Category: Respiratory

Person holding a blue inhaler attached to an AeroChamber spacer

Proper Use of Asthma/Reactive Airway Inhalers

On By Dr. Scott RennieIn RespiratoryLeave a comment

Reviewed and updated August 2026. Originally published June 2012.

I am Scott Rennie, DO, board certified in Family Medicine and Obesity Medicine. I practice entirely by telemedicine, licensed in all 50 states. Most of my work now is weight loss, metabolic health and menopause care. If this was useful, Start here lists what I write about now.

Editor’s note, August 2026. The inhaler technique described here is still correct, and it is still the thing patients most often get wrong. One thing around it has changed: since 2019 the Global Initiative for Asthma no longer recommends treating asthma with a reliever inhaler alone, even in mild disease. If albuterol is the only inhaler you have been given, ask about that.

shutterstock_139782763shutterstock_163394081                       Today a patient came into the clinic and said that his asthma inhaler wasn’t working.  He’d been diagnosed with mild asthma last week and his primary care physician gave him an albuterol inhaler to use when his asthma flares and he starts coughing.  He had his inhaler with him, so I asked him to demonstrate how he uses it.  He promptly put the inhaler to his lips and sprayed the inhaler into his mouth and then took a big breath in.  I was able to see that he wasn’t getting the medication into his lungs efficiently, and since this is a common problem when using inhaled medication, I decided that the subject needed some attention. Using an inhaler can actually be quite challenging, and I find that most patients medications are only effective if they are used properly.  If you use the inhaler correctly the medication is delivered to the lungs where it works to control your symptoms.  If you are not using your inhaler correctly, little or no medication reaches your lungs and your asthma or reactive airway symptoms will not be adequately treated. Asthma inhaler types:  Most asthma inhalers are meter dose inhalers (MDI’s) and deliver a small spray of liquid medication such as albuterol (aka Proventil or Ventolin).  Since 2008, new inhaler canisters have come out that use a propellant that does not damage the ozone layer.  They are known as HFA inhalers and have a different taste compared to the previous inhalers and are also more expensive. The spray is also softer, but works just as well as the older inhalers. The other type of asthma inhaler is called a dry powder inhaler (DPI).  This type of inhaler has a small amount of powder that you breath in.  It has less taste, but the powder can fall out if you tip the device down towards to ground.  This type of inhaler is used commonly with medications such as the Advair diskus. Spacer devices:  A spacer is a device that is basically a small tube that allows the medicine to have a little extra time and space to get down into your lungs rather than be deposited in the back of your mouth or on your tongue.  It is not required to use a spacer, but it is highly recommended.  If you don’t have a spacer to use with your inhaler, you can make one using an empty cardboard toilet paper roll.  You put the spacer over the mouthpiece of the MDI and then put the other end of the spacer in your lips and inhale the medication from the metered dose inhaler through the spacer and into your lungs. Before using a metered dose inhaler MDI for the first time: 1)   Prepare the inhaler by shaking it for 5 seconds 2)   Prime the inhaler by pressing down on the canister with the index finger to release the medication.  Hold the inhaler away from your face to prevent the medication getting into your eyes.  Press the canister down again 3 more times 3)   After using for the first time, it does not need to be primed again unless you don’t use it for more than 2 weeks. Technique for using a metered dose inhaler (MDI): 1)   Shake the canister for 5 seconds 2)   If you have a spacer (recommended), insert the MDI into the spacer and hold the MDI upright with the index finger on the top of the medication canister and the thumb supporting the bottom of the inhaler.  Some people find that using the other hand to hold the spacer is easiest. 3)   Breathe out normally 4)   Close your lips around the spacer.  If your spacer has a mask, hold the mask tightly to the face.  If you do not have a spacer, close lips around mouthpiece or hold at a position about 4cm from your mouth. 5)   Keep your tongue away from the spacer opening/mouthpiece area 6)   Press down on the top of the medication canister with the index finger to release the medication 7)   At the same time as the canister is pressed, inhale deeply and slowly through your mouth until your lungs are completely filled – this should take about 4-6 seconds 8)   Hold your breath in for as long as possible – 10 seconds is recommended before breathing out. 9)   If a second puff of medication is recommended, wait about 15-30 seconds before repeating the procedure for the second puff. Remember to shake the canister before each puff 10)  Recap the mouthpiece 11)  Rinse your mouth with water rather than swallowing after the treatment.  This is recommended especially after using an inhaled cortisone medication to prevent developing thrush *Tip:  If you’re having difficulty timing your breath while spraying the medication, there are inhalers that automatically release the medication when you take a breath.  An alternative is to use a spacer or a dry powder inhaler (DPI). Cleaning your MDI:  Your inhaler must be cleaned at least once a week to prevent blockages.  The manufactures recommend cleaning the mouthpiece at least once per week. 1)   Remove the canister but do not wash the canister or put it in the water 2)   Run warm water through the top and bottom of the plastic mouthpiece for 60 seconds 3)   Shake off the excess water and allow the mouthpiece to dry completely overnight 4)   If you need to use your inhaler before it is dry, shake off all the water, replace the canister and test spray (away from your face) two times before using 5)   Remember to clean your spacer How to determine when your inhaler is empty:  You can’t always know when your inhaler is empty by shaking it because some propellant remains in the canister when all the medication is gone.  Some inhalers have a dose counter (Ventolin-HFA and Proventil) to track how much is used.  If your inhaler doesn’t have a counter but you use it regularly (2 puffs twice per day), you will need a refill in 30 days.  Write the date you will need a refill on the canister with a permanent maker to remind yourself. If you don’t use your inhaler very often, write the date you start using it on the canister in permanent maker and consider getting a refill in 3-4 months. Dry powder inhalers (DPIs):  These types of inhalers have a small dose of dry powdered medication in them.  They deliver a very fine powder to the lungs when you breathe in.  The advantage of using a DPI, is that you do not need to coordinate the squeezing of the canister with your breathing.  You must be able to breath in more forcefully with a DPI than with a spray type inhaler to ensure that the powder gets into the lungs.  These types of inhalers might be more difficult for patients who cannot breath in very deeply.  It’s also important not to exhale into the device before breathing in so that you don’t scatter the powdered medicine before it’s inhaled. How to use a DPI: 1)   For single use devices, load a capsule into the device as directed 2)   Breathe out slowly and completely (but not into the mouthpiece or you will scatter the powdered medication before you have a chance to breathe it in). 3)   Place the mouthpiece between your lips 4)   Breath in through the mouth quickly and deeply over 2-3 seconds 5)   Remove the inhaler from your mouth and hold your breath as long as possible – 10 seconds is recommended 6)   Breathe out slowly Cleaning a DPI:  Do not use soap and water.  The mouthpiece can be cleaned with a dry cloth. For more information about asthma, here is a list of resources: Center for disease control and Prevention  American Academy of Allergy, Asthma and Immunology American Lung Association   I hope that you have found this information useful.  Wishing you the best of health,

