Disorders of the Bronchi Part `1 Flashcards
What are the risk factors for acute bronchitis?
Tobacco abuse/secondhand smoke
Air pollutant exposure
Chronic bronchopulmonary disease (COPD)
Immunosuppression (primary immune deficiency, HIV, cancer)
Infants (RSV = worse prognosis)
Older adults (esp if COPD or HF; influenza = worse prognosis)
What is the pathophysiology of acute bronchitis?
Injury to bronchial epithelial cells with secondary mucus overproduction and thickening of the bronchial wall
What is the most common etiology of acute bronchitis in all groups?
Viral
What is the most common etiology of acute bronchitis in pediatric patients <2
Adenovirus
What is the most common etiology of acute bronchitis in pediatric patients 2-5
RSV
Parainfluenza
Metapneumovirus
What is the most common etiology of acute bronchitis in patients >5 years old
Adenovirus
influenza A/B
parainfluenza
coxsackievirus
rhinovirus
coronavirus
What is the most common bacterial etiology of acute bronchitis if <5 years old?
Streptococcus pneumoniae
Group A strep pyogenes
Haemophilus influenza
What is the most common bacterial etiology of acute bronchitis if > 5 years old?
Mycoplasma pneumoniae
Chlamydia pneumoniae
Bordatella pertussis
What are the symptoms of acute bronchitis?
Cough
Fever (low grade)
Tachypnea
SOB
Pharyngitis
Describe the cough associated with acute bronchitis?
Often sudden onset
Often nonproductive to productive
W/O underlying evidence of pneumonia, asthma, COPD, or common cold
May persist 2-3 weeks or more
Acute bronchitis on auscultation?
rales, rhonchi, wheezes
Acute bronchitis labs?
Sputum C&S (only if need to r/o bacterial etiology)
Viral nasal swab in winter/spring
WBC count
ABGs if severe (hypoxemia)
Acute bronchitis imaging?
Normal chest x ray with no signs of consolidation
May have mild peribronchial cuffing
How to treat acute bronchitis IF suspected bacterial etiology or severe comorbidities?
ABx:
Amoxicillin
T/S
doxycycline
Macrolides (confirmed pertussis)
*if ABx treatment failure - fluoroquinolones
How to treat symptoms of acute bronchitis?
Antipyretic - acetaminophen, ibruprofen
Cough suppressant - dextromethorphan, guaifenesin, codeine
Bronchospasm: systemic corticosteroids and inhaled SABA
How to treat specific viral pathogens associated with acute bronchitis?
Influenza - oseltamivir, relenza
*within 48 hours of symptoms onset
Supportive treatment for acute bronchitis?
tobacco smoke avoidance/cessation
Vaporizers/humidifiers
Hydration
Rest
Usually treated outpatient unless significant comorbidities
What is are some potential complications of acute bronchitis?
older adults may develop secondary bacterial infection
If recurrent episodes, consider asthma or other underlying disease process
Define bronchiolitis?
Various inflammatory and obstructive processes which affect the bronchioles
What is the pathophysiology of bronchiolitis?
necrosis of epithelial cells with release of inflammatory mediators resulting in:
edema
mucus secretion
luminal obstruction
What is the prevalence/etiology of bronchiolitis?
Most common in infants and children (newborns - 2 years old)
**Leading cause of hospitalization in infants/children
RSV - 70%, +adenovirus and others
Epidemics common in winter and spring
Does bronchiolitis only effect children?
No, it is becoming increasingly recognized as common and serious in older adults
What are the risk factors for bronchiolitis?
Cigarette smoke exposure
Low birth rate
immunodeficiency
Formula feeding (lacks IgA)
Day-care exposure
What are the risk factors for RSV in older adults?
Age 65+
Chronic lung disease
Chronic heart disease
Diabetes mellitus
Immunosuppressed
End-stage renal disease
Symptoms/Signs of acute bronchiolitis?
Irritability
Anorexia, vomiting
Fever
Noisy breathing
Cough
Grunting/apnea
Tachypnea
Wheezing
Retractions
Hypoxia/cyanosis
*symptoms typically last 2-3 weeks
How is acute bronchiolitis diagnosed?
Rapid respiratory viral antigen test (nasal swab) - detects RSV and other viruses but is usually not medically necessary since treatment is symptomatic
*spirometry would show obstructive lung dz but it is not typically done due to low peak age
What is found on CXR for acute bronchiolitis?
Increased AP diameter
Flattened diaphragm
Air trapping
+/- infiltrates
Focal atelectasis
bilateral perihilar fullness (image)
How is acute bronchiolitis treated?
Most at home
Supportive:
-nasal suction
-supplemental O2
-intubation
Antiviral - ribavirin
NOT helpful - SABA and systemic steroids
What is the hospital admission criteria for acute bronchiolitis?
Tachypnea
respiratory distress
hypoxia
underlying cardiopulmonary disease
dehydration/poor feeding
When should prevention for acute bronchiolitis be used in pediatrics and with what meds?
Palivizumab
<24 moths with various conditions/criteria
Nirsevimab
<8 months born during or entering their first RSV season
<5kg - 50 mg IM
>5kg - 100 mg IM
What prevention measures are there for acute bronchiolitis other than for pediatrics?
RSV vaccine - Abrysvo, Arexvy. mRESVIA
-Older adults
-high risk 18-59
-Pregnant women
*review chart in powerpoint
