Acute bronchitis Flashcards
What are the most common presenting complaints in clinics?
- URI and LRIs
Definition of acute bronchitis?
- inflammation of large bronchi (medium sized airways) in the lungs that is usually caused by viruses or bacteria and may last several days or weeks
- often called a chest cold
What is the etiologies of acute bronchitis?
- viral: 80-90% same viruses that cause URIs: coronavirus rhinovirus RSV adenovirus bacteria: 10-20% strep pneumoniae H. flu Chlamydia pneumoniae (college students and military) mycoplasma pneumoniae (college students and military) - less common cause: whooping cough: bordetella pertussis , illness can still develop in those who were vaccinated
Pathophys of acute bronchitis?
- inflammation of bronchial wall
- increased mucous production along with edema of bronchus
- infection clears in several days but the repair of bronchial wall may take several weeks (because of insult to airway and continual sloughing of airway epithelium)
- half of all pts continue to cough for 3-6 weeks due to period of repair
- PFTs: demonstrate bronchial obstruction similar to asthma but as sxs abate, PF returns to normal
Clinical features of acute bronchitis?
- cough is hallmark of lower respiratory infection
- sxs usually begin 3-4 days after URI such as cold or flu
- fever: usually mild (less than 101)
- cough: main sx, may be nonproductive initially and after a few days becomes productive. May keep awake at night or worsen when lies down
- streaks of blood - breaking blood vessels
- clear, yellow, or green
- malaise
- sensation of tightness, burning or dull pain in chest that is worse with breathing deeply or coughing
- hoarseness
- wheezing
Dx of acute bronchitis?
-H&P
- appearance: shouldn’t appear toxic
coughing during exam, on pulm exam: look at throat, percussion (may have abnorm. breath sounds)
- vital signs to include O2 sats (may do ortho BP to see if pt is dehydrated)
What are impt things to think about and ask the pt during the exam?
- duration of sxs, associated sxs
- miss any work, school?
- any underlying lung disease: COPD, emphysema, asthma, bronchiectasis
- smoking
- when was last time you were on abx, how many x a year do you get this?
hx:
any chronic illness that may result in immune compromise
immunization hx
ill contacts (work in daycare)
When do you need a CXR for a pt presenting with acute bronchitis?
- pt is really unwell
- pt prone to pneumonia due to underlying disease, age or alcoholism (aspirating risk)
- hx of pneumonia
- tobacco use
impt parts of management?
- fluids: want to keep secretions in bronchial tubes less viscous and easier to expel by coughing
- pt education
2 categories of management?
- sx management
- abx therapy
Sx management?
- antitussives: codeine, dextromethorphane or hydrocodone cough syrup tessalon perles: Rx, orally, numbs coughing reflex
- expectorants: guifenisen (mucinex)
- inhalers: if wheezing may be beneficial
B2 agonists - bronchodilation albuterol: 2 pufs 4-6 hrs prn (stim cilia to become more active to loosen up mucus)
-this can make pt very shaky and nervous, instruct on proper technique (spacer recommended) - get anti-tussive with guaifenesin syrup (guaifenesin + codeine)
phenergan with codeine
DM
What pt needs abx?
if pertussis expected: macrolide
what about smoking hx - makes them immunocompromised
- so once you dx with acute bronchitis - and pt doesnt have chronic lung disease then ask if pt is immunocompromised - if yes than consider abx but if no just do sx tx, if pt does have chronic lung disease - go to abx therapy
abx therapy for moderate ABECB and or any of the following: pts younger than 65, FEV1 greater than 50%, no cardiac disease, or less than 3 exacerbations a year?
- azithro - 500 mg 1st day then 350 next 4 or - clarithro 250-500 mg BID for 7-14 days or - doxy 100 mg BID for 7 days or - trimethoprim-sulfamethoxazole 1 tablet BID for 10-14 days or - cefuroxime 250-500 mg q12 hr 10 days or - cefdinir 300 mg BID for 5-10 days or - cefpodoxime 200 mg q12 hr for 10 days * if recent abx exposure w/in 3 months - use alt. class
Severe ABECB and or anyone of following: age older than 65, FEV1 less than 50%, cardiac disease, or more than 3 exacerbations a year?
- consider hospitalization
- amox-clav (augmentin)
or
levo
or
gemifloxacin
or
moxiflocacin - if at risk for pseudomonas infection consider sputum culture and tx with cipro
- if recent exposure within 3 months, use alt class
Need for ICS for airway inflammation in acute bronchitis?
- high dose inhaled corticosteroids may be benefit short term but not for every pt
- likely will need oral steroid burst for pts who have exacerbation of chronic bronchitis or an asthma exacerbation secondary to acute bronchitis
- may be able to prevent asthma exacerbation by increasing ICSx 1 month
