Acute Bronchitis Flashcards
What is another term for acute bronchitis
Tracheobronchitis
*lower respiratory tract infecon
What is acute bronchitis
- Acute inflammation of the trachea and bronchi
*self limited
*diagnosed clinically
What usually causes acute bronchitis
Viral etiology (85 to 95% of cases)
*definitive cause is unknown
What can help providers determine the source of the pathogen
- Presence of epidemics
- Time of year
- Populations vaccination status
Do people usually receive ATB for their acute bronchitis
Yes
*do not give ATB bc it is usually viral in nature
*giving ATB will lead to resistance
When is there a higher occurrence of acute bronchitis
- Late fall and winter
What are the viral causes of AB (90% off all cases)
- Adenovirus
- Influenza A B
- Parainfluenza
- Coronavirus type 1 and #
- Rhinovirus
- RSV
- Human metapneumovirus
- COVID-19
What are the bacterial causes of AB (Only 10% of the cases)
- Streptococcus pneumonia
- Haemophilus influenza
- Moraxella catarrhalis
- Bordetella pertussis
- Mycoplasma pneumonia
- Chlamydia pneumoniae
What patient population usually has a bacterial cause of AB
- Patients who have co-morbidities
*AB caused by bacterial is rare in heathy adults
What is the cardinal symptom of AB
- Non productive or productive cough greater than a week (min 5 days)
What are some other symptoms of AB
- Mild fever
- Malaise
- Fatigue
- Wheezing
- Dyspnea
- Nasal congestion
- Sore throat
- Chest wall tenderness (muscle strain from coughing)
What will be on the PE of a patient with AB
- Wheezing and rhonchi may be present
- No consolidation or rales
What are some other clinical manifestations of AB
- Purulent sputum
*reported in 50% of patients with AB
Why does purulent sputum occur in AB
- Sloughing of cells from the tracheobronchial epithelium along with inflammatory cells
- Purulent sputum in a suspected AB case does NOT signify bacterial infection and the need for ATB
What should you keep in mind when a patient has Ssx of URI/VR or AB
- You may not be able to distinguish from URI/RV From AB in the first few days
*high possibility when the cough persists over >5 days, no improvement or worsening (AB)
What are the DDx of AB
- Pneumonia
- PND
- GERD
- Asthma
- ACE inhibitor use
- Heart failure
- Lung cancer
What are some scenarios where it is not AB
- Patient presents with severe cough, fever, sputum production and other significant constitutional symptoms (flu or pneumonia)
- PE has signs of parenchyma consolidation or pleural inflammation (pulmonary disease beyond the bronchi)
How to make the diagnosis for AB
- Can be made solely asked on the H &P
*further testing is not needed
When can ATB be used for AB
- Only in patients with highly suspected bacterial pathogens or immunocompromised, elderly, COPD, those unresponsive patients
- paroxysm of cough with an inspiratory whoop
*first line is macrolides (Emycin, clarithromycin, Azithromycin)
Do antihistamines work against AB
- Weak or no evidence
Can inhaled corticosteroids work for AB
- Can be used if wheezing is present, but typically not used
What are some symptomatic treatment (supportive care) options for AB
- Cough suppressants
*throat lozenges, hot tea, honey - Mucolytics (helps break down mucous component)
- Acetaminophen, ibuprofen
- Cough drops
- Rest, fluids
What are some things to avoid with AB
- Avid dairy products, ETOH, caffeine (make the sputum thicker)
- Avoid exposure to smoke, air pollutants
What are some red flags to watch out for with AB
- Coughing up blood
- Difficult swallowing