BRONCHITIS.

MANY MALADIES AREN'T OBVIOUS to an observer. You may have a headache but, unless you grasp your forehead and shriek in agony, no one knows. Perhaps you have athlete's foot but, as long as you keep your shoes on, who can tell? But develop a cough and just watch - you're an instant outcast.

Bronchitis is different from run-of-the-mill coughs. In bronchitis, the bronchi - the main, branching passageways of the lungs - are inflamed. There are two main typs of bronchitis: acute (sudden) and chronic (continuing). Acute bronchitis is usually a complication of a viral infection such as a cold or the flu. The cough typically starts off dry and hacking. Then it becomes rattling and produces grey or yellow mucus, possibly with wheezing or mild shorthess of breath. For half of those with acute bronchitis, the cough lingers three weeks or longer. In most cases, it eventually goes away without any conventional treatment.

In chronic bronchitis, persistent inflammation results in a mucus­producing cough that lasts at least three months. Coughing is worse in the morning. Symptoms often intensify over time, with breathlessness and wheezing. The best treatments for chronic bronchitis are quitting smoking and avoiding air pollutants. No herbal or conventional treatments can substitute for these two crucial steps.

DON'T TREAT THIS CONDITION AT HOME

Bronchitis is a matter for prompt medical attention if the following symptoms occur:

* You have severe chest pain

* You develop a fever over 38.9°C

* You cough up blood

* Your symptoms persist longer than four weeks

* Your symptoms worsen

TWO EASY LUNG-EASERS

Here are two old-fashioned strategies for loosening bronchitis.

* Drink a lot of liquids, especially water, teas, broths. This helps thin respiratory secretions and makes them easier to cough up. Warm liquids also help relax the airways.

* Steam inhalation also thins respiratory mucus and promotes expectoration (a fancy word for getting rid of that gunk in your chest). You can use a commercial steamer, steam room or a kettle of boiling water. For the latter, simply boil water, pour it carefully in a heat-resistant bowl and place it on a sturdy table. Cover your head with a towel and hold your face at least 30 centimetres from the steam so that it feels warm but not unpleasantly hot.

Herbal steams can be doubly helpful. Many herbs contain volatile oils that rise with the steam and have antiseptic, expectorant and airway-relaxing properties. Good choices include eucalyptus, thyme, peppermint and rosemary; use about a total of 4 tablespoons of herbs for every 1 litre of water. You can also add 3 to 5 drops of the essential oil of these herbs.

DRUG TREATMENT

Cough Suppressants

Dextromethorphan (Benylin Dry Cough, Day Nurse, many others); codeine (Boots Catarrh Cough Syrup); either of the above may be combined with decongestants or expectorants. Function: act directly on the cough centre in the brain. Dextrometborpban side effects: few when taken as directed but many people experience side effects from the decongestants in combination products. Codeine side effects: increased effects of central nervous system depressants such as alcohol, tranquillisers and many antidepressants; dizziness, drowsiness, headache, nausea, vomiting, stomach ache, constipation, over­excitement; can be habit-forming.

Expectorants
Guaienesin (Dimotane Expectorant, Robitussin, many others). Function: loosens respiratory secretions so they are more readily expelled in coughing.

Inhaled Bronchodilators
Salbutamol (Ventolin), fenoterol (Berotec), salmeterol (Serevent), terbutaline (Bricanyl). Function: relax smooth muscle encircling airways to widen their diameter, thus easing breathing. Side effects: nervous tension, headaches.

HERBAL REMEDIES

Liquorice (Glycyrrhiza glabra)
This root is a one-stop herb shop for bronchitis. It soothes mucous membranes and is expectorant, anti-inflammatory and directly antiviral. It also stimulates cells to produce interferon, the body's own antiviral compound.
Typical dosage: six 400- to 500-milligram capsules per day; or 20 to 30 drops of tincture up to three times per day; or 3 to 4 cups of tea per day (simmer 4 tablespoons of root in 450 millilitres of water for 10 to 15 minutes).
Caution: do not take for longer than six weeks. Do not use if you are pregnant or breast­feeding or if you have severe liver, kidney or heart disease, or high blood pressure. Do not use with diuretics that cause potassium loss.

Mullein (Verbascum thapsus)
If your cough is wet, mullein helps you expel mucus; if your cough is dry, it helps ease that rasping pain.
Typical dosage: 25 to 40 drops of tincture every three hours; or up to 6 cups of tea per day (steep 2 teaspoons of dried leaves and flowers in % litre of hot water for 10 to 15 minutes).

