Bronchitis

Question 1

Define and classify bronchitis

Answer 1

Inflammation of bronchial tubes , classified into acute and chronic

Question 2

Differentiate between acute and chronic bronchitis

Answer 2

Acute -inflammation of trachea and bronchial passage following viral(90%)/bacterial infection, chemical irritation ie cigarette
Chronic -daily production of sputum for at least 3 months in 2 consecutive years
Or repeated attacks of acute bronchitis

Question 3

Pathophysiology of Bronchitis

Answer 3

There is mucosal inflammatory response of bronchial passage due to hyperemic and edematous mucous membranes thus leading to increase of bronchial secretions and destruction of respiratory mucosa which ends up altering mucociliary functions .

Question 4

Give examples of viral and bacterial pathogens that cause bronchitis

Answer 4

Viral-adenovirus, rhinovirus, Parainfluenza, Respiratory syncytial virus(RSV)
Bacterial - S. Pneumonia, moraxella catarrhalis, H.influenza, C.pneumonia and M. Pneumonia

Question 5

Signs and symptoms bronchitis

Answer 5

Upper respiratory tract infections- hacking cough(hallmark), fever , phlegm, and nasopharyngeal complaints
Other -headache , muscle ache , chest pain, runny nose, dyspnea and cyanosis esp COPD, malaise and fatigue

Question 6

Complication bronchitis

Answer 6

Pneumonia
Hemoptysis
Chronic bronchitis
Bacterial superinfection

Question 7

Differentials bronchitis

Answer 7

Asthma
Influenza
COPD
Tonsilitis
Acute /chronic sinusitis
Viral pharyngitis

Question 8

How does bronchitis present in a child and the most likely organism for <5 years and for 6-18years

Answer 8

Acute airway injury /exposure to allergen causes , bronchospasms , cough, edema , inflammation ( Asthma)
<5years - S. Pneumonia, H. Influenza, M. Catarrhalis, M. Pneumonia
6-18- M. Pneumoniae

Question 9

Tracheostomies

Answer 9

Flora-alpha hemolytic streptococci and gamma hemolytic streptococci
Acute exacerbation of tracheo-broncholitis include P. Aeuruginosa
S. Aureus , MRSA

Question 10

Diagnostic tests bronchitis

Answer 10

FBC/CBC
Culture of respiratory secretions identify H. Influenza, M.pneumonia
Sputum cytology if cough present
Spirometry to asses bronchospasms
Chest radiograph esp if pneumonia is suspected
Blood culture ie bacterial superinfection suspected
Procalcitonin distinguish between bacterial and viral infections

Question 11

Mucocilary system consists of?

Answer 11

Cilia
Protective mucus layer
Airway surface liquid (ASL) layer

Question 12

Goals of management bronchitis

Answer 12

Correct dehydration
Treat respiratory symptoms
Alleviate symptoms of acute bronchitis
Prevent complications of bronchitis
Open obstructed airways

Question 13

Non pharmacological management bronchitis

Answer 13

Adequate oxygenation
Bed rest( lethargy and malaise)
Increase fluid intake to reduce viscosity of secretions
Avoid chemical irritants esp cigarettes

Question 14

Management of acute bronchitis

Answer 14

Paracetamol 500mg q4-6hours
Inhaled bronchodilator -salbutamol 90-180mcg (1-2puffs) q4-6hours
Inhaled corticosteroids-beclomethasone 200-400mcg q12h
Dextromethopharn-15-30mg q4-6hours
child 5-15mg q4-6hours
Codeine if severe cough

Question 15

What is the purpose of antibiotic therapy in bronchitis

Answer 15

Directed towards respiratory pathogens ie H. Influenza , Strep.pneumo, M.pneumo after confirmation through cultures

Question 16

Which antibiotic used for acute exacerbation of chronic bronchitis

Answer 16

Amox/clav 500/125mg q8h else erythromycin 500mg q6h else doxy 100mg q12h

Question 17

Acute exacerbation of chronic bronchitis where hospitalization is unlikely but more than 2risk factors and FEV1<50%

Answer 17

1.2gen or 3rd gen ceph ie 2-cefaclor 3-ceftriaxone
Cefaclor-250-500mg q8h 7-14days
Ceftriaxone 1-2g q12 5-14 days
Macrolide -azithromycin 500mg q24 3 days and 250 q24h for 5 days
Doxy 100mg q12h

Question 18

Acute exacerbation of chronic bronchitis with hospitalization

Answer 18

P.aureginosa
Meropenem-500 mg q8h IV for 15 minutes
Cipro-500mg q12h
Pip/tazo-3g q6h IV infusion 30minutes to 4 hours

Question 19

Monitoring parameters bronchitis

Answer 19

Adherence
Symptoms control ie cough, fever
Cipro-QT prolonged, tendon rupture , peripheral neuropathy
Assses other tests

Question 20

Assessment of severity based on symptoms bronchitis

Answer 20

Use of anthonisen criteria
Worsening dyspnea
Increased sputum purulence
Increase in sputum volume
Type 1severe- all 3
Type 2 moderate -2
Type 3 mild -1 element plus URI in past 5 days, increased wheezing or cough , increased HR , fever w/o apparent cause

Question 21

Risk factors for severity of AECB

Answer 21

Age
COPD severity>4 exacerbation/year
Cardiac disease
Use of oxygen
Antibiotic use in past 3 months
Recent corticosteroid use

Question 22

Moderate exacerbation of AECB

Answer 22

Bronchodilator
Oral corticosteroids
Antibiotic if increased sputum volum , discharge reasses 90days , adopt anti-pneumococcal vaccines, smoking cessation

Question 23

Very severe exacerbation bronchitis

Answer 23

ICU

Question 24

Severe exacerbation bronchitis

Answer 24

Oral corticosteroids
Antibiotic esp if 3 cardinal symptoms ie dyspnea, increased sputum vol
Hospitalization with O2 if hypoxemic
Xanthines if inadequate treatment response
Discharge reassess 30dags , give anti-pneumococcal vaccination, stop smoking, respiratory rehabilitation