Updated for 2026: The Rescue Inhaler Rule Has Been Turned Around

If you read only one update on this site, make it this one. What I wrote in 2012 described the standard of the time, and that standard has since been reversed. The old model was simple and everybody knew it. Albuterol is your rescue inhaler, you carry it, you puff it when you are tight. A steroid inhaler is the controller, added later if things get bad enough. That is no longer what the global asthma guidance recommends for adults and adolescents. GINA now says plainly that adults and adolescents should not be treated with a short acting reliever alone (1). The reason is that albuterol relieves the symptom without touching the inflammation causing it. You feel better, the underlying disease keeps going, and the pattern of leaning harder on the reliever while the airways get angrier is exactly what precedes the attacks that put people in hospital.

What Replaced It

A combination inhaler containing both a steroid and formoterol, used as the reliever. Formoterol is a long acting bronchodilator that happens to work fast, so the same puff that opens you up also delivers an anti inflammatory dose. Treating the symptom and the cause in one action. At the milder end that inhaler is used only when needed, no daily maintenance at all. Further up, the same inhaler is used both on a schedule and as the reliever, which goes by maintenance and reliever therapy, or MART (1). The effect on serious attacks is large, roughly a sixty percent reduction in severe exacerbations compared with reliever-only treatment. Different analyses land slightly differently within that range, but the direction and the size are consistent (1). There is a second track for people who cannot get a steroid and formoterol combination. In that case you may still use albuterol as your reliever, but never on its own. It must be paired with a separate steroid inhaler taken regularly. If you are an adult carrying only an albuterol inhaler and nothing else, that is worth raising at your next visit. It was correct advice once. It is not the current advice.