Marshmallow (Althaea officinalis)
An excellent mucous-membrane soother, marshmallow is a good choice for dry coughs. It also has a mild stimulating effect on the immune system.
Typical dosage: up to six 400- or 500-milligram capsules per day; or 20 to 40 drops of tincture up to five times per day; or 3 to 4 cups of tea per day (simmer 1 teaspoon of dried root in1/4 litre of water for 10 minutes). Or use marshmallow blended with other tea herbs (some people find its taste off-putting when used alone).

Plantain (Plantago lanceolata)
This herb has a strong reputation as a gentle cough suppressant, demulcent and antibacterial agent. The German Commission E, that country's counterpart to the Medicines Control Agency, endorses it as safe and effective for bronchial conditions.
Typical dosage: up to 6,000 milligrams in capsules per day; or up to 4 cups of tea per day (steep 2 teaspoons of dried leaf in 1/4 litre of boiling water for 10 to 15 minutes).

Garlic (Allium sativum)
This expectorant fights many bacteria and some of the viruses that cause flus and colds. Its aromatic oils are excreted through the lungs (which is why eating the bulb produces garlic breath). In the process, those oils act directly to kill micro-organisms and to help you cough up mucus.
Typical dosage: up to three 500- to 600-milligram capsules per day (look for products that deliver 4,000 micrograms of allicin daily); or 1 to 3 fresh garlic cloves per day (mince and eat raw, or crush and add to cooked foods just before serving).

Wild Black Cherry (Prunus serotina)
The bark of this tree inhibits the cough reflex. Although herbal cough suppressants tend to have a more subtle action than dextromethorphan and codeine, you should still use these natural alternatives only for dry, hacking coughs. You'll find wild cherry bark most often blended with other herbs in teas and syrups; follow the manufacturer's recommendations on dosage.
Caution: while black cherry bark is safe when used for short-term ailments at recommended dosages, it is not recommended for long-term use.

Thyme (Thymus vulgaris)
Expectorant, antispasmodic and antibacterial, thyme is endorsed by Commission E for treating bronchitis. It turns up in cough syrups and other blended liquid extracts. You can drink thyme tea and make a thyme steam to inhale (see 'Two Easy Lung-Easers').
Typical dosage: up to 4 cups of tea per day (steep 1 teaspoon of dried leaves in 1/4 litre of just-boiled water for 10 minutes).

Horehound (Marrubium vulgare)
You'll see horehound in both lozenge and syrup products on the shelves of health food stores; these products soothe sore throats and promote expectoration.
Typical dosage: up to 3 cups per day of tea (steep 2 teaspoons of dried leaves in 1/4 litre of hot water for 10 minutes); or take lozenges or syrup as the manufacturer recommends.

Peppermint (Mentha x piperita)
The menthol in peppermint relaxes the airways and fights bacteria and viruses. To make a herbal steam with peppermint, add 3 to 5 drops of the essential oil to 4 cups of just-boiled water.
Typical dosage: 1 cup of tea as needed (steep 2 teaspoons of dried leaves in 1/4 litre of hot water for 5 to 10 minutes); or 10 to 20 drops of tincture three or four times per day.

Hyssop (Hyssopus officinalis)
This bee-attracting herb is antiviral and expectorant; you can find it in syrups and liquid extracts.
Typical dosage: 10 to 40 drops of tincture up to four times per day; or 1 cup of tea as needed (steep 1 teaspoon of dried herb in 1/4 litre of hot water for 10 to 15 minutes).

Lobelia (Lobelia inflata)
Both the leaves and the seeds of this potent expectorant and anti­spasmodic are used.
Typical dosage: 20 to 30 drops of tincture three times per day. In America another common name for this plant is puke weed - and for good reason: even small doses can cause nausea or vomiting. For this reason, it may be best to purchase a blended product containing this herb and follow the manufacturers instructions, or consult a qualified practitioner for instructions on using it.
Caution: do not use if you are pregnant or have heart conditions.

Echinacea (Echinacea angustifolia, E. purpurea, E. pallida)
This herb stimulates white blood cell activity, increases the body's production of antiviral substances such as interferon, and helps immune cells engulf and destroy invading microbes. It combats some of the viruses that commonly cause bronchitis.
Typical dosage: up to nine 300- to 400-milligram capsules per day (taken in several doses); or up to 60 drops of tincture three times per day. Most herbalists agree that you should take echinacea for no more than two weeks, then discontinue it for one week.
Caution: not recommended for people with multiple sclerosis, HIV infection or other autoimmune disease. Rarely, people with allergies to other members of the daisy family may also be allergic to echinacea.