Acute Bronchitis

Question 1

Acute Bronchitis Definition

Answer 1

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.

Question 2

Etiology of Acute Bronchitis

Answer 2

Viral 80-90% of cases
The same viruses that cause URI’s

Bacteria (10-20%)

Question 3

Common viruses that cause acute bronchitis?

5

Answer 3

1. Coronavirus
2. Rhinovirus
3. Respiratory Syncytial virus
4. Adenovirus
5. Influenza A and B

Question 4

Common bacteria that cause acute bronchitis?4

Answer 4

1. Strep Pneumoniae
2. Haemophilus infuenza
3. Chlamydia pneumoniae:
   College students & Military
4. Mycoplasma pneumoniae: College students & Military

Question 5

Other less common causes of acute bronchitis?

Why is this important to find out?

Answer 5

Whooping Cough: Bordetella pertussis (Bacteria)

The illness can still develop in those who were vaccinated.

YOU ARE OBLIGATED TO RULE THIS OUT

Question 6

Pathophysiology: Inflammation of the bronchial wall. What does this
cause?

Answer 6

Increased mucous production along with edema of the bronchus

Question 7

When does the infection clear?

But how long can the disease process last?

Answer 7

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”

Question 8

Pulmonary function studies (if done) demonstrate what?

Answer 8

bronchial obstruction similar to asthma but as symptoms abate, pulmonary function returns to normal

Question 9

1. 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

Answer 9

1. Cough!!!!!!!!!!

3-4 days

• fever
• cough
• malaise
• pleuritic chest pain
• hoarseness
• wheezing

Question 10

Describe how the following symtpoms will present in acute bronchitis?

1. Fever:
2. Cough
   - Color?
   - Sputum?
   - When is it worse?
3. Malaise?
4. Chest pain?

Answer 10

1. usually mild and less than 101 degrees F
2. 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
3. general feeling of tiredness
4. Sensation of tightness,
   burning or dull pain in the chest that is worse when breathing deeply or coughing

Question 11

How should the patient appear? 3

What do we HAVE to rule out?
2

Answer 11

1. Should not appear “toxic”
2. Coughing during the exam
3. Pulmonary exam (auscalation, percussion skills. look in oropharynx/edema in the legs)

Pneumonia
Whooping cough
THINGS THAT COULD KILL THEM

Question 12

Why would we consider orthostatic BP in an acute bronchitis pt?

Answer 12

make sure that patient is not dehydrated

Question 13

Important aspects of the evaluation in the patient’s history?
9

Answer 13

1. Duration of symptoms
2. Associated symptoms
3. Any underlying lung disease?
4. Smoking (cigarettes, e-cigs, pipe, cigar, marijuana, etc.)
5. When was the last time they were on antibiotics for this?
6. How many times a year do they get this?
7. Any chronic illness that may result in immune compromise?
8. Immunization history
9. Ill contacts

Question 14

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?

Answer 14

1. COPD,
2. emphysema,
3. asthma,
4. bronchiectasis, etc.

antibiotics

Question 15

When is a CXR Needed in acute bronchitis pts?

4

Answer 15

1. Patient is particular unwell
2. Patient is particularly prone to pneumonia due to underlying disease, age or alcoholism
3. History of pneumonia
4. Tobacco use

Question 16

Management of acute bronchitis in patients that dont have increased risk factors? 2

And what does this help with?

Answer 16

1. Patient education
2. Fluids
   Keeps secretions into the bronchial tubes less viscous and easier to expel by coughing.

Question 17

Acute Bronchitis Management can be broken into 2 categories:

Answer 17

1. Symptom management

2. Antibiotic therapy

Question 18

Symptom Management

3

Answer 18

Antitussives
Expectorants
Inhalers

Question 19

What are the Antitussive therapies? 2

Expectorants? 1

Inhalers? 1

Answer 19

Antitussives

1. Codeine, dextromethorphan or hydrocodone cough syrup
2. Tessalon perles

Expectorants
1. Guifenisen (Mucinex)

Inhalers
If wheezing, may be beneficial
1. Albuterol (Ventolin) MDI, 2 puffs 4-6 hours prn

Question 20

What are the combined cough suppressant therapies?

3

Answer 20

1. Guaifenesin syrup with codeine
   - –Get the expectorant along with cough suppression
2. Phenergan with codeine
3. DM (Robitussin/Guaf with DM available OTC)

Question 21

Types of inhalers that we would use?

How does it work?

SE?

Instruct on proper technique. Describe this.

Answer 21

1. 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.

Question 22

If pertussis is expected treat with what?

Answer 22

Macrolide

Question 23

Any of the following:
Presents as “ill”
Hypoxia
Concern for pneumonia
Fever
Tachypnea
Tachycardia
Evidence of consolidation on PE

Yes?
No?

Answer 23

Yes?
CXR to R/O pneumonia (PNA)

No?
Chronic lung disease?

Question 24

Dont have chronic lung disease?

Do have it?

Answer 24

Yes: Antibiotic therapy
No: Ask if they are Immunocomprimsed

Question 25

If they pt is immunocomprimised?

If not?

Answer 25

Consider antobiotic treatment

Just treat symptoms

Question 26

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?

Answer 26

1. Azithromycin 500 mg PO on first day then 250 mg PO daily for next 4 days or
2. Clarithromycin 250-500 mg PO BID for 7-14 days or
3. Doxycycline 100 mg PO BID for 7 days or
4. Trimethoprim-sulfamethoxazole (160 mg/800 mg) 1 DS tablet PO BID for 10-14 days or
5. Cefuroxime 250-500 mg PO q12h for 10 days or
6. Cefdinir 300 mg PO BID for 5-10 days or
7. 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

Question 27

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?

Answer 27

1. Consider hospitalization.
2. Amoxicillin-clavulanate (875 mg/125 mg) 1 tablet PO BID for 7-10 days or
3. Levofloxacin 500 mg PO daily for at least 7 days or
4. Gemifloxacin 320mg PO daily for 5 days or
5. Moxifloxacin 400 mg PO daily for 5 days
6. 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.

Question 28

What about ICS for the airway inflammation? 2

Oral steriod use?
who 2

Answer 28

1. High dose inhaled corticosteroids may be of benefit short term but not for every patient
2. 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

1. chronic bronchitis or an
2. asthma exacerbation secondary to acute bronchitis