Acute Bronchitis

Question 1

Acute Bronchitis

• aka
• what is it?
• what causes this?

Answer 1

• aka: chest cold
• inflamm of large bronchi (medium sized airways) in the lungs

-what causes this: virus (80-90%) or bacteria

Viruses: coronavirus, rhinovirus, RSV, adenovirus, influenza A & B
Bacteria: strep pneumo, h flu, chlamydia pneumoniae, mycoplasma pneumoniae
*less common cause if whooping cough

Question 2

Bronchitis:

• pathophysiology
• duration of dz

Answer 2

pathophys: increased mucous production along with edema of the bronchus

Duration: infection clears in several days but the repair of the bronchial wall takes several weeks. Inflammatory post infectious state, the insult to the airway continual sluffing of the airway epithelium is why it takes 6weeks to get back to normal.

Question 3

Do we do PFT for bronchitis?

Answer 3

you dont really need to do them, but if you did they would come up with an obstructive pattern d/t edema, after they clear the infection they go back to normal.

Question 4

Bronchitis Sx

Answer 4

sx begin 3-4 days after URI sx.

• fever
• cough*** (non productive initially, becomes productive; yellow/green/streaked with blood)
• malaise
• tightness, burning, dull chest pain worse when breathing deeply
• hoarseness
• wheezing

Question 5

Dx of Acute Bronchitis

Answer 5

• H&P
• Appearance:
• -not toxic
• -coughing during exam
• -pulmonary exam
• -VS normalish

Question 6

Pt recently treated with abx for acute bronchitis, now they are having new infection of bronchitis; how do you treat them?

Answer 6

make sure to find out what they were treated with previously to ensure you choose a new abx for this infection.

Question 7

When is a CXR needed in Acute Bronchitis?

Answer 7

• normally you dont need one
• patient is prone to pneumonia d/t underlying disease, age, or alcoholism,
• swallowing disorders
• hx of pneumona
• tobacco use?

Question 8

Management of Acute Bronchitis

Answer 8

• Fluids (keeps secretions less viscous and loose)
• patient education (long duration)

Symptom Management:

• ANtitussives: codeine, dextromethorphan or hydrocodoen cough syrup, Tessalons perles (numb the airway reflexes)
• Expectorants: Guifenisen (Mucinex)
• Inhaler: B2 Agonist: albeuterol, ICS (not for everyone)
• Oral steroid burst for pt w/ exacerbation of chronic bronchitis or asthma 2ndry to bronchitis.

Question 9

If pertussis is suspected what do you treat with?

Answer 9

macrolide abx

Question 10

Algorithm of Acute Bronchitis Tx

Answer 10

Any of the following sx:

• “ill”
• hypoxia
• concern for pneumona:
• -fever
• -tachypnea
• -tachycardia
• -evidence of consolidation on PE…….Go to 1 or 2.
  1. A)*if NO…….chronic lung dz?…..if NO…….immunocompromise??…..if yes…ABX!!
  1. B) if NO…..chronic lung dz?…if NO….immunocompromised?…if NO….symptomatic tx.
  1. C) if NO…chronic lung dz?…if YES….Abx!!!

2. A) if YES…. CXR R/O PNA…if +pneumo….Rx PNA
3. B) if YES…..CXR R/O PNA……if -pneumo….ABX!

Question 11

Abx Options for moderate Acute Bacterial exacerbation of chronic bronchitis (ABECB) for:
1.)less than 65yrs, FEV1 greater than 50% predicted, no cardiac dz, less than 3 exacerbations/year

2.)greater/= 65, FEV1 less than/= 50% predicted, cardiac dz, greater than/= 3 exacerbations/year

Answer 11

1.) Azithromycin*
Clarithromycin
Doxycycline*
Bactrim/Sulfa
Cefuroxime
Cefdinir
Cefpodoxime

• if recent abx exposure within 3 mo use alternative class.
• for COPD who have acute exacerbation of chronic bronchitis or your asthmatics/DM if they are sick enough

2.) AMoxicillin-Clavulanate 
Levofloxacin
Gemifloxacin
Moxifloxacin 
*if at risk for pseudomonas consider sputum culture and tx w/ ciprofloxacin
*these are the heavier duty abx