Technique, Which Is Still Where Most of the Benefit Is Lost

None of the above matters if the medicine ends up on the back of your throat. Use a spacer with a metered dose inhaler. Not sometimes, routinely. Shake the suspension inhalers before every puff, which includes albuterol and the budesonide-formoterol and fluticasone-salmeterol combinations. One slow steady breath in, then hold it. If you are too breathless for that, five or six normal tidal breaths through the spacer will do instead. Children under three need a mask, three to five a mouthpiece (1).

What a Video Visit Is Actually Good For Here

This one surprises people. Inhaler technique is better assessed on video than almost anything else I do. I can watch you use it. In a clinic room I would ask you to demonstrate with a placebo device in an unfamiliar setting. On video you are holding your own inhaler and your own spacer, in your own kitchen, doing what you actually do every morning. I catch more real errors that way, and I have changed more outcomes by fixing a grip and a breath than by changing a drug. I can also count your reliever use, review your action plan, and check whether your prescription still matches current guidance. What I cannot do from here is listen to your chest or measure your lung function. Spirometry and peak flow need equipment.

Get Emergency Care If

You cannot finish a sentence. You are using neck and shoulder muscles to breathe. Peak flow under half your personal best. Lips or fingertips turning blue. Repeated reliever doses are not touching it, or you have gone past the maximum daily dose of a steroid and formoterol reliever. That last one is a genuine emergency signal rather than a dosing footnote. Blowing through the daily maximum means the attack is winning.

The Bottom Line

Albuterol alone is no longer the answer for adults and adolescents. If that is all you carry, ask about a steroid and formoterol combination. And use a spacer, because the best inhaler in the world does nothing from the back of your throat.

Related Reading

Wheezing and Possible Asthma: What Should You Do Next? What Causes a Cough and What Are the Treatment Options? Pneumonia: Viral, Bacterial or Walking? Am I at Risk? When to Use Telemedicine vs. Urgent Care: How I Spot the Sick One

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Sources

1. Update on Asthma Management Guidelines. Missouri Medicine. 2024 Sep-Oct;121(5):364-367. https://pmc.ncbi.nlm.nih.gov/articles/PMC11482852/ 2. Global Initiative for Asthma. GINA 2025 Report and Summary Guide. https://ginasthma.org/
Man coughing into his elbow while holding a mug on a sofa

What Causes a Cough and What Are the Treatment Options?

