Bronchitis Flashcards
Define and classify bronchitis
Inflammation of bronchial tubes , classified into acute and chronic
Differentiate between acute and chronic bronchitis
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
Pathophysiology of Bronchitis
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 .
Give examples of viral and bacterial pathogens that cause bronchitis
Viral-adenovirus, rhinovirus, Parainfluenza, Respiratory syncytial virus(RSV)
Bacterial - S. Pneumonia, moraxella catarrhalis, H.influenza, C.pneumonia and M. Pneumonia
Signs and symptoms bronchitis
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
Complication bronchitis
Pneumonia
Hemoptysis
Chronic bronchitis
Bacterial superinfection
Differentials bronchitis
Asthma
Influenza
COPD
Tonsilitis
Acute /chronic sinusitis
Viral pharyngitis
How does bronchitis present in a child and the most likely organism for <5 years and for 6-18years
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
Tracheostomies
Flora-alpha hemolytic streptococci and gamma hemolytic streptococci
Acute exacerbation of tracheo-broncholitis include P. Aeuruginosa
S. Aureus , MRSA
Diagnostic tests bronchitis
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
Mucocilary system consists of?
Cilia
Protective mucus layer
Airway surface liquid (ASL) layer
Goals of management bronchitis
Correct dehydration
Treat respiratory symptoms
Alleviate symptoms of acute bronchitis
Prevent complications of bronchitis
Open obstructed airways
Non pharmacological management bronchitis
Adequate oxygenation
Bed rest( lethargy and malaise)
Increase fluid intake to reduce viscosity of secretions
Avoid chemical irritants esp cigarettes
Management of acute bronchitis
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
What is the purpose of antibiotic therapy in bronchitis
Directed towards respiratory pathogens ie H. Influenza , Strep.pneumo, M.pneumo after confirmation through cultures
Which antibiotic used for acute exacerbation of chronic bronchitis
Amox/clav 500/125mg q8h else erythromycin 500mg q6h else doxy 100mg q12h
Acute exacerbation of chronic bronchitis where hospitalization is unlikely but more than 2risk factors and FEV1<50%
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
Acute exacerbation of chronic bronchitis with hospitalization
P.aureginosa
Meropenem-500 mg q8h IV for 15 minutes
Cipro-500mg q12h
Pip/tazo-3g q6h IV infusion 30minutes to 4 hours
Monitoring parameters bronchitis
Adherence
Symptoms control ie cough, fever
Cipro-QT prolonged, tendon rupture , peripheral neuropathy
Assses other tests
Assessment of severity based on symptoms bronchitis
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
Risk factors for severity of AECB
Age
COPD severity>4 exacerbation/year
Cardiac disease
Use of oxygen
Antibiotic use in past 3 months
Recent corticosteroid use
Moderate exacerbation of AECB
Bronchodilator
Oral corticosteroids
Antibiotic if increased sputum volum , discharge reasses 90days , adopt anti-pneumococcal vaccines, smoking cessation
Very severe exacerbation bronchitis
ICU
Severe exacerbation bronchitis
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
