Acute bronchitis
(Redirected from Bronchitis)
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
- Temperature >38 (100.4)
- Exam findings consistent with focal consolidation, egophony, or fremitus
- Age >64yr
Epidemiology
- Viruses are most common cause
- Influenza, paraflu, RSV, coronavirus, adenovirus, rhinovirus
- 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
- 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
Mild peri hilar cuffing as seen in a viral bronchitis. CXR may alternatively be negative and is not required for diagnosis.
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]
- Oral Steroids do not reduce duration or severity of symptoms in patients with acute bronchitis [6]
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)
- ↑ Hay, AD et al. Effect of oral prednisolone on symptom duration and severity in nonasthmatic adults with acute lower respiratory tract infection: a randomized clinical trial. 2017 Aug 22;318(8)