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Pharmacotherapeutics > Bronchitis > Flashcards

Bronchitis Flashcards

1
Q

Classifications of bronchitis


A

Acute bronchitis
Chronic bronchitis

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2
Q

Acute Bronchitis

A

Characteristics:
* Swelling of the lining of the trachea and bronchial tree.
* Narrowing of the tubes.
* Increased secretion of inflammatory fluid.

Common Features:
* Occurs following viral (commonly) or bacterial infection.
* Can result from chemical irritation (e.g., cigarette smoking, air pollution, or gastric acid reflux).
* Common in individuals of all ages.
* More prevalent in winter and/or areas with increased irritants

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3
Q

Chronic Bronchitis

A

Definition:
* Daily production of sputum for at least 3 months in 2 consecutive years.

Characteristics:
* Persistent inflammation of the bronchial passages.
* Prolonged and recurring symptoms.
* Often associated with long-term exposure to irritants.

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4
Q

Viral Agents Associated with Acute Bronchitis

A
  • Influenza A and B.
  • Respiratory syncytial virus (RSV).
  • Parainfluenza.
  • Adenovirus.
  • Cold viruses (Rhinovirus & Coronavirus)
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5
Q

Bacterial Pathogens in Acute Bronchitis

A
  • Streptococcus pneumoniae.
  • Moraxella catarrhalis.
  • Haemophilus influenzae.
  • Chlamydia pneumoniae.
  • Mycoplasma pneumoniae
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6
Q

Etiology and Pathophysiology

A
  • Viral infection of trachea and bronchi leads to mucosal inflammatory response.
  • Increased bronchial secretions result in acute bronchitis.
  • Destruction of respiratory mucosa is part of the process
  • Dysfunction impairs clearance and contributes to chronic airway diseases
  • Recurrent or repeated acute respiratory infections
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7
Q

Pathophysiology in children

A
  • Acute airway injury or continuous exposure to environmental agents, allergens, or irritants can lead to bronchospasm and cough.
  • Recurrent aspiration or repeated viral infection increases the risk of chronic infections and lower respiratory tract infections.
  • Children Predisposed to Aspiration:

If protective airway mechanisms are compromised, children may be infected with oral anaerobic strains of streptococci due to oropharyngeal aspiration.

  • Tracheostomies in Children:

Often colonized with flora like α-hemolytic and γ-hemolytic streptococci.

Acute exacerbations may involve pathogens like Pseudomonas aeruginosa and Staphylococcus aureus (including methicillin-resistant strains)

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8
Q

Common Organisms in Children

A
  • Streptococcus pneumoniae.
  • Haemophilus influenzae.
  • Mycoplasma pneumoniae.
  • Moraxella catarrhalis- More prevalent in children aged 6-18 years and preschoolers (age < 5 years)
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9
Q

Mucociliary System in Acute Bronchitis

A
  • Mucociliary clearance is the primary defense mechanism.
  • Dysfunction impairs clearance and contributes to chronic airway diseases
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10
Q

Components of mucociliary system

A
  • Cilia
  • protective mucus layer
  • airway surface liquid (ASL) layer.
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11
Q

ASL Dehydration and Chronic Inflammation

A
  • ASL dehydration reduces mucus clearance.
  • Contributes to mucous obstruction, goblet cell hyperplasia, and chronic inflammatory cell infiltration
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12
Q

Clinical presentation of acute bronchitis

A
  • Follows upper respiratory infection.
  • Hallmark: Hacking cough.
  • Nasopharyngeal complaints.
  • Production of clear phlegm, yellow, or green sputum.
  • Fever and N/V/D are rare but can occur
  • Sore throat.
  • Runny or stuffy nose.
  • Headache.
  • Muscle aches.
  • General malaise/fatigue.
  • Chest pain (severe cases).
  • Dyspnea and cyanosis, especially in patients with COPD
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13
Q

Complications of bronchitis

A
  • Bacterial superinfection
  • Chronic Bronchitis
  • Pneumoniae
  • Hemoptysis
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14
Q

Differential Diagnoses

A
  • Asthma
  • Influenza
  • Bronchiolitis
  • Chronic bronchitis (COPD)
    Bronchiectasis
  • Acute or chronic sinusitis
  • Bacterial tracheitis/
    pharyngitis
  • Tonsillitis
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15
Q

Tests and investigations

A
  1. Full blood count
  2. Sputum cytology
  3. Chest radiography
  4. Bronchoscopy
  5. Spirometry
  6. Blood culture
  7. Troat swab
  8. Respiratory secretion cultures
  9. Procalcitonin
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16
Q

Procalcitonin

A
  • Levels increase in bacterial infections (not in viral or other inflammatory conditions).
  • Values ≥ 0.25 mcg/L (in non-ICU patients) or > 0.5 mcg/L (in ICU patients).

Clinical Use:

  • Indicative for initiation of antibiotic therapy
  • A decrease of at least 80% in levels can be a guide for discontinuing antibiotics.

Antibiotic Usage and Complications:

  • The use of a procalcitonin algorithm may reduce antibiotic usage without increasing the risk of complications
17
Q

Goals of Management

A
  • Alleviate symptoms of acute bronchitis.
  • Correct dehydration.
  • Treat associated respiratory symptoms.
  • Maintain and open obstructed bronchial airways.
  • Thin obstructive mucus to facilitate expectoration.
  • Prevent the development of complications
18
Q

Symptomatic and Supportive care (Non-pharmacological)

A
  • Ensure adequate oxygenation.
  • Increase fluid intake to prevent dehydration.
  • Decrease viscosity of respiratory secretions.
  • Bed rest to relieve lethargy and malaise.
  • Reassurance.
  • Avoidance of environmental irritants, especially cigarette smoke.
19
Q

Medications for management of Acute bronchitis

A
  • Analgesics and antipyretics (e.g., paracetamol, aspirin, ibuprofen) to alleviate symptoms.
  • Inhaled bronchodilators (e.g., salbutamol, terbutaline) for bronchial relaxation.
  • 90-180 mcg (1-2 puffs) inhaled PO q4-6 hours.
  • Inhaled corticosteroids (e.g., beclomethasone, fluticasone, budesonide inhaler).
  • Oral corticosteroids (e.g., prednisolone) for a short course.
  • Dextromethorphan for mild persistent cough.
  • Codeine intermittently for severe cough
20
Q

Antibiotic Therapy

A
  • Routine antibiotic use discouraged.
  • Consider if there is a suboptimal response to supportive intervention or persistent respiratory symptoms with fever.
  • Directed toward respiratory pathogens (e.g., Strep. pneumoniae, H. influenzae, M. pneumoniae).
  • Examples of antibiotics: Macrolides, fluoroquinolones, or beta-lactamase-resistant antimicrobials.
21
Q

Evaluation of Therapy in Acute Bronchitis

A
  • Amelioration of symptoms.
  • Assess to rule out pneumonia and other complications.
  • Treat any complications that arise.
  • Assess the need for antibiotics based on clinical response.
  • Ensure adherence to prescribed medications.
  • Reassure the patient about the natural course of the disease.
  • Encourage avoiding unnecessary antibiotic use

Pharmacotherapeutics (6 decks)

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