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Flashcards in Acute bronchitis Deck (16):
1

What are the most common presenting complaints in clinics?

- URI and LRIs

2

Definition of acute bronchitis?

- inflammation of large bronchi (medium sized airways) in the lungs that is usually caused by viruses or bacteria and may last several days or weeks
- often called a chest cold

3

What is the etiologies of acute bronchitis?

- viral: 80-90%
same viruses that cause URIs:
coronavirus
rhinovirus
RSV
adenovirus
bacteria: 10-20%
strep pneumoniae
H. flu
Chlamydia pneumoniae (college students and military)
mycoplasma pneumoniae (college students and military)
- less common cause: whooping cough: bordetella pertussis , illness can still develop in those who were vaccinated

4

Pathophys of acute bronchitis?

- inflammation of bronchial wall
- increased mucous production along with edema of bronchus
- infection clears in several days but the repair of bronchial wall may take several weeks (because of insult to airway and continual sloughing of airway epithelium)
- half of all pts continue to cough for 3-6 weeks due to period of repair
- PFTs: demonstrate bronchial obstruction similar to asthma but as sxs abate, PF returns to normal

5

Clinical features of acute bronchitis?

- cough is hallmark of lower respiratory infection
- sxs usually begin 3-4 days after URI such as cold or flu
- fever: usually mild (less than 101)
- cough: main sx, may be nonproductive initially and after a few days becomes productive. May keep awake at night or worsen when lies down
- streaks of blood - breaking blood vessels
- clear, yellow, or green
- malaise
- sensation of tightness, burning or dull pain in chest that is worse with breathing deeply or coughing
- hoarseness
- wheezing

6

Dx of acute bronchitis?

-H&P
- appearance: shouldn't appear toxic
coughing during exam, on pulm exam: look at throat, percussion (may have abnorm. breath sounds)
- vital signs to include O2 sats (may do ortho BP to see if pt is dehydrated)

7

What are impt things to think about and ask the pt during the exam?

- duration of sxs, associated sxs
- miss any work, school?
- any underlying lung disease: COPD, emphysema, asthma, bronchiectasis
- smoking
- when was last time you were on abx, how many x a year do you get this?
hx:
any chronic illness that may result in immune compromise
immunization hx
ill contacts (work in daycare)

8

When do you need a CXR for a pt presenting with acute bronchitis?

- pt is really unwell
- pt prone to pneumonia due to underlying disease, age or alcoholism (aspirating risk)
- hx of pneumonia
- tobacco use

9

impt parts of management?

- fluids: want to keep secretions in bronchial tubes less viscous and easier to expel by coughing
- pt education

10

2 categories of management?

- sx management
- abx therapy

11

Sx management?

- antitussives: codeine, dextromethorphane or hydrocodone cough syrup tessalon perles: Rx, orally, numbs coughing reflex
- expectorants: guifenisen (mucinex)
- inhalers: if wheezing may be beneficial
B2 agonists - bronchodilation albuterol: 2 pufs 4-6 hrs prn (stim cilia to become more active to loosen up mucus)
-this can make pt very shaky and nervous, instruct on proper technique (spacer recommended)
- get anti-tussive with guaifenesin syrup (guaifenesin + codeine)
phenergan with codeine
DM

12

What pt needs abx?

if pertussis expected: macrolide
what about smoking hx - makes them immunocompromised
- so once you dx with acute bronchitis - and pt doesnt have chronic lung disease then ask if pt is immunocompromised - if yes than consider abx but if no just do sx tx, if pt does have chronic lung disease - go to abx therapy

13

abx therapy for moderate ABECB and or any of the following: pts younger than 65, FEV1 greater than 50%, no cardiac disease, or less than 3 exacerbations a year?

- azithro - 500 mg 1st day then 350 next 4
or
- clarithro 250-500 mg BID for 7-14 days
or
- doxy 100 mg BID for 7 days
or
- trimethoprim-sulfamethoxazole 1 tablet BID for 10-14 days
or
- cefuroxime 250-500 mg q12 hr 10 days
or
- cefdinir 300 mg BID for 5-10 days
or
- cefpodoxime 200 mg q12 hr for 10 days
* if recent abx exposure w/in 3 months - use alt. class

14

Severe ABECB and or anyone of following: age older than 65, FEV1 less than 50%, cardiac disease, or more than 3 exacerbations a year?

- consider hospitalization
- amox-clav (augmentin)
or
levo
or
gemifloxacin
or
moxiflocacin
- if at risk for pseudomonas infection consider sputum culture and tx with cipro
* if recent exposure within 3 months, use alt class

15

Need for ICS for airway inflammation in acute bronchitis?

- high dose inhaled corticosteroids may be benefit short term but not for every pt
- likely will need oral steroid burst for pts who have exacerbation of chronic bronchitis or an asthma exacerbation secondary to acute bronchitis
- may be able to prevent asthma exacerbation by increasing ICSx 1 month

16

Preferred tx regimen for TB?

- initial phase: Daily INH, RIF, PZA, and EMB for 2 months
- continuation phase: Daily INH and RIF for 4 more months or twice weekly INH and RIF x 4 months