Acute Bronchitis Flashcards
Define acute bronchitis
Infection and Inflammation of the trachea and major bronchi (LRTI) but not of the lung parenchyma - oedematous large airways and production of spututm
Self limiting in nature - short term
Typically viral
What is the relevant epidemiology of acute bronchitis?
Peak 50-60yrs
Ten times more common than pnuemonia
80% of episodes occur in winter or autumn.
What are the typically symptoms of acute bronchitis?
Cough - may be productive
Sore throat
Rhinorrhoea
Wheeze
May also have a low grade fever
How does acute bronchitis appear on examination?
Patient may have a normal chest examination
Wheeze
Rhonchi - snoring like sound cleared on coughing
Prolonged expiration - due to bronchial obstruction
What investigations should be done for acute bronchitis?
Is typically a clinical diagnosis
However, if CRP testing is available this could be used to determine if antibiotics are needed.
Bedsice - resp viral swab, spututm culture
Bloods - CRP
Imaging - CXR (rule out pneumonia)
What are some key ways to differentiate between acute bronchitis and pneumonia?
History - wheeze, sputum and breathlessness - more common in pneumonia
Exam - no focal chest signs (dullness, crepitation, bronchial breathing) in bronchitis.
Pneumonia has more systemic features - malaise, myalgia and fever
How is acute bronchitis managed conservatively?
Good fluid intake
Reassurance and safety netting - seek medical help is worsen or not improved in 3/4w
Self care - lozenges or honey
Advise smoking cessation
At what CRP values should antibiotics be offered for acute bronchitis?
20-100mg/L offer a delayed prescription
>100mg/L offer immediateley
What is the prognosis for acute bronchitis?
Usually resolves before 3 weeks
However 25% of patients will still have a cough beyond this time.
Recurrence is common especially in patients who smoke
What are the risk factors for acute bronchitis?
Smoking
Age - very young or very old
Lung disease - COPD or asthma
Exposure to infections - COVID-19 or flu
Irritants - dust, fumes, air pollution or tobacco smoke
Malnutrition
Reflux - irritate throad and increase risk
What are the common causes of acute bronchitis?
Mjaority are viral - rhinovirus, coronavirus, adenovirus
Bacteria may cause up to 10% of cases - streptococcus pneumonia, H.Influenza, Moraxella catarrhalis.
How is acute bronchitis managed medically?
Analgesia - paracetamol
Consider antibiotics is systemically unwell, pre-exisintg co-morbidities, dependent on CRP value.
First line - doxycycline 5/7(not in children or pregnant women) alternative is amoxicillin.
What are some complications of acute bronchitis?
Pneumonia - esp in vulnerable, edlerly, frail or immunosuppressed
Persistent cough - over a month in 25%, up to 6m in ‘post bronchitis syndrome’