How do we treat bronchitis and pneumonia in the athlete?

Respiratory tract infections are the most common types of illness affecting athletes. Pathogenic organisms (viruses, bacteria, fungus) can colonize any portion of the respiratory tract causing a range of nonspecific symptoms, from mild nasal congestion to serious systemic illness. If severe enough, these types of infections can have a detrimental effect on athletic performance and, in turn, rigorous exercise can hamper your immune system’s ability to fight infection. Activities that require close contact with others or be in close quarters with other athletes increase the chance that an individual will “catch” an infection. Some athletes may be at increased risk due to the physical and psychological stress associated with high levels of competition. Additionally, athletes that have pre-existing conditions (i.e. asthma, chronic illness, immunosuppressed) also have an increased chance of acquiring infections.

Distinguishing between bronchitis and pneumonia is vital to proper treatment and resolution of symptoms. Features of bronchitis include cough with or without wheezing that is usually preceded by upper respiratory symptoms (congestion, headache, sore throat) for a few days. Symptoms are usually self-limited but can last for up to 1-3 weeks. The diagnosis is made clinically by symptom history and physical exam. Treatment typically involves rest, cough suppressants, non-steroidal anti-inflammatory drugs, and possibly oral antibiotics. Pneumonia, on the other hand, typically presents as a more severe cough with shortness of breath, chest pain with breathing, and systemic symptoms such as fever, chills, and general malaise or fatigue. Your healthcare provider may order a chest x-ray and blood work to further characterize the severity of your illness and determine whether you require hospital admission for more aggressive treatment.

After you have been diagnosed and begun treatment for your respiratory infection, it is important to understand how and when to return to your regular exercise or athletic routine. If symptoms are primarily above the neck (upper respiratory), those with mild infections can continue as long as they feel able to perform but should stay well-hydrated and cease activity if symptoms worsen. Begin with 10-15 minutes of light exercise and continue as tolerated. Should symptoms below the neck (lower respiratory, fever, malaise, gastrointestinal upset) persist, refrain from activity until you are without fever, off anti-fever medications and/or antibiotics for 24 hours, and feel physically ready to perform. Your return-to-exercise routine should be gradual. As a general rule-of-thumb, for every day of exercise you missed due to illness, give yourself 2-3 days of graded return. You should aim to increase the frequency of activity first, then its duration, and finally its intensity. To avoid over exertion early on, limit your intensity increments to 10% at a time. Of course, stay well-hydrated and maintain a balanced diet to optimize your immune function.

Preventative measures should be taken to make sure you or other athletes do not acquire an infection in the first place. Hand hygiene is paramount to preventing contact spread of germs in any setting, especially in athletic venues where close contact with others’ is the norm. Avoid sharing personal items with other athletes and clearly label your equipment. If you are known to be contagious, try your best to avoid direct contact with others and wear a face mask if being around others is unavoidable. All athletes should be up-to-date with their vaccinations, including the annual flu vaccine and pneumococcal vaccine (if appropriate, click here for more information). Finally, make sure to take your recovery time as seriously as your training to avoid overtraining and decreased immune function.

 

References:

Jaworski CA, Donohue B, Kluetz J. Infectious disease. Clin Sports Med 2011; 30:575.

Wenzel RP, Fowler AA 3rd. Clinical practice. Acute bronchitis. N Engl J Med 2006; 355:2125.

Musher DM, Thorner AR. Community-acquired pneumonia. N Engl J Med 2014; 371:1619.

Metz JP. Upper respiratory tract infections: who plays, who sits? Curr Sports Med Rep 2003; 2:84.