Acute Bronchitis Flashcards
What is acute bronchitis?
Acute bronchitis is defined as a lower respiratory tract infection which causes inflammation in the bronchial airways.
What are the viral causes of acute bronchitis?
Acute bronchitis is usually caused by a viral infection.
The most common viruses associated with acute bronchitis include rhinovirus, enterovirus, influenza A and B, parainfluenza, coronavirus, human metapneumovirus, respiratory syncytial virus, and adenovirus.
What are the bacterial causes of acute bronchitis?
Bacteria are detected in between 1 in 100 and 1 in 10 cases, including Streptococcus pneumoniae, Haemophilius influenzae and Moraxella catarrhalis.
What are the signs of acute bronchitis?
- Wheeze
- Rhonchi that improve with coughing
What are the symptoms of acute bronchitis?
- Cough <30 days
- Productive cough
- Substernal or chest wall pain may be present when coughing
- Sometimes mild constitutional symptoms
Note: need to rule out history of chronic respiratory illness
What investigations should be ordered for acute bronchitis?
Acute bronchitis is generally diagnosed clinically, though tests may be needed to exclude other diagnoses such as asthma or pneumonia.
- Pulse oximetry
- CXR
- CRP
Why investigate using pulse oximetry?
Arrange urgent hospital admission for people who require supplemental oxygen.
Aim:
- 94-98% in most
- 88-92% in COPD
Why investigate using CXR?
May be helpful to rule out pneumonia as cause of cough and fever.
Normal in acute bronchitis.
Why investigate using CRP?
Should be ordered if after clinical assessment a diagnosis of pneumonia has not been made, and antibiotic therapy is being considered to help guide therapy.
<20 mg/L (no antibiotics); 20-100 mg/L (delayed antibiotics); >100 mg/L (immediate antibiotics).
What safety netting is given in acute bronchitis?
Advise the person to seek medical help if symptoms worsen rapidly or significantly, do not improve after 3 to 4 weeks or they become systemically very unwell.
Briefly describe the treatment for acute bronchitis
Do not routinely offer an antibiotic to treat an acute cough associated with acute bronchitis in people who are not systemically very unwell or at higher risk of complications.
Offer an immediate antibiotic prescription if the person is systemically very unwell.
Consider an immediate antibiotic prescription or a back-up antibiotic prescription for a person at higher risk of complications,
What information needs to be given to the patient as to why antibiotics are not prescribed?
Inform the patient that:
- Acute bronchitis is usually a self-limiting illness and the cough usually lasts about three to four weeks
- Antibiotics do not make a large difference to the duration of symptoms, only shortening cough duration by about half a day on average
- Adverse effects, including diarrhoea and nausea are possible with antibiotic treatment
- Unnecessary antibiotic prescriptions may result in antibiotic resistance
What conditions may put a patient at high risk of complications in acute bronchitis?
A pre-existing comorbid condition such as heart, lung, kidney, liver, or neuromuscular disease, immunosuppression, or cystic fibrosis.
Older than 65 years of age with two or more of the following, or older than 80 years with one or more of the following:
- Hospital admission in the previous year
- Type 1 or type 2 diabetes mellitus
- History of congestive heart failure
- Current use of oral corticosteroids
According to NICE, what is the first line antibiotic choice for acute bronchitis?
First-line choice is oral doxycycline: 200 mg on the first day, then 100 mg once a day for 4 days (5-day course in total).
Note doxycycline should not be given to pregnant women.
What other antibiotics can be prescribed for acute bronchitis following first-line treatment?
Amoxicillin (preferred in pregnant women), clarithromycin or erythromycin (preferred in pregnant women).