On By Dr. Scott RennieIn RespiratoryLeave a comment
shutterstock_137335274 Cough is actually the body response to help clear particles and secretions from the lungs and help prevent infection.   A cough everyone once in awhile is normal, however if it continues it can be due to an infection (viral or bacteria), allergic reaction, acid reflux, a medication reaction or asthma. A cough where there is no production of mucus is sometimes called a “dry” cough as opposed to a “wet” or “productive” cough that is associated with mucus production. Possible causes of cough include: 1)   An infection of the airways or lungs 2)   Postnasal drip – mucus from the nose drips down or flows along the back of the throat and drain into the bronchioles of the upper airway and can cause irritation and cough 3)   Asthma or COPD (emphysema) can create cough and make it hard to breathe 4)   Acid reflux is when acid that is normally in your stomach backs up into the esophagus (the tube that carries food from your mouth to your stomach) 5)   Medication reaction – this happens with about 10% people who take ACE inhibitors for blood pressure 6)   Smoking cigarettes 7)   Cancers – A cancer of the lung or upper airway can cause a cough, but cancer is a less common cause than those other possibilities listed above Testing:  There are some tests that can be done in addition to a medical provider performing a thorough examination. 1)   Chest X-ray 2)   Breathing tests – these are also called pulmonary function tests and can be helpful to diagnose asthma or chronic lung disease such as emphysema 3)   Allergy skin test – these tests are helpful to find out if there is an environmental allergic that could be causing symptoms including cough 4)   CT or Cat scan of the chest or sinuses – this is sometimes done to get a detailed view of the structures inside the chest and can be more useful if there are abnormalities that are seen on chest x-ray that are difficult to visualize.  The sinuses are also examined using a CT scan and for individuals with sinus pressure/pain and cough it may help determine whether surgery may be helpful 5)   Bacterial culture – sometimes a culture of the mucus (sputum) is done to determine the type of bacteria that are present within the lungs 6)   Bronchoscopy – a test where a physician inserts a special scope with camera down the throat and into the upper airways of the lungs to look for abnormalities 7)   Nasopharyngoscopy – a test where the ear/nose/throat physician inserts a scope with camera through the nose and down into the throat to examine the areas of the nose, throat and larynx, trachea and vocal chords to look for abnormalities 8)   pH probe – a test that involves putting a tube in the mouth and down into the esophagus to look for acid entering the esophagus and causing cough Cough treatments:  There are many treatments for cough and we usually tailor the treatment to the individual patient depending on the cause of the cough.  Possible treatments might include antibiotics if the cause is a bacterial infection, a bronchodilator, if the cause is asthma, an acid reducer if the cause is stomach acid, or antihistamines if the cause is excess mucus production from allergies.  If the cause is an allergic reaction or side effect, that medicine or substance is avoided.   I hope that you have found this information useful.  Wishing you the best of health,

Related Reading

The Doctor Says You Have Bronchitis: Is That Really Bad? Pneumonia: Viral, Bacterial or Walking? Am I at Risk? Wheezing and Possible Asthma: What Should You Do Next? My Child Has a Barking Seal-like Cough: Is It Croup? Proper Use of Asthma/Reactive Airway Inhalers

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Mother comforting a child in bed beside a running humidifier

My Child Has a Barking Seal-like Cough: Is It Croup?

