Acute/ Chronic Bronchitis

Answer 1

Acute Bronchitis
This refers to an acute inflammation of the bronchial mucosa. It is often found in association with upper respiratory tract infection. Most cases do not require antibiotics, however, they may be prescribed if the patient’s SPO2 is less than 92% or if there is an underlying co-morbidity like malnutrition, measles, rickets, anaemia, diabetes mellitus, chronic bronchitis or HIV/AIDS.

Question 2

Causes

Answer 2

Causes
y Viruses e.g. Influenza virus, Corona virus (common cold)
y Bacteria e.g. Streptococcus pneumoniae, H. influenza, Moraxella catarrhalis, Staph. aureus (tends to cause post-influenza chest
infections, including bronchitis)

Question 3

Signs and symptoms

Answer 3

Symptoms
y Dry cough
y Sputum production y Sore throat
y Pleuritic chest pain y Low grade fever
Signs
y Fever
y Rhinorrhoea
y Rhonchi (wheeze) y Crepitations (rare)

Question 4

Investigations

Answer 4

Investigations
y FBC

y Sputum culture and gram stain
y Sputum AFBs (2 samples) for tuberculosis if symptoms have lasted
more than 2 weeks
y SinusX-rayforrhinosinusitis(withpostnasaldrip)asapossiblecause
for prolonged cough 😷

Question 5

Treatment

Pharmacological treatment STG page 181

Answer 5

Treatment
Treatment objectives
y To relieve symptoms
y To treat suspected bacterial infection if any
Non-pharmacological treatment
y Bed rest
y Oral fluids to keep well hydrated
y Humidified air or steam inhalation if necessary

Question 6

Chronic Bronchitis

Answer 6

Chronic Bronchitis
This is chronic inflammation of the bronchial mucosa due to irritants such as tobacco smoke. It occurs after the age of 40 years and is part of the syndrome of chronic obstructive pulmonary disease (COPD). There is progressive worsening with age, eventually resulting in chronic respiratory failure. It is aggravated by recurrent viral and bacterial infections.
Oxygen therapy in these patients must be given with caution to prevent carbon dioxide retention due to depression of respiration. High flow rates remove the central hypoxic drive that maintains respiratory effort and can be harmful.

Question 7

Causes

Answer 7

Causes
y Cigarette smoking
y Industrial dust
y Chemical irritants
y Inhaled smoke from use of biomass fuels (eg. charcoal, wood)

Question 8

Signs and symptoms

Answer 8

Symptoms
y Shortness of breath, particularly on exertion
y Wheeze
y Fever
y Cough with production of sputum for most of the year
y Infective exacerbation associated with increased quantity of thick
purulent sputum
Signs
y May be none
y Barrel chest
y Pursed lip breathing
y Clubbing
y Cyanosis
y Increased respiratory rate
y Use of assessory muscles i.e. neck and/or abdominal muscles, for
breathing
y Hyperresonance on percussion and loss of cardiac dullness y Wheeze or rhonchi
y Reduced Peak Expiratory Flow Rate (PEFR)

Question 9

Investigations

Answer 9

Investigations
y FBC
y Spirometry, shows reduced lung volumes, particularly FEV1 which is
not reversed post-bronchodilator administration y Chest X-ray
y Sputum culture and gram stain

Question 10

Treatment

Pharmacological treatment page 184 STG

Answer 10

Treatment
Treatment objectives
y To minimise or stop cough
y To prevent or minimise wheeze and shortness of breath y To reduce quantity of sputum produced
y To prevent infective exacerbations
Non-pharmacological treatment
y Smoking cessation
y Physical exercise
y Good nutrition
y Use of face mask in high risk occupations

Answer 11

Referral Criteria
Refer all patients not improving on initial management, with acute exacerbation, recurrent infective exacerbations or rapidly deteriorating to a specialist.