S8C67 - Acute bronchitis and URTI Flashcards
Acute bronchitis
- inflm large airways with cough up to 3w (+/- sputum)
- cough plus PND or throat clearing is more consistent with a common cold (URTI)
- causes viral: RSV, coronavirus, adenovirus, rhinovirus, enterovirus
- atypical bacterial causes (
Common cold
- cause: rhinovirs **, coronavirus, adenovirus
- sore throat, malaise, low-grade fever, cough w/in 24-48h, rhinorrhea
- peaks at d3-4, resolves by d7
Influenza and avian influenza
- fever, chills, myalgias, h/a, cough, rhinitis
- may cause PNA
- if Sx
Parainfluenza
- croup in children
- laryngitis in adults, mild sx
RSV
- winter and spring
- adults exposed to infants with bronchiolitis usually have cold-like sx, ear pain
Coronavirus
- common cold
- severe resp distress in eldery
Adenovirus
-similar to influenza with abrupt onset of fever
Rhinovurs
- mild cold sx
- fever uncommon
Enterovirus
- febrile illness
- may cause rhinitis, pharyngitis, rarely PNA
Chronic bronchitis
- productive cough x3m of the year for 2 consecutive years
- often have partially reversible airway obstruction
Cough >3w
-consider asthma, COPD, pertussis, PND, GERD
Bacterial causes of bronchitis
- bordetella pertussis: incubation 1-3w, whooping cough, fever uncommon, treatment prevents spread with azithro 500mg d1, 1250mg d2-5 OR septra DS BID
- mycoplasma pneum: incubation 2-3w, onset 2-3d, common in adolescents, can consider azithro course
- chlamydophila pneumoniae: incubation 3w, gradual onset, hoarseness before cough, consider azithro
Criteria suggestive of PNA
- HR >100
- RR >24
- temp >38 (100.4)
- abnormal chest exam
- age >64yo
-if none of the criteria above are met then the likelihood of PNA is sufficiently low to exclude the need for a CXR (all 5 criteria must be absent to safely r/o PNA on clinical grounds)
Bronchitis: Tx
- antibiotics decrease cough by 0.6d
- may have benefit from bronchodilators (ventolin) if wheeze rpesent