On By Dr. Scott RennieIn RespiratoryLeave a comment
shutterstock_109784702A variety of respiratory illness in children can cause what we cause croup.  We see children with croup in the urgent care frequently, mostly during the winter months.  It occurs mostly in infants and young children between 6 months and 3 years of age.  We don’t see it often in kids that are older than 6 years of age.  Most of the time croup is mild and can be treated at home, but sometimes it can become serious and need immediate medical care. When to seek help:  A child with severe or worsening croup should be evaluated immediately because croup can be a life-threatening illness .  Some features of worsening or severe croup include: 1)   Drooling or difficulty swallowing 2)   Difficulty breathing 3)   Inability to speak or cry due to difficulty taking a breath 4)   A whistling sound when breathing, or noisy-high pitched breathing while sitting or resting 5)   Sucking in of the skin around the ribs or abdomen with breathing 6)   Pale or blue-tinged skin It’s important for parents not to attempt to drive their children to their medical provider if they are struggling to breath or are having severe croup symptoms.  Instead, calling 911 and having emergency medical care assist in the treatment on the scene where the child is located and help with transport is critical in this potentially life-threatening situation. Causes:  A viral infection with influenza or para-influenza are the most frequent causes although most of the time these viruses people with these viruses don’t get croup.  The infection can lead to swelling of the voice box and windpipe and as the infection progresses, this can cause the windpipe to become swollen and narrow. Bacterial infection can also cause croup or trachiitis but this is usually more severe and requires a different treatment than a viral infection. Symptoms:  Usually it starts with congestion and runny nose and then can progress to a characteristic “barking cough,” and hoarseness.  Symptoms seem to be worse at night in most children.  Fever can develop in patients as well as a rash and redness to the eyes.  Swollen lymph nodes are common.  As the upper airway narrows due to swelling from the infection, high-pitched, noisy breathing (called stridor) can develop.  If the child becomes anxious, the breathing often becomes more difficult because the agitation can increase the narrowing.  The effort to breathe faster and harder is tiring and some children become exhausted and in severe cases, they might not be able to breath on their own. A blue-tinge to the skin (called cyanosis) can develop if airflow to the lungs is restricted.  Cyanosis may first be noticed in the fingers and toenail, ear lobes, tip of the nose, lips and tongue.  This is uncommon in croup, but can happen in severe cases. Severity:  Croup is often graded in terms of severity as mild, moderate or severe.  A brief description of these grades is listed below: 1)   Mild:  Child is alert and may have a barking cough.  Stridor (high-pitched noisy breathing) is not present at rest, but may be notable as the child coughs or cries.  There are not retractions (severe abdominal or chest movements with breathing) 2)   Moderate:  Children with moderate croup may have stridor at rest.  They may also have retractions (severe abdominal or chest movement as they breath).  They may look uncomfortable. 3)   Severe:  Child with this grade of croup has stridor and chest/abdominal retractions at rest.  The child struggles to take each breath and may appear anxious, agitated or fatigued.  A patient with severe croup should generally not be seen in the primary care or urgent care and be seen in the emergency room.  These patients may be transported to the hospital by ambulance. Diagnosis:  Usually the diagnosis is made clinically and is based on the child’s symptoms including barking cough, and stridor.  X-ray or other laboratory work is rarely needed. Treatment:  The type of treatment generally depends on the severity of symptoms.  Generally moderate to severe symptoms suggest the child should be seen by a healthcare provider. Mild croup: most often is able to be treated at home without difficulty.  Use of a mist humidifier or sitting in the bathroom with parents with the shower running (to produce steam) may be helpful.  Other treatments such as allowing the child to breathe cold air during the night by opening a window or door, treatment of fever with Tylenol or Ibuprofen, and elevating the child’s head slightly may also be helpful. Moderate to severe croup:  Usually moderate to severe croup should be evaluated by a healthcare provider who is able to handle an urgent respiratory illness.  Severe croup can be life-threatening, and treatment should not be delayed.   We will use humidified air or oxygen as needed, intravenous fluids if there are signs of dehydration, and even place a breathing tube or assist in oxygenation by applying a non-rebreather mask over the child’s mouth so the oxygen is delivered in a higher concentration.  We also monitor the child’s oxygen levels, breathing rate, heart rate, skin color and the alertness of the child closely. Medications for croup:  In the clinic, we often prescribe a single to multiple doses of dexamethasone which is a steroid medication that decreases the inflammation of the airway (windpipe and voice box area).  If there is stridor or the croup is severe, we will sometimes give nebulized treatments of racemic epinephrine (aka adrenaline).  This also reduces swelling in the airway and actually starts working faster than dexamethasone.  Racemic epinephrine works for a short period of time (two hours or less) and may be given every 15-20 minutes for severe symptoms.   I hope that you have found this information useful.  Wishing you the best of health,

Related Reading

What Causes a Cough and What Are the Treatment Options? Wheezing and Possible Asthma: What Should You Do Next? Pneumonia: Viral, Bacterial or Walking? Am I at Risk?

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Woman using an inhaler while seated in a bright living room

Wheezing and Possible Asthma: What Should You Do Next?

