9

Acute inflammation of the trachea or the entire tracheobronchial tree. Basically, depending on the level and type of inflammation, one can distinguish between:

catharrhal, hemorrhagic, fibrinous, pseudomembranous, ulcerative or necrotizing

• Tracheitis
• Tracheobronchitis
• Bronchitis
• Bronchiolitis

Children, elderly people and immunocompromised patient groups

Chronic damage to the tracheobronchial tree due to harmful environmental factors such as industrial gases, car exhaust fumes, dusts favour infections such as:

• Viral infections (90%): Adeno-, Parainfluenza viruses, Rhino-, ECHO-, Coxsackie-viruses. Influenza viruses are also present: haemorrhagic tracheitis, "real flu".
• Bacterial infections: haemophilus influenzae, pneumococci, Staph. aureus, Mycoplasma pneumoniae
• Fungal infections: Candida albicans and other yeast species. Especially in immunocompetent patients.

Dry cough, partly retrosternal pain, later rhinitis, pharyngitis, slight fever. In case of bronchioles: detection of dyspnoea, gills.

If the course is uncomplicated, therapy is not absolutely necessary. In the case of severe cough irritation, antitussives, possibly analgesics/antipyretics (acetylsalicylic acid, paracetamol).

In case of feverish course with purulent sputum: antibacterial therapy.

Duration of acute viral bronchitis: in uncomplicated cases 7 days with spontaneous healing. In case of bacterial superinfection: 2-3 weeks.

The naturopathic therapeutics can essentially be divided into 3 main groups:

• Essential oil-containing drugs(Anisi fructus = aniseed fruits, Foeniculi fructus = fennel fruits, Thymi herba = thyme herb) with bronchospasmolytic and expectorant effect

• Saponindrogen(Hederae folium = ivy leaves, Primulae radix/Primulaeflos = primrose root/flowers) with antiphlogistic, secretion-motor and bacteriostatic effect

• Mucus drugs (marshmallow root, mallow leaves/flowers, ribwort herb) with antiphlogistic, mucous membrane protective and soothing effect

Other drugs with proven effect on bronchitic symptoms: elderflower and sundew.

Remark: By combining several different drugs their effect can be optimized.

The following preparationsarewell-supported by studies andapprovedbythe BfArM for this indication:

Cineol, the fixed-dose combination (Armoraciae rusticanaeradix/Tropaeoli maji herba, commercially available as Angocin® Anti-Infekt), andPelargonii sidoidis radix(^Umckaloabo®).

Cineol

In a double-blind, placebo-controlled, multicenter study, a total of 242 patients with acute bronchitis were treated with 3 x 200 mg of cineol or placebo over 10 days. As early as 4 days into treatment, patients treated with cineol showed significant improvements in the Bronchitis Sum Score, along with a significant reduction in cough frequency (Fischer J et al. 2013).

In a non-interventional multicenter study of children with acute bronchitis aged 2–7 and 8–11 years, treatment with cineol at a dose of 3 × 100 mg/day over 7 – 9 days, a significant improvement in the bronchitis symptom sum score was observed, with 79% of the children achieving symptom-free recovery during that period (Nauert C et al. 2015).

Armoraciae rusticanae radix/Tropaeoli maji herba

In a randomized, two-arm, placebo-controlled, double-blind Phase IV study involving a total of 384 patients—195 of whom received the fixed-dose combination (Armoraciae rusticanaeradix/Tropaeoli maji herba, commercially available preparation Angocin^® Anti-Infekt) versus 189 patients receiving placebo, a statistically significant acceleration in the resolution of bronchitis symptoms was observed starting on the 3rd day of treatment, accompanied by a reduction in cough, mucosal pain, and chest pain (Albrecht U et al. 2023). 

In 2007, Goos KH et al. demonstrated in a prospective cohort study involving a total of 858 children and adolescents aged 4 to 18 years—including 290 patients with acute bronchitis—that the fixed-dose combination of Armoraciae rusticanae radix/Tropaeoli maji herba (commercially available preparation Angocin® Anti-Infekt) is comparable in efficacy to standard antibiotics, with significantly fewer side effects (Goos KH et al. 2007).

Pelargonii sidoidis radix 

A randomized, double-blind, placebo-controlled study demonstrated a significant decrease in the Bronchitis Sum Score, the duration of illness, and a 16% reduction in work disability among patients treated with Pelargonii sidoidis radix (^Umckaloabo®) whereas this figure was 43% in the placebo group. A response to therapy was evident within the first 4 days (Matthys H et al. 2003). 

A randomized, double-blind, placebo-controlled multicenter study involving 406 patients treated with different doses of Pelargonii sidoidis radix demonstrated, with regard to the bronchitis symptom score, statistically highly significant superiority ofover the placebo in all dosage groups (30 mg, 60 mg, and 90 mg/day) demonstrated statistically highly significant superiority of over the placebo. The duration of illness was significantly shortened (Matthys H et al. 2008).

Pelargonii sidoidis radix also demonstrated comparable efficacy and safety in children with acute bronchitis: In an open-label, randomized clinical trial involving 591 children (ages 1–5 years) with acute bronchitis, the children were treated for 7 days with Pelargonii sidoidis radix as a syrup or solution. After one week of treatment, more than 90% of the children showed improvement or remission of the Bronchitis Sum Score. 80% of the children had fully recovered or shown significant improvement by the 7th day. Side effects included infections (7.2% for the syrup and 7.4% for the solution) and gastrointestinal disturbances (2.7% for the syrup and 2.7% and 3.2% for the solution) (Kamin W et al. 2023).

In accordance with guidelines:

^Soledum®(cineol),^GeloMyrtol® forte (eucalyptus, sweet orange, myrtle, and lemon oils), 

^{Umckaloabo® (} Pelargonium sidoides)

^{Bronchipret®}(thyme and ivy),

^Bronchicum®Fixe (thyme and primrose root)

^Prospan®,^Hedelix®(dry extract of ivy leaves)