Pain in acute and chronic bronchitis: causes, what to do?

Pain accompanies many diseases: in some cases it is one of the signs of inflammation, and in others it is the result of some accompanying disorders in the body. Thus, pain in bronchitis can be caused by direct changes due to the inflammatory process in the respiratory system. But in some cases they indicate the presence of other health problems.

Bronchitis is a kind of borderline disease that often gets seriously complicated. Therefore, the appearance of pain should not only alert you, but also become a reason for urgent medical attention. Some types of pain signal extremely dangerous conditions, in which medical care must be provided immediately.

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Causes bronchitis pain

Bronchitis can be caused by a viral or microbial pathology. Sometimes it develops under the influence of an allergic process or chemical intoxication, but bronchitis always involves an inflammatory process of various etiologies. Pain in bronchitis is a consequence of a specific "response" of the respiratory receptors to regular stimulation (cough) or other irritants.

Localization, depending on the source of pain in bronchitis, can be different. And it is not only the chest, but also the back, hypochondrium, head. Therefore, it is impossible to accurately indicate whether such pain is a consequence of the inflammatory process in the bronchi. A similar symptom occurs with other diseases that can develop against the background of the same bronchitis, for example:

• Pleurisy is accompanied by pain behind the breastbone, which intensifies both when coughing and when inhaling.
• Tracheitis - most often manifests itself as pain in the left side of the chest.
• Pneumonia – manifests itself as severe chest pain; often the patient is simply unable to breathe.
• Tuberculosis - can be accompanied by pain in the chest, back and joints.

No less often, the causes of pain in bronchitis are diseases of the cardiovascular system (myocardial infarction, angina attack), mechanical injuries to the chest or spine, and disorders in the functioning of organs located below the chest (liver, biliary system, intestinal area, diaphragm).

To the listed diseases, which are diagnosed somewhat less frequently, we can add the following:

• vegetative-vascular dystonia;
• vertebral hernia;
• osteochondrosis;
• acute leukemia.

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Risk factors

Risk factors for the occurrence of pain during bronchitis include:

• hypothermia, sharp decrease in immunity;
• inhalation of irritating volatile substances, chemical intoxication;
• chest injuries;
• smoking;
• prolonged stay in dusty, gas-polluted or smoky rooms;
• lack of necessary treatment for acute bronchitis.

The following patients are at risk for developing pain due to bronchitis:

• workers in hot shops, cooks, barbecue operators;
• stove-makers;
• workers in the grain processing industry;
• miners, masons;
• railway and road workers;
• workers in chemical plants and warehouses;
• painters, plasterers, concrete workers.

Patients suffering from frequent allergic reactions and bronchial asthma are also at special risk.

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Pathogenesis

There are a large number of nerve endings along the bronchial tree. This is why, when coughing, the patient may feel pain in the back, or more precisely, in the thoracic spine. Painful sensations are a consequence of a sharp muscle contraction, especially if the cough is long and painful.

During coughing, contractions of not only the chest muscles, but also the abdominal and intercostal muscles are observed. At the moment of contractions, pressure is exerted on the nerve fibers extending from the spinal column in the thoracic and lumbar regions, which also manifests itself as pain.

At the initial stage of bronchitis, the cough is always more pronounced, which is explained by the excessive viscosity of sputum secretions, which are poorly separated and leave the bronchi with difficulty. At the same time, muscle contractions occur constantly: hence the appearance of pain in the back and chest.

However, it is possible to assume that there are other causes of pain during bronchitis:

• other respiratory diseases besides bronchitis;
• neuritis, neuralgia;
• cardiovascular diseases;
• disorders of the spinal column.

In many patients, the pain is provoked not by bronchitis, but by the main symptom of the disease – cough. For example, with atypical pneumonia, which is practically asymptomatic, pleurisy may develop: this complication will already be accompanied by severe pain during coughing or body movements. In such a situation, we can talk about the development of chronic bronchitis.

Osteochondrosis can also proceed without specific symptoms: pain can only be detected with the onset of bronchitis - when coughing. An equivalent picture is observed with intercostal neuralgia, inflammation of the pericardium or multiple myositis.

Considering the above, when pain occurs with bronchitis, it is necessary to undergo a series of diagnostic procedures in order to find out the exact cause of the unpleasant symptom.

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Epidemiology

According to statistics, pain from bronchitis bothers every third patient. The main cause of pain is various complications: the transition of the disease to a chronic form, the development of pneumonia, etc.

Pain in bronchitis most often bothers patients over 40 years of age, as well as heavy smokers. Children and young people can also complain of painful sensations, but much less often.

