Acute Bronchitis, Tracheobronchitis , Bronchiolitis

Question 1

Define Acute Bronchitis ?

Answer 1

Inflammation of the bronchi

Question 2

Is it viral or bacterial ?

Answer 2

In previously healthy patients its usally viral.

Otherwise if bacterial then it could be Streptococcus pneumoniae (Gram +) and Haemophilus influenzae (Gram -)

Question 3

Who is it more likely to occur in ?

Answer 3

Smokers or COPD patients

Question 4

Symptoms?

Pathogenesis

Answer 4

Irritating non productive cough and discomfort behind the sternum

Later on cough becomes productive with yellow or green sputum , mild fever , neutrophil leucocytosis

Infiltration of neutrophils, lymphocytes, and monocytes.

Dyspnea , wheeze , crackles

Causes mucosal edema, hypersecretion of mucus, and epithelial damage

Question 5

Diagnosis ?

Answer 5

Clinical symptoms cough , sputum production, wheeze etc

X-ray to rule out pneumonia

Question 6

Differential diagnosis?

Answer 6

Asthma , pneumonia, COPD , bronchiolitis

Question 7

Treatment for Acute bronchitis ?

Answer 7

Fluids , cough suppressant (Dextromethorphan) ages > 4
, paracetamol to reduce fever , bronchodilators

Antibiotics only if bacterial: Amoxicillin 500mg twice daily

Paracetamol max 4g daily 500-1000mg every 6 hours

Paracetamol children 10-15mg/kg every 4-6 hours

Amoxicillin 500-875mg every 8-12 hours for 5-7 days

Children : 20-40mg/kg/ day in divided doses

Dextromethorphan

Adults: 10–20 mg every 4 hours or 30 mg every 6–8 hours (max 120 mg/day)
• Children (6–12 years): 5–10 mg every 4 hours (max 60 mg/day)

Bronchodilators

Nebulized: 2.5 mg every 4–6 hours as needed
• Inhaler: 100–200 mcg (1–2 puffs) every 4–6 hours as needed

Question 8

Tracheobronchitis

Answer 8

Inflammation of the trachea and bronchi

Almost same symptoms like acute bronchitis etc

Question 9

Bronchiolitis ?

Causes ?

Answer 9

Bronchiolitis is inflammation of the small airways also known as the bronchioles in the lungs.

Most common serious respiratory infection of infancy 2-3% hospitalised yearly

Causes : RSV ( 80% ), others : Parainfluenza, rhinovirus adenovirus

Necrosis of bronchiolar epithelial cells.

Question 10

What are some risk factors for bronchiolitis ?

Answer 10

Prematurity, CF , congenital heart disease , broncho pulmonary dysplasia

Question 11

Bronchiolitis symptoms?

Answer 11

• Dry wheeze cough , tachypnoea , tachycardia
• Hyperinflation of chest because air trapping makes it harder to push air out , increased airway resistance
  High pitches wheezes , expiration > inspiration

Drop of intrathroacic pressure as there is an increased effort to inhale , chest recession

Question 12

When to admit into hospital?

Answer 12

Pulse oximeters is < 90%
Inadequate oral fluid intake
Severe respiratory distress
RR > 70 breaths / min

Question 13

What is the normal respiratory rate for the following ages :

Up to 6 months
6-12 months
1-5 years
6-12 years
12 years and up

Answer 13

Up to 6 months = 30-60/ min
6-12 months 24-30/ min
1-5 years 20-30
6-12 years 12-20
12 years and up 12-20

Question 14

How to manage bronchiolitis ?

Answer 14

Oxygenated humidified ( nasal canula )
Fluids ( NG tube / iv )
CPAP in severe cases

Question 15

Most patients recover in ? For bronchiolitis

Answer 15

2 weeks

Question 16

Prevention for bronchiolitis

Answer 16

Monthly RSV monoclonal antibody for high risk infants ( IM injections)

Given usually before 8 months

Passive immunity