On By Dr. Scott RennieIn RespiratoryLeave a comment
shutterstock_137805167Millions of people suffer from asthma worldwide.  The cause is due to narrowing of the airways (small tubes) in the lungs which is partially or completely reversible. Symptoms of asthma: 1)   Coughing 2)   Wheezing 3)   Chest tightness 4)   Shortness of breath Asthma symptoms tend to come and go and are affected by the amount of inflammation or narrowing of the airways are present.  Things that can cause the airways to narrow may include: 1)   Viruses that increase the production of mucus 2)   Allergens 3)   Exercise 4)   Certain foods 5)   Environmental conditions Asthma Triggers:  We call factors that set off or worsen asthma symptoms “triggers.”  One of our goals is to identify factors that cause asthma flare-ups so we can reduce or prevent asthma attacks.  Some of these asthma triggers in most patients are: 1)   Smoke or chemical irritants 2)   Allergens such as dust, pollen or pet fur 3)   Respiratory infections 4)   Emotional stress 5)   Physical activity 6)   Menstrual cycle in some women 7)   Certain medications such as aspirin, ibuprofen or Aleve have caused asthma symptoms in a small number of patients.  This is rare however. Categories of asthma:  We categorize asthma according to the severity and adjust the treatment plan depending on the patient’s age, level of control and severity of symptoms. 1)   Intermittent asthma:  These patients usually have symptoms that occur two or fewer times per week, the asthma does not interfere with their daily activities and nighttime symptoms awaken the patient two or fever nights per month and oral steroid medication is needed no more than once per year to treat symptoms. 2)   Persistent asthma:  These patients have symptoms more frequently, and there may be days that activities are limited due to symptoms.  Symptoms tend to awaken to patient from sleep more often need to be treated more regularly than for intermittent asthma to keep symptoms from returning. Treatment:  Asthma treatments tend to be separated into two categories: 1)   Short acting bronchodilator medications to treat an acute asthma flare.  These medicines work by temporarily relaxing the muscles around the narrowed airways.  Albuterol (also called Ventolin, Proventil and Proair) is the most commonly used inhaled bronchodilator used in the US There is no benefit to using a short-acting bronchodilator alone on a regular basis, and the guidance has moved further than that since this was written. Since 2019 the Global Initiative for Asthma has advised against reliever-only treatment with albuterol at every step of severity, including mild asthma, because a bronchodilator on its own leaves the underlying airway inflammation untreated. The preferred approach for adults and adolescents is an inhaled corticosteroid taken whenever a reliever is taken, most often as a combined budesonide and formoterol inhaler used as needed. If you are reaching for albuterol alone more than twice a week, that is worth raising with your physician.  If symptoms are occurring more than twice a week, other medications for asthma may be more helpful. 2)   Asthma controller medications:  For patients with more persistent symptoms, inhaled glucocorticoids, long acting bronchodilators, leukotriene modifiers, or oral glucocorticoids may be used. The benefit of regularly using a inhaled glucocorticoid medication is that it will reduce of frequency of symptoms so that the need for the short acting inhaled bronchodilator (albuterol) is not needed as often and improves quality of life and decreases serious attacks. Patients who present to the medical clinic or urgent care generally have progressed beyond treating a mild episode of asthma and usually require a medication in addition to a short acting bronchodilator such as albuterol.  We usually use an oral steroid medicine such as prednisone or dexamethasone. In patients who use an inhaler, it is important to understand how to use it properly.  Most inhalers work best if you hold the mouthpiece of the inhaler 1 to 2 inches in front of your mouth when you activate it.  If you close your mouth on the mouthpiece of the inhaler, less medicine generally reaches the lungs.  A spacer can be very helpful because it allows you to breathe in slowly and fully to inhale more of the asthma medication. Exercise induced asthma:  In patients who get asthma symptoms with exercise, we usually recommend an extra dose of albuterol before exercise to prevent the asthma symptoms.  Sometimes a leukotriene modifier (such as Singulair) or cromolyn may be used on a daily basis to prevent flares in these patients.   I hope that you have found this information useful.  Wishing you the best of health,

Related Reading

Proper Use of Asthma/Reactive Airway Inhalers What Causes a Cough and What Are the Treatment Options? The Doctor Says You Have Bronchitis: Is That Really Bad? My Child Has a Barking Seal-like Cough: Is It Croup?

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

A cup of hot tea beside a small jar of honey with a wooden honey dipper on a kitchen table

The Doctor Says You Have Bronchitis: Is That Really Bad?