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Symptoms

The first and most pronounced symptom of bronchitis is considered to be a cough. At first it is dry, and as the disease progresses it becomes wet, with abundant mucus discharge. And only at the next stage can pain appear with coughing and bronchitis: such pain intensifies with intense attacks. The chest, head, back, liver area may hurt. The exact characteristics of the pain also depend on the cause of this phenomenon.

• Chest pain during bronchitis is usually accompanied by dry, persistent coughing fits. Such pain is manifested by an unpleasant sensation of scratching in the sternum area: the symptom intensifies during coughing and may indicate the development of tracheitis - an inflammatory process in the respiratory tube that connects the bronchi and larynx.
• Headache with bronchitis is a common occurrence if the disease is accompanied by fever and chills. In such a situation, headaches indicate general intoxication of the body: the condition is aggravated by general weakness, drowsiness, pale skin, thirst. In patients prone to hypertension, headaches may be associated with increased blood pressure.
• If the back hurts with bronchitis, then one can suspect the development of complications such as pleurisy or pneumonia. With pleurisy, pain occurs in the area between the shoulder blades. Other symptoms include: high temperature, loss of appetite, shortness of breath, persistent cough. Among other possible causes may be pancreatitis, which also causes pain in the back.
• Pain in the lungs during bronchitis occurs with the development of complications such as pneumonia and pleurisy: with pneumonia, breathing becomes difficult, up to attacks of suffocation. With pleurisy, a dry cough with stabbing pains is observed, which intensify with a deep breath.
• Sore throat with bronchitis, intense "tearing" cough, tingling or burning in the nasopharynx, dryness, hoarseness, tickling - these are signs of pharyngitis or laryngitis. The patient complains of painful swallowing and paroxysmal dry cough.
• Rib pain during bronchitis when inhaling may be a sign of intercostal neuralgia - a reflex syndrome that is provoked either by pinching of the spinal nerve root in the thoracic part of the spine, or by irritation of the intercostal nerves in the intercostal space. However, in some cases, such pain may be a sign of pleurisy, pneumonia, heart failure and even stomach ulcers. Therefore, careful diagnostics in this situation is extremely necessary.
• If the chest hurts with bronchitis, then chest trauma, liver disease and tumor processes should be excluded. If the pain is localized in the lower parts of the chest, the cause may be an intense, straining cough, accompanied by contraction of the diaphragm muscles.
• Heart pain during bronchitis may be associated with ischemic heart disease (such pain goes away after a period of rest or taking Nitroglycerin), with myocardial infarction (arrhythmia, weakness, shortness of breath are observed), with pericarditis (sharp, aching pain in the anterior chest area), with cardiac insufficiency (edema and ascites are observed).
• Pain in the side with bronchitis is a sign that may indicate the development of a complication in the form of unilateral pneumonia. Depending on the nature of the clinical picture, with pain in the right side, one can also suspect liver or gallbladder disease.
• Chest pain with bronchitis against the background of difficulty breathing (up to paroxysmal suffocation) can be observed both with pleurisy and pneumonia, and with heart disease. Diagnostic measures in such a situation should be urgent.
• Pain under the shoulder blade during bronchitis may be a consequence of osteochondrosis, pericarditis, or indicate the development of a pre-infarction condition. With such a symptom, it is important to make the patient an electrocardiogram in a timely manner.
• Muscle pain during bronchitis is most often associated with excessive muscle tension during paroxysmal intense coughing. The condition of muscle pain and aches is also possible after a long fever with a strong increase in temperature. If the pain is sharp, "shooting", then one can suspect the development of neuralgia.
• If the ear hurts with bronchitis, then one can suspect not only otitis, but also other diseases of the ENT organs (due to their close anatomical connection). So, first of all, the development of otitis, sinusitis and tonsillitis should be excluded.

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Diagnostics bronchitis pain

To determine the cause of pain in bronchitis, it is necessary to first find out the anamnesis of the disease. The doctor listens carefully to the patient's complaints and specifies what other symptoms there are, in addition to pain. Additionally, the length of smoking and the intensity of smoking, as well as professional and everyday characteristics are taken into account.

A lot of information is provided by a simple auscultation: the doctor will pay attention to the harshness of breathing, the lengthening or shortening of exhalation, the presence of dry, wet or wheezing rales. If we are talking about emphysema, then a peculiar box sound will be determined by percussion.

Instrumental diagnostics, in particular chest X-ray, is of particular value for confirming various respiratory diseases. This method allows identifying chronic bronchitis, pneumonia, tuberculosis, emphysema, and malignant processes.

Microscopy of sputum allows us to determine the degree of its viscosity, nature (mucous, purulent), and the presence of neutrophils.

