Acute Bronchitis Flashcards
Acute Bronchitis Definition
Inflammation of the large bronchi (medium-size airways) in the lungs that is usually caused by viruses or bacteria and may last several days or weeks.
Etiology of Acute Bronchitis
Viral 80-90% of cases
The same viruses that cause URI’s
Bacteria (10-20%)
Common viruses that cause acute bronchitis?
5
- Coronavirus
- Rhinovirus
- Respiratory Syncytial virus
- Adenovirus
- Influenza A and B
Common bacteria that cause acute bronchitis?4
- Strep Pneumoniae
- Haemophilus infuenza
- Chlamydia pneumoniae:
College students & Military - Mycoplasma pneumoniae: College students & Military
Other less common causes of acute bronchitis?
Why is this important to find out?
Whooping Cough: Bordetella pertussis (Bacteria)
The illness can still develop in those who were vaccinated.
YOU ARE OBLIGATED TO RULE THIS OUT
Pathophysiology: Inflammation of the bronchial wall. What does this
cause?
Increased mucous production along with edema of the bronchus
When does the infection clear?
But how long can the disease process last?
Infection clears in several days but the repair of the bronchial wall may takes several weeks
Half of all patients continue to cough for 3-6 weeks due to the period of “repair”
Pulmonary function studies (if done) demonstrate what?
bronchial obstruction similar to asthma but as symptoms abate, pulmonary function returns to normal
- Clinical Features: ______ is the hallmark of a lower respiratory tract infection
Symptoms usually begin ______after an URI such as a cold or influenza
What are the symtpoms? 6
- Cough!!!!!!!!!!
3-4 days
- fever
- cough
- malaise
- pleuritic chest pain
- hoarseness
- wheezing
Describe how the following symtpoms will present in acute bronchitis?
- Fever:
- Cough
- Color?
- Sputum?
- When is it worse? - Malaise?
- Chest pain?
- usually mild and less than 101 degrees F
- Main symptom of bronchitis. May be non productive initially and after a few days becomes productive. May keep awake at night or worsen when lies down
Streaks of blood
Clear, yellow or green - general feeling of tiredness
- Sensation of tightness,
burning or dull pain in the chest that is worse when breathing deeply or coughing
How should the patient appear? 3
What do we HAVE to rule out?
2
- Should not appear “toxic”
- Coughing during the exam
- Pulmonary exam (auscalation, percussion skills. look in oropharynx/edema in the legs)
Pneumonia
Whooping cough
THINGS THAT COULD KILL THEM
Why would we consider orthostatic BP in an acute bronchitis pt?
make sure that patient is not dehydrated
Important aspects of the evaluation in the patient’s history?
9
- Duration of symptoms
- Associated symptoms
- Any underlying lung disease?
- Smoking (cigarettes, e-cigs, pipe, cigar, marijuana, etc.)
- When was the last time they were on antibiotics for this?
- How many times a year do they get this?
- Any chronic illness that may result in immune compromise?
- Immunization history
- Ill contacts
What are examples of underlying lung disease that would put acute bronchitis pts at higher risk of more severe disease?
4
If they have any of these what do we want to highly consider?
- COPD,
- emphysema,
- asthma,
- bronchiectasis, etc.
antibiotics
When is a CXR Needed in acute bronchitis pts?
4
- Patient is particular unwell
- Patient is particularly prone to pneumonia due to underlying disease, age or alcoholism
- History of pneumonia
- Tobacco use
Management of acute bronchitis in patients that dont have increased risk factors? 2
And what does this help with?
- Patient education
- Fluids
Keeps secretions into the bronchial tubes less viscous and easier to expel by coughing.
Acute Bronchitis Management can be broken into 2 categories:
- Symptom management
2. Antibiotic therapy
Symptom Management
3
Antitussives
Expectorants
Inhalers
What are the Antitussive therapies? 2
Expectorants? 1
Inhalers? 1
Antitussives
- Codeine, dextromethorphan or hydrocodone cough syrup
- Tessalon perles
Expectorants
1. Guifenisen (Mucinex)
Inhalers
If wheezing, may be beneficial
1. Albuterol (Ventolin) MDI, 2 puffs 4-6 hours prn
What are the combined cough suppressant therapies?
3
- Guaifenesin syrup with codeine
- –Get the expectorant along with cough suppression - Phenergan with codeine
- DM (Robitussin/Guaf with DM available OTC)
Types of inhalers that we would use?
How does it work?
SE?
Instruct on proper technique. Describe this.
- B2 agonists
Albuterol
2 puffs every 4-6 hrs prn wheezing
Bronchodilation
Improve ciliary clearance
Can make very shaky or nervous
Hold inhaler approximately two finger widths from the mouth and breath out completely then breath in slowly and administer. Using a SPACER is always highly recommended.
If pertussis is expected treat with what?
Macrolide
Any of the following: Presents as “ill” Hypoxia Concern for pneumonia Fever Tachypnea Tachycardia Evidence of consolidation on PE
Yes?
No?
Yes?
CXR to R/O pneumonia (PNA)
No?
Chronic lung disease?
Dont have chronic lung disease?
Do have it?
Yes: Antibiotic therapy
No: Ask if they are Immunocomprimsed
If they pt is immunocomprimised?
If not?
Consider antobiotic treatment
Just treat symptoms
Moderate ABECB* and/or any one of the following: age less than 65 years, FEV1 >50% predicted, no cardiac disease, or less than 3 exacerbations per year:
7 treatment types
What happens if they had recent antibiotic exposure in that last three months?
- Azithromycin 500 mg PO on first day then 250 mg PO daily for next 4 days or
- Clarithromycin 250-500 mg PO BID for 7-14 days or
- Doxycycline 100 mg PO BID for 7 days or
- Trimethoprim-sulfamethoxazole (160 mg/800 mg) 1 DS tablet PO BID for 10-14 days or
- Cefuroxime 250-500 mg PO q12h for 10 days or
- Cefdinir 300 mg PO BID for 5-10 days or
- Cefpodoxime 200 mg PO q12h for 10 days
If recent antibiotic exposure within 3 months, use alternative class.
*ABECB: Acute bacterial exacerbation of chronic bronchitis
Severe ABECB and/or anyone of the following: age ≥65 years, FEV1 less than or equal to 50% predicted, cardiac disease, or ≥3 exacerbations per year:
6 treatment types
If recent antibiotic exposure within 3 months?
- Consider hospitalization.
- Amoxicillin-clavulanate (875 mg/125 mg) 1 tablet PO BID for 7-10 days or
- Levofloxacin 500 mg PO daily for at least 7 days or
- Gemifloxacin 320mg PO daily for 5 days or
- Moxifloxacin 400 mg PO daily for 5 days
- If at risk for Pseudomonas infection consider sputum culture and treatment with ciprofloxacin 500-750 mg PO BID for 7-14 days.
use alternative class.
What about ICS for the airway inflammation? 2
Oral steriod use?
who 2
- High dose inhaled corticosteroids may be of benefit short term but not for every patient
- May be able to prevent asthma exacerbation by increasing ICS X 1 month
Likely will need oral steroid burst for patients who have an exacerbation of
- chronic bronchitis or an
- asthma exacerbation secondary to acute bronchitis