On By Dr. Scott RennieIn RespiratoryLeave a comment
shutterstock_151516097Patients frequently come into the clinic with bronchitis, especially during the winter months.  Often, they are not sure what bronchitis is or how to treat it.  Here is some information about bronchitis and how it is treated that will hopefully answer some of these questions.  Bronchitis:  Inflammation/swelling of the bronchi (large tubes that carry air to the lungs).  There are two types of bronchitis.  The first type is acute (sudden onset) which is the most common reason for patients to come to the clinic and the second type is chronic (long-standing).  Acute bronchitis occurs with a viral infection such as a common cold – sometimes called a “chest cold.” When to see a medical provider:  Fever (temperature greater than 100.4 degrees F or 38 degrees C), cough that lasts greater than 10 days, chest pain with coughing, difficulty breathing, or coughing up blood, a barking cough that makes it hard to speak,  cough accompanied by unexplained weight loss. Symptoms of acute bronchitis:  The most common symptom of acute bronchitis is a nagging cough.  Some people cough up mucus that may be clear, yellow or green.  Fever is uncommon.  Chest discomfort, fatigue, and wheezing can be present.  Even after acute bronchitis has cleared, you may have a dry, nagging cough that lingers for several weeks. Causes of acute bronchitis:  The most common cause is a viral infection of the upper airway.  Less likely, it can also be caused from a bacteria called Bordetella pertussis which causes “whooping cough.” Treatment of acute bronchitis:  Relieve the symptoms of sore throat and congestion.  Antibiotics do not help acute bronchitis caused by a virus.  Antiviral agents are useful in some cases when the cause is influenza.  Do not smoke, drink plenty of fluids and rest.  Symptoms usually go away within 7 to 10 days if you do not have a underlying lung disorder.  A dry, hacking cough can linger for a number of months however. Although no specific treatment exists – there are several available options to reduce symptoms: 1)   Non-steroidal anti-inflammatory medication such as ibuprofen or naproxen 2)   Heated, humidified air can help improve symptoms of nasal congestion and cough 3)   Cough suppressant medications have not shown to be helpful for most patients 4)   Inhaler medications, commonly used for patients with asthma can sometimes be helpful to reduce bronchospasm/wheezing. Complications:  Pneumonia can develop from either acute or chronic bronchitis. Prevention:  Do not smoke, get a yearly flu vaccine and a pneumonia vaccination as directed by your doctor, reduce exposure to air pollution, wash your hands (and your children’s hands) frequently. Chronic bronchitis:  A cough that occurs on most days of the month for at least three months of the year during 2 consecutive years. Preventing the spread to others:  Hand washing is very important.  Alcohol-based rubs are a good alternative if no sink is available.  Use a tissue to cover your mouth hen sneezing or coughing and promptly throw away the tissue immediately.   I hope that you have found this information useful.  Wishing you the best of health,

Related Reading

Pneumonia: Viral, Bacterial or Walking? Am I at Risk? What Causes a Cough and What Are the Treatment Options? Why Won’t Antibiotics Cure a Viral Infection? Doctor Explains

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Chest X-ray with labeled lung anatomy including bronchi, lobes, pulmonary arteries and veins, diaphragm, and alveoli inset

Pneumonia: Viral, Bacterial or Walking? Am I at Risk?