Sputum culture helps to identify the bacterial pathogen, which may be streptococcus, staphylococcus, Haemophilus influenzae, Klebsiella, pseudomonas, enterobacteria, etc. If there are difficulties with collecting sputum, then a bronchoscopy with bacterial examination of bronchial washing fluid is performed.

Bronchography allows to exclude bronchiectasis.

To exclude cardiovascular diseases, an electrocardiogram, ultrasound of the heart, and blood pressure monitoring are performed.

Laboratory tests include a general urine and blood test, an assessment of total protein with protein fractions. Such parameters as fibrin, CRP, immunoglobulins, sialic acids, etc. are also examined. If there is severe respiratory failure, the acid-base balance of the blood and its gas composition are examined.

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Differential diagnosis

In no case will the doctor be able to answer exactly whether the pain is a consequence of bronchitis. After all, a similar symptom is present in many other diseases. Therefore, differential diagnostics is additionally carried out, during which the following diseases are considered:

• pleurisy (accompanied by sharp pain in the chest when inhaling);
• tracheitis (accompanied by pain on the left side of the chest);
• pneumonia (pain can affect the entire chest, radiating to the back);
• tuberculosis (pain can occur in the chest, back, and joints).

Heart disease (myocardial infarction, coronary heart disease), chest and back injuries, diseases of the hepatobiliary system, osteochondrosis, and spinal diseases should also be excluded.

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Treatment bronchitis pain

In order to eliminate pain from bronchitis, it is necessary to act on the main cause of the unpleasant sensations. This may be either bronchitis itself or another concomitant pathology.

Drug treatment is prescribed by a doctor, depending on the results of diagnostics and the established diagnosis.

There are a number of rules that must be followed in order for the treatment to be successful:

• When you have pain from bronchitis, you need to strictly stay in bed. If you suffer from the disease "on your feet", the condition may worsen.
• It is important to avoid excessive physical activity.
• When you have bronchitis, you should drink relatively a lot of warm liquids in the form of clean water, herbal infusions, and tea.
• If the pain of bronchitis is caused by a dry cough, it is recommended to drink non-carbonated alkaline warm water.
• In consultation with your doctor, it is advisable to take vitamin supplements along with general treatment.
• According to the doctor's instructions, you need to take expectorants and antihistamines. And if there is no therapeutic effect during the first three days from the onset of the disease, the doctor may insist on antibiotic therapy.
• Pain is relieved by prescribing painkillers and anti-inflammatory drugs.

For severe pain, you can take Ibuprofen, Paracetamol and other non-steroidal drugs, and for pain in the spine or ribs - Ortofen and Nimesulide. Patients with bronchitis are often prescribed a specific drug that stops the development of the inflammatory process in the respiratory system. We are talking about Fenspiride. This medication is present in other drugs, for example:

• Siresp is a syrup drug that is taken 3-6 tablespoons per day before meals. In some cases, the intake may be accompanied by stomach upset, dizziness, and skin itching. The duration of therapy is determined by the doctor.
• Eladon is taken 1 tablet 2-3 times a day. Possible side effects are tachycardia, nausea, drowsiness.
• Epistat is taken one tablet up to three times a day, with plenty of water. During treatment, stomach upset and nausea may occur.
• Erespal is taken one tablet in the morning and one in the evening (for children, Erespal is available as a syrup). The most common side effects include indigestion and diarrhea.
• Erispirus is taken before meals, 80 mg up to 3 times a day (for children - 4 mg per kg per day). Side effects are rare - mainly in the form of moderate dyspeptic symptoms.

The listed medications stop the development of inflammation and relieve bronchial spasms.

Other antispasmodics can also be used to relieve pain, such as myotropic drugs that act on adenosine receptors and relax smooth muscles. Theophylline, Euphyllin can be used orally, rectally or by injection.

Vitamins

The absence of hypovitaminosis in the body of a patient suffering from bronchitis pain provides a better chance of a speedy recovery. Therefore, in many cases, in addition to the main treatment, the doctor may recommend taking vitamins. Particular attention should be paid to ascorbic acid, vitamins E and A. Ascorbic acid strengthens the vascular walls, increases the body's resistance to infectious diseases. A lot of vitamin C is present in rose hips and sea buckthorn berries, black currants, viburnum, citrus fruits, kiwi, cabbage. If for some reason it is not possible to include the proposed products in the diet, the doctor may prescribe ascorbic acid in the form of dragees.

The presence of vitamin A in the diet helps to strengthen the immune system: this vitamin is present in large quantities in dairy products, liver, carrots, spinach, apricots, and greens.

