You consult for bronchitis. The doctor is interested in your current cough, but he also asks you a question about the weeks that preceded it. Have you ever been out of breath when you went up the stairs? During the Respidays conference, organized by Pfizer on November 4, Dr. Gérard Roussey, general practitioner in Paris, explained why an acute episode can be an opportunity to go further back in a patient’s respiratory history.
What matters is what you find once the episode is over. If your breathing remains short on a familiar route or if bronchitis returns regularly, tell your doctor, even if you have eventually adjusted your pace. What happens between two episodes can guide the assessment.
What recurrent bronchitis can reveal
The observation: respiratory difficulty sometimes existed before bronchitis
In the office, an example is often more telling than a simple “I’m out of breath”. You started to slow down to follow someone on the street. You pause on a staircase that you were climbing in one go. Or you cough regularly, even when you are not sick. If you find yourself out of breath with the slightest effort, specify how long ago and what has changed in your activities.
Caroline Cottini, who lives with COPD and is an administrator of the Santé respiratory France association, gave an example during the conference. There is only one floor in her house. If she rides it too fast, she sometimes has to sit down once she gets to the top to catch her breath. This gesture tells us what a patient may have changed in their day before even thinking about reporting it in consultation.
The explanation: bronchitis can draw attention to a underlying problem
Isolated bronchitis is not enough to conclude that it is a chronic disease. The doctor looks to see if the episodes repeat themselves, if a cough or shortness of breath persists between them, and if there are any risk factors. After age 40, respiratory symptoms associated with current or past smoking, or certain occupational exposures, may lead to a diagnosis of COPD.
Chronic obstructive pulmonary disease permanently hinders the passage of air through the bronchi. It may worsen temporarily during an infection. This is what doctors call an exacerbation. The consultation for this episode can bring to light an older discomfort, which has gone unnoticed because it has set in gradually.
Why can the doctor suggest spirometry after bronchitis?
What the test measures when you blow
During spirometry, you take a deep breath, then blow hard and as completely as possible into a mouthpiece. The device measures how much air you exhale and how quickly you expel it. It helps to identify if air is coming out of the lungs less easily. If COPD is suspected, the doctor also interprets the measurement after administering a bronchodilator, a medication that opens the bronchi.
Why it is often better to wait until the acute episode has passed
Dr Roussey distinguishes between the time of the consultation for bronchitis and that of the respiratory assessment. The High Authority for Health recommends, if possible, performing spirometry
when the respiratory state has become stable again. The doctor then seeks to find out if an obstruction persists outside of the acute episode. Recommendations from the High Authority for Health on the diagnosis of COPD.
To prepare for this consultation, write down the number of episodes you remember and describe what you could do before. A climb to the floor without a break, a walk that has become slower or unusual shortness of breath on the stairs give the doctor concrete points of reference to decide whether a breath assessment is indicated.