Acute bronchitis: Difference between revisions
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*[[Pneumonia]] must be excluded by clinical evaluation or by CXR | *[[Pneumonia]] must be excluded by clinical evaluation or by CXR | ||
**If all 5 are negative pneumonia is safely excluded: | **If all 5 are negative pneumonia is safely excluded: | ||
** | **#HR >100 | ||
** | **#RR >24 | ||
** | **#Temp >38 (100.4) | ||
** | **#Exam findings consistent with focal consolidation, egophony, or fremitus | ||
** | **#Age >64yr | ||
===Epidemiology=== | ===Epidemiology=== | ||
Revision as of 02:49, 14 August 2016
Background
- Inflammation of large airways of the lung
- Pneumonia must be excluded by clinical evaluation or by CXR
- If all 5 are negative pneumonia is safely excluded:
- HR >100
- RR >24
- Temp >38 (100.4)
- Exam findings consistent with focal consolidation, egophony, or fremitus
- Age >64yr
- If all 5 are negative pneumonia is safely excluded:
Epidemiology
- Viruses are most common cause
- Influenza, paraflu, RSV, corona, adeno, rhino
- Bacterial cause occurs in <10% of cases
- Mycoplasma, C. pneumoniae, pertussis (1% of bronchitis cases)
Clinical Features
- Cough, with or without sputum, without evidence of pneumonia, common cold, or Asthma
- Cough >5d is more suggestive of bronchitis than common cold
- Cough may persist for 10-20d
- Cough >3wk suggests asthma, COPD, pertussis, postnasal drip, GERD
- Often follows URI
Differential Diagnosis
Cough
Acute (< 3 wks)
- URI (rhinitis, sinusitis, pertussis)
- LRI (bronchitis, pneumonia)
- Influenza
- Allergy
- Asthma
- Environmental irritants
- Transient airway hyperresponsiveness
- Foreign body
- SARS
Chronic (> 8 wks)
- Postinfectious; pertussis
- Smoking and/or chronic bronchitis
- Postnasal discharge
- Asthma
- GERD
- ACEI/ARB
- CHF
- Lung cancer or intrathoracic mass
- Emphysema
- Interstitial lung disease
- Psychiatric
Evaluation
- Clinical diagnosis
- CXR only indicated in elderly or suspicion for pneumonia
Management
American College of Chest Physicians 2006 Guidelines[1]
- Routine treatment with antibiotics is NOT necessary
- Antitussive agents can be useful (codeine, dextromethorphan)
- In individuals without comorbidities antibiotics have NO IMPROVEMENT in symptoms or duration [2]
- Do not treat patients with antibiotics unless:[3]
- older than 65 years
- Recent hospitalizations in the past year
- Diabetes
- On chronic steroids
- If treating based upon the above criteria then a 5 day treatment is preferred [4]
- Bronchodilators only useful if there is wheezing
- Despite the recommendations for no antibiotics in the non complicated course of acute bronchitis, patients continue to receive antibiotic prescriptions[5]
Disposition
- Typically outpatient
See Also
References
- ↑ Braman SS. Chronic cough due to chronic bronchitis: ACCP evidence-based clinical practice guidelines. Chest. Jan 2006;129(1 Suppl):104S-115S.
- ↑ Aagaard E, Gonzales R. Management of acute bronchitis in healthy adults. Infect Dis Clin North Am. Dec 2004;18(4):919-37
- ↑ Tan T, Little P, Stokes T. Antibiotic prescribing for self limiting respiratory tract infections in primary care: summary of NICE guidance. BMJ. Jul 23 2008;337
- ↑ El Moussaoui R, Roede BM, Speelman P, Bresser P, Prins JM, Bossuyt PM. Short-course antibiotic treatment in acute exacerbations of chronic bronchitis and COPD: a meta-analysis of double-blind studies. Thorax. May 2008;63(5):415-22
- ↑ Barnett, Michael. Jeffrey A. Linder. Antibiotic Prescribing for Adults With Acute Bronchitis in the United States, 1996-2010. May 21, 2014, 311(19)