Vitamin E improves gas exchange in the lungs. Nuts, sea fish, sea buckthorn berries, cereals, and vegetable oil contain sufficient amounts of it.

Physiotherapy treatment

For pain caused by bronchitis, the following basic physiotherapeutic procedures can be used:

• Inhalations.

This method is easy to use even at home. It is suitable for both children and the elderly, as well as women during pregnancy. Mainly herbal inhalations with chamomile, calendula, St. John's wort, or saline solution are used. If you have an ultrasonic nebulizer, you can also use medications and mineral water as a therapeutic agent.

• Massage treatments.

Chest massage helps to ease breathing, remove phlegm from the bronchi, and avoid mucus stagnation. Duration of one procedure is 5-10 minutes. The course consists of 5-15 procedures.

• Ultra-high-frequency inductothermy method.

The method involves the use of thermal electromagnetic radiation, which is absorbed by the affected tissue. During the procedure, blood and lymph flow improves, the severity of the inflammatory process decreases, and mucous tissues are restored. The session lasts 15-20 minutes, and the course will require 6-12 such sessions.

• Magnetic therapy.

This procedure relieves inflammation and pain, eliminates swelling, increases pulmonary respiratory volume, accelerates the removal of sputum secretions, and stimulates the body's defense function.

• Electrophoresis.

The method allows many medications to be delivered directly to the affected tissues, bypassing the digestive tract. This approach is more practical and effective for bronchitis pain.

• Aerosol therapy.

The method involves the introduction of anti-inflammatory and antibacterial drugs that expand the bronchi and accelerate tissue regeneration. The procedure includes: salt halogenation, medicinal inhalation and normobaric hypoxic therapy.

• Heat treatment, paraffin treatment.

The method stimulates capillary blood flow in the bronchi, accelerates metabolism and improves tissue trophism, and also has a distracting effect.

Folk remedies

Traditional methods are allowed to be used only when the cause of pain in bronchitis is precisely known, and the attending physician has nothing against such treatment. The use of recipes also depends on the localization of pain.

• Back pain due to bronchitis can be eliminated with the help of dandelion tincture. Freshly picked flowers of the plant are poured into a 1 liter glass jar, filled with 0.5 liters of vodka. Cover the container with a lid and keep in a dark cupboard for 10 days, occasionally stirring the contents. Then filter the tincture and use it to rub the painful area, 3-4 times a day.
• Intercostal pain during bronchitis can be relieved with a compress of black radish. Take a small piece of thick natural fabric and place it on the painful area. Grate the radish, and spread the pulp evenly over the fabric. Cover the fabric with the pulp with cling film and wrap it with a warm towel on top. Keep the compress on the skin until a strong burning sensation appears. Then remove the fabric and wipe the skin with a warm damp cloth. Repeat the procedure 1-2 times a day until the pain is completely gone.
• Chest pain is relieved with a heat treatment. Sew a linen bag measuring approximately 30 by 30 centimeters. Fill it with dried cherry or sweet cherry pits and sew it up. When pain occurs, heat the bag in a microwave or oven to 50°C, then apply it through a towel to the painful area. The frequency of treatments is 1-2 times a day. The duration depends on the severity of the pain.
• Pain from bronchitis can be eliminated by using birch bud oil (sold in pharmacies). Rub the painful area with oil several times a day. Immediately after rubbing, you can take several clean birch leaves, apply them to the sore spot and bandage. This method helps to "pull out" the pain and enhance the healing effect of the oil.

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Herbal treatment

• Pour 1 tbsp. of aspen buds with 200 ml of boiling water, leave in a thermos for an hour. Filter and take 1 tbsp. orally up to five times a day.
• Pour 3 teaspoons of dried parsley rhizome into a saucepan, add 0.5 liters of water. Boil over low heat for about five minutes, then filter and drink 1 tablespoon twice a day.
• Take 100 g of dry nettle leaf, 200 g of dry burdock leaf, 100 g of oregano. Pour 1 liter of boiling water over all the prepared raw materials and leave overnight. Take 1 tbsp. in the morning and evening.
• Pour 1 teaspoon of adonis with 200 ml of boiling water, leave for 60 minutes. Filter and drink 1 tablespoon three times a day.
• Mix equal amounts of lemon balm leaves and dry lemon peel. Pour 200 ml of boiling water over 2 teaspoons of the mixture and leave for 60 minutes. Add 1 teaspoon of valerian tincture and 1 teaspoon of honey to the cooled infusion. Drink 200 ml of the resulting remedy in the morning and evening.

