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Q: I'm 55 years old and have had bronchitis once a year for few years now. This year I've had it twice. I've been a smoker for almost 40 years. My doctor keeps telling me that I don't need antibiotics. What do you think?

-- M.P., Houston

A: With your smoking history, you may be fortunate to have had so few problems with bronchitis so far. But I'm afraid that it will probably get worse in the future unless you stop smoking.

The term bronchitis has two meanings that are similar but make a big difference in understanding what medical treatment to recommend. There also has been a great deal of controversy about the best treatment, regardless of the definition used.

Bronchitis may simply mean an inflammation, for whatever reason, of the lining of the tubes (bronchi) that carry air in and out of the lungs. But in practice, the term is often limited to a cough that produces sputum that appears to be infected.

It's also important to understand that the approach to treatment depends on whether the bronchitis is acute (short-lived) or chronic. For bronchitis to be considered chronic, you would cough for at least three weeks twice in each of the past two years.

Many causes of bronchitis exist, including irritants in the air and infections. When an infection is the underlying cause, it is almost always caused by a virus. However, bacteria may be the initial cause or may become a secondary problem. Unfortunately, many of the bacteria in question are normally found in the sputum so it's hard to make that determination.

As you probably know, standard antibiotics only work against bacteria. And antibiotics may cause negative side effects in you, including the possibility of creating bacteria that are resistant to bacteria.

That's why your doctor, along the lines of many experts treating bronchitis, did not routinely recommend the use of antibiotics for bronchitis. A review of the medical literature in a recent issue of the Journal of Family Practice indicated that this is a reasonable approach.

The research showed that some people treated with antibiotics did lose their cough a little quicker and their sense of feeling ill went away a little faster. But they also had a significant number of adverse reactions to the antibiotics.

The researchers in the above article found that antibiotics seemed to be a better recommendation if a person was older than 55, appeared more ill and did not have a runny nose or sore throat.

I'm sorry if my explanation may be a bit confusing, but as you can see, medical science is a bit confused as well. But it's clear that the best approach for your acute bronchitis is to quit smoking as soon as you can.

Even more importantly, I would predict that if you continue to smoke, after a few years, you will get bronchitis and it will last for longer periods of time. At that time, you will be diagnosed with chronic bronchitis and emphysema.

These conditions are not only characterized by coughing up purulent sputum for weeks at a time several times a year, but you could also expect to have recurrent bouts of pneumonia.

And as your lungs get worse over time, you would also expect to have greater and greater difficulty breathing. This will lead to fatigue and greatly limit what you are able to do.

However, if you quit smoking now -- even after 40 years -- you will find over the next five years that you will have a very good chance of stopping or greatly slowing down the deterioration process.

Please ignore the increased cough you will get for a few weeks after smoking cessation. It means that nicotine's anesthetic effect on the lining of your bronchi is being removed.

Dr. Allen Douma welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, Ill. 60611. His e-mail address is

This column is for informational and educational purposes only. It is not intended to provide medical advice or take the place of consultation with a doctor or other health-care provider.

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