Acute bronchitis (1A) Flashcards
What is acute bronchitis?
An infection of the bronchi (the large airways) - LRTI
It is common and is usually due to infection with a virus
Infection with a bacteria is a less common cause
What symptoms usually present with acute bronchitis?
Cough +/- sputum production, SOB, wheeze
What are examination findings in acute bronchitis?
- mildly ill
- bilateral wheeze
- rhonchi (may improve on coughing)
- low-grade fever
When do the majority of acute bronchitis cases occur?
80% occur in autumn or winter
What would be seen in CXR for acute bronchitis
Nothing - CXR would be clear
CXR is not usually indicated except to rule out pneumonia is diagnosis is unclear
When are antibiotics indicated in acute bronchitis?
Antibiotics ONLY if:
1) systemically unwell
2) CRP >100mg/L
3) pre-existing conditions
heart, lung, kidney, liver or neuromuscular disease, immunosuppression or cystic fibrosis
4) >80 (with 1 of following) or >65 (with 2 of following):
- hospitalisation in past year
- oral corticosteroids
- diabetic
- history of HF
When is a delayed antibiotic prescription indicated in acute bronchitis?
if CRP 20-100mg/L - offer delayed prescription of antibiotics
A 28 year old female presents to the GP and you suspect acute bronchitis. Her past medical hx consists of cystic fibrosis. She is not pregnant. You advise self care and smoking cessation.
(A) What is your management plan for her?
(B) How would you management plan change if she was pregnant?
(C) How would your management plan change if she was <18 years old
(A) antibiotic - doxycycline
(B) Amoxicillin if pregnant
(C) Amoxicillin if <18yrs
NOTES:
18 or older - doxycycline
<18 OR pregnant then amoxicillin
A 67-year-old female attends the emergency department with a 3-week history of cough productive of clear sputum and intermittent low-grade fever. She denies shortness of breath, chest pain, weight loss or haemoptysis. She has no history of respiratory illness, but takes metformin for type 2 diabetes and has a 25-pack-year smoking history. She has no known drug allergies.
A chest x-ray is performed in the emergency department which is normal.
Blood tests are taken which show:
Hb: 140 g/L (normal)
WBC: 7.8 * 109/L (normal)
CRP: 108 mg/L (< 5)
What is the most appropriate management plan?
(A) Supportive
(B) Amoxicillin
(C) Doxycycline
(D) Clarithromycin
(C) Doxycycline
An 82-year-old man presents to his GP with a three-day history of a cough productive of green sputum and shortness of breath. On examination, rhonchi are present. Observations are stable.
The GP suspects acute bronchitis.
The patient has a history of type 2 diabetes, managed with metformin and heart failure, for which he takes ramipril, bisoprolol, and furosemide.
What is the most appropriate management?
(A) IV co-amoxiclav
(B) Inhaled salbutamol
(C) Oral doxycycline
(D) Oral flucloxacillin
(E) Supportive care
(C) Oral doxycycline
How is doxycycline prescribed for acute bronchitis?
DAY 1 > 200mg OD
DAY 2-5 > 100mg OD
(5-day course in total)