Homeopathy

Homeopathic remedies can be used as an alternative treatment. When choosing a drug of this kind, you need to focus not only on the recommendations for use, but also on the characteristics of the pain, modality (a factor affecting the reduction or increase of pain), as well as on the pathological signs accompanying the pain. It is optimal if the drug is chosen by a homeopathic doctor.

• Aconite 6 is used for pain in muscles and joints, which are accompanied by fever and chills. The pain intensifies when lying down.
• Arnica 6 is used for pain and a feeling of being broken down. The pain is aggravated even by touch, accompanied by numbness and a feeling of “crawling ants”.
• Rus toxicodendron 6 is prescribed for pain associated with hypothermia, for pain along the nerves. Accompanying symptoms are general weakness, tremor of the extremities.
• Ruta 6 is used for intercostal pain, overexertion. The pain is excruciating, stabbing, and is found against the background of painful sensitive muscles.

The listed homeopathic remedies are taken in granules, one dose 4 times a day, for one week.

Surgical treatment

Surgery may be prescribed in case of complications of bronchitis. For example, if pains during bronchitis are associated with bullous pulmonary emphysema, then pathologically altered areas are removed.

If there is a picture of severe respiratory failure, in which long-term oxygen therapy is indicated, it may be necessary to perform a lung transplant operation.

Surgical treatment is also carried out in the event of the development of purulent complications or the detection of malignant tumors.

Complications and consequences

The complications that may arise from bronchitis pain can only be judged by knowing the underlying cause of the pain. Most often, doctors diagnose bronchopneumonia in patients: along with painful sensations, attacks of difficulty breathing begin, the right ventricle of the heart enlarges, and the myocardium suffers. Such bronchitis can also be complicated by heart failure and fainting.

Another serious complication is bronchiectasis. However, it is not diagnosed as often as pneumonia.

Numerous suffocating attacks lead to swelling of the mucous tissues. As a result, the development of bronchial asthma is possible.

If pain is accompanied by wheezing, labored breathing, one may suspect bronchial obstruction, emphysema, or diffuse pneumosclerosis.

The most severe complication is considered to be acute respiratory failure. The symptoms of such pathology worsen quite quickly, and not only is the respiratory capacity impaired, but changes occur throughout the body (as a result of impaired gas exchange and oxygen deficiency).

Arterial pulmonary hypertension is characterized by pain in the heart area, behind the breastbone, as well as irregular heart rhythms and increased blood pressure.

With pulmonary emphysema, shortness of breath is observed, heart sounds are muffled, and blood pressure increases.

Acute heart failure may develop against the background of bronchitis complicated by exudative pleurisy or acute pneumonia.

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Prevention

Preventive measures to prevent the occurrence of pain during bronchitis can be as follows:

• The most important preventive step is to give up such a bad habit as smoking. The longer a person has been smoking, the greater the risk of developing complications with bronchitis.
• It is equally important to observe basic hygiene rules: wash your hands before eating, after walking and using the toilet, brush your teeth, and shower regularly.
• In case of respiratory diseases, breathing exercises have a good preventive effect, preventing the development of complications. They are done daily, 3-4 times a day, for 5-10 minutes. The exercises include inhaling through the nose, mouth, producing a hissing sound (exhalation is longer, with the displacement of the maximum volume of air).
• Moisturizing is of no small importance – both external and internal. External consists of creating a comfortable humidity in the room where the patient is located (about 50-70%). Internal moisturizing includes drinking enough liquid.
• To avoid the development of complications, including the appearance of pain with bronchitis, you can use exercise therapy procedures, chest massage, and frequent walks in the fresh air (even more welcome are walks in parks and forests with coniferous trees).
• One of the basic preventive factors is proper nutrition, with a sufficient amount of plant products and greens.

To speed up recovery, you should also take care to normalize your living conditions:

• Avoid inhaling dust, animal hair, and mold spores;
• It is necessary to regularly ventilate the rooms and check that there is a functioning, adequate exhaust system.

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Forecast

The quality of the forecast is influenced by many factors:

• age of the patient (risk factor – old age over 60 years);
• long-term smoking, smoking more than one pack of cigarettes daily;
• concomitant cardiac diseases;
• concomitant infectious diseases;
• general immune weakness of the body.
• The most unfavorable outcome is death, which can happen:
• in chronic heart failure;
• in acute respiratory failure;
• in the development of pneumothorax, pneumonia;
• in case of pulmonary artery occlusion;
• with obstructive bronchitis.

Provided that the causes of the deterioration of the condition are diagnosed quickly and efficiently, and that the correct treatment is prescribed, and that the doctor's instructions and recommendations are followed, pain from bronchitis can be eliminated, while simultaneously curing the underlying disease.

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