Acute Bronchitis

Question 1

What is acute bronchitis?

Answer 1

Acute bronchitis is a self-limiting Lower Respiratory Tract Infection (LRTI), characterised by inflammation of the bronchi, from the primary to tertiary bronchus.

Question 2

What is the epidemiology of acute bronchitis?

Answer 2

The highest incidence of acute bronchitis occurs in smokers and is more common in autumn and winter than in spring and summer.

Question 3

What triggers the pathophysiology of acute bronchitis?

Answer 3

Microorganisms trigger inflammation of bronchial mucosa.

Question 4

What are the common viral infections that cause acute bronchitis?

Answer 4

Commonly caused by viral infections include Influenza, Respiratory Syncytial Virus (RSV), coronavirus, and rhinovirus.

Question 5

What are typical bacterial infections associated with acute bronchitis?

Answer 5

Typical bacterial infections include Moraxella, Strep pneumoniae, and Staphylococcus aureus.

Question 6

What are atypical bacterial infections that can cause acute bronchitis?

Answer 6

Atypical bacterial infections include Mycoplasma pneumoniae, Bordetella pertussis, and Chlamydia.

Question 7

What is the presentation of acute bronchitis?

Answer 7

Acute bronchitis is a lower respiratory tract infection characterized by a productive cough that can produce yellow/green phlegm.

Question 8

What are the structures involved in upper respiratory tract infections?

Answer 8

Nasal cavity: Rhinitis
Sinuses: Sinusitis
Pharynx: Pharyngitis
Larynx: Laryngitis
Tonsils: Tonsillitis
Epiglottis: Epiglottitis
Opening of auditory tube (middle ear): Otitis media

Question 9

What are the typical symptoms of upper respiratory tract infections?

Answer 9

Headaches, sneezing, sore throat, runny nose

Question 10

What is the typical duration of upper respiratory tract infections?

Answer 10

1-2 weeks

Question 11

What is the prognosis for upper respiratory tract infections?

Answer 11

Usually shorter and more mild

Question 12

What are the complications of upper respiratory tract infections?

Answer 12

Respiratory failure, meningitis, sepsis

Question 13

What are the structures involved in lower respiratory tract infections?

Answer 13

Trachea: Tracheitis
Bronchi: Bronchitis
Bronchioles: Bronchiolitis
Lungs and alveoli: Pneumonia

Question 14

What are the hallmark features of lower respiratory tract infections?

Answer 14

Productive cough, dyspnea or tachypnea, wheezing, blue skin tint due to oxygen deficit, chest pain, fever

Question 15

What is the typical duration of lower respiratory tract infections?

Answer 15

1-3 weeks

Question 16

What is the prognosis for lower respiratory tract infections?

Answer 16

Usually longer and more severe

Question 17

What are the complications of lower respiratory tract infections?

Answer 17

Respiratory failure, pulmonary emboli, empyema, bacteraemia, lung abscess, brain abscess, death

Question 18

What is the investigation for acute bronchitis?

Answer 18

Serology and cultures to identify microorganism, serum procalcitonin level, nasopharyngeal swab, sputum test, and chest X-ray.

Question 19

What does a high serum procalcitonin level indicate?

Answer 19

It is a marker of bacterial infection; the higher it is, the more likely that acute bronchitis is due to bacterial infection.

Question 20

What microorganisms can be identified with a nasopharyngeal swab?

Answer 20

Bordetella pertussis, mycoplasma pneumoniae, and chlamydia.

Question 21

What is the typical course of acute bronchitis?

Answer 21

Usually self-limiting within 1-3 weeks.

Question 22

What self-care treatments are encouraged for acute bronchitis?

Answer 22

Stop smoking, honey, and over-the-counter cough medicines.

Question 23

When should oral antibiotics be prescribed for acute bronchitis?

Answer 23

Only if the patient is systemically very unwell or at high risk of complications.

Question 24

What is the first-line antibiotic for patients aged 18 and over?

Answer 24

Doxycycline.

Question 25

What are the second-line antibiotics for patients aged 18 and over?

Answer 25

Erythromycin (pregnancy-safe), azithromycin, clarithromycin, amoxicillin (pregnancy-safe).

Question 26

What is the first-line antibiotic for patients aged 12-17?

Answer 26

Amoxicillin.

Question 27

What are the second-line antibiotics for patients aged 12-17?

Answer 27

Erythromycin, clarithromycin, azithromycin, doxycycline.