On By Dr. Scott RennieIn RespiratoryLeave a comment
shutterstock_112862059I have many patients who come to the urgent care this time of year due to cough and fever and they are worried about the possibility of pneumonia.  This is a valid concern, as pneumonia is a common illness and can lead to grave disability and even death.  Here are some questions they I often get asked and some information.  This is for informational use – please see a physician if you are worried about the possibility of pneumonia. What is pneumonia?  Community acquired pneumonia as an illness with symptoms that might be present such as cough (sometimes with mucus), fever, shaking chills, shortness of breath (may only occur when climbing stairs), and occasionally with confusion (especially in the elderly), excess sweating and clammy skin, headache, loss of appetite, low energy, and sharp or stabbing chest pain that gets worse when you breath deeply or cough. When I listen your lungs, I am listening for “crackles” which sound like scratchy sounds that sound similar to that produced by rubbing strands of hair together close to your ear. Sometimes I will order a blood test called a CBC to check white blood cell count, chest x-ray, CT  scan of the chest, and even a culture of the mucus you cough up to determine if there are bacteria present. What causes pneumonia?  Pneumonia can be caused by viruses or bacteria.  The most common pneumonia-causing germ in adults and young kids is Streptococcus pneumonia (pneumococcus).  Atypical pneumonia, often called walking pneumonia, is caused by bacteria such as Legionella pneumophila, Mycoplasma pneumonia and Chlamydophila pneumonia. Pneumocystis jiroveci pneumonia is sometimes seen in people whose immune system is not working well. Viruses are also a common cause of pneumonia, especially in infants and young children. What factors/conditions increase my chance of getting pneumonia?   Cerebral palsy, chronic lung disease (such as COPD, bronchiectasis, cystic fibrosis), cigarette smoking, difficulty swallowing (due to stroke, dementia, Parkinson’s disease, or other neurological condition), immune system problem, impaired consciousness, living in a nursing facility (such as a nursing home), other serious illnesses (such as heart disease, liver cirrhosis, or diabetes), recent surgery or trauma or recent cold, laryngitis or flu. How do you decide whether I need antibiotics and which antibiotic to use?  The choice of antibiotic is often determined by multiple factors including the patients age (certain germs are found more commonly in certain age groups), findings on chest x-ray and symptoms of the patient.  Chest x-ray in typical bacterial pneumonia (ie. pneumococcus or Streptococcus pneumonia usually confirms lobar involvement.  In contrast, in atypical pneumonia, chest x-ray shows more diffuse involvement (source – http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2795279/).  If the pneumonia is caused by a virus, the antibiotic will obviously not affect the viral lung infection. What is pneumoncoccus (Streptococcus pneumonia)?  In countries like the United States, pneumococcus remains the most common and important disease-causing organism in infants. Although exact numbers are difficult to obtain, it is estimated that pneumococcus infection is responsible for more than one million of the 2.6 million annual deaths due to acute respiratory infection in children younger than 5 years. Children younger than 5 years, particularly aged 2 years or younger are at an increased risk of disease. In addition, absence of breastfeeding, exposure to cigarette smoke, daycare attendance, and lack of immunization with the pneumococcal conjugate vaccine further increase the risk of disease. Adults older than 55-65 years are the next most commonly affected age group worldwide.  As in the United States, the most common cause of Community Acquired Pneumonia (CAP) in Europe is S pneumoniae infection, affecting approximately 100 per 100,000 adults each year. Pneumococcus is usually treated with a medication such as penicillin/amoxicillin. What is atypical pneumonia (walking pneumonia)?  Atypical pneumonia refers to pneumonia caused by certain bacteria including Legionella, Mycoplasma and Chlamydophila.  Atypical pneumonia is most common in young adults and children.  Pneumonia due to mycoplasma and chlamydophila bacteria is usually mild.  The antibiotics used to treat atypical pneumonia include:  Azithromycin, Clarithromycin, Erythromycin, Fluroquinolones and Tetracyclines. What are the most common bacteria causing pneumonia in children?  That depends on the age of the child. 1)    Newborns (0 – 30 days):  Group B Streptococcus, Listeria, E-Coli, Klebsiella pneumonia 2)    Young infant (1 – 3 months):  S. pneumonia, S. aureus, and H. influenza 3)    Infants, toddlers and preschool-aged children:  Viruses remain the most common cause for approximately 90% of all pneumonias.  RSV(Respiratory Syncytial Virus) is the most common viral pathogen. 4)    School-aged children and young adolescents:  Mycoplasma pneumonia is the most frequent cause among older children. 5)    Older adolescents:  Mycoplasma pneumonia is the most common cause of community-acquired pneumonia during the teenage and young adult years. 6)    Immunocompromised children: Children with cystic fibrosis are especially prone to develop infections with S. aureus, P. aeruginosa, B. cepacia and other multi-drug resistant organisms. How is pneumonia spread?  Most of the time the infection is carried in the upper respiratory tract of the person infected.  It is spread by airborne or direct exposure to respiratory droplets from the infected person.  Illness among casual contacts is infrequent. How soon after exposure do symptoms occur?  The incubation period may vary, but is generally 1 to 3 days. Is there a vaccine to help prevent infections?  Yes, there are two different vaccines.  One primarily for adults and one for children.  The vaccine for adults had been available for many years and is called Pneumovax.  The pediatric vaccine is called Prevnar and is only for use in children under 5 years of age. Who should receive the  adult vaccine?  All adults 65 years of age or older.  All persons 2 years of age or older with:  chronic illness such as diabetes, heart or lung diseases, anatomic or functional asplenia, immunocompromised conditions (due to disease, cancer, chemotherapy or steroids), HIV infected individuals. Who should receive the childhood vaccine?  All children less than 24 months of age.  All children aged 2 to 5-6 yrs with high risk medical conditions.   I hope that you have found this information useful.  Wishing you the best of health,

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Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.