Acute bronchitis: Difference between revisions
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==Background== | ==Background== | ||
[[File:Blausen 0865 TracheaAnatomy.png|thumb|Trachobronchial anatomy.]] | |||
[[File:Bronchial anatomy with description.png|thumb| A - Alveoli | |||
AS - Septum alveolare | |||
BR - Bronchus respiratorius | |||
BT - Bronchus terminalis | |||
D - Mucous gland | |||
DA - Ductus alveolaris | |||
M - Musculus | |||
N - Nervus | |||
PA - Branch of Arteria pulm. | |||
PV - Branch of Vena pulm.]] | |||
*Inflammation of large airways of the lung | *Inflammation of large airways of the lung | ||
*[[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: | |||
* | *#HR >100 | ||
* | *#RR >24 | ||
* | *#Temperature >38 (100.4) | ||
* | *#Exam findings consistent with focal consolidation, egophony, or fremitus | ||
* | *#Age >64yr | ||
===Epidemiology=== | ===Epidemiology=== | ||
*Viruses are most common cause | *Viruses are most common cause | ||
**[[Influenza]], paraflu, RSV, | **[[Influenza]], paraflu, [[RSV]], [[coronavirus]], [[adenovirus]], [[rhinovirus]] | ||
*Bacterial cause occurs in <10% of cases | *Bacterial cause occurs in <10% of cases | ||
**[[Mycoplasma]], [[C. pneumoniae]], [[pertussis]] (1% of bronchitis cases) | **[[Mycoplasma]], [[C. pneumoniae]], [[pertussis]] (1% of bronchitis cases) | ||
==Clinical Features== | ==Clinical Features== | ||
*[[Cough]], with or without sputum, without evidence of [[ | [[File:Depiction of a person suffering from Bronchitis.png|thumb|]] | ||
*[[Cough]], with or without sputum, without evidence of [[pneumonia]], common cold, or [[asthma]] | |||
**Cough >5d is more suggestive of bronchitis than common cold | **Cough >5d is more suggestive of bronchitis than common cold | ||
**Cough may persist for 10-20d | **Cough may persist for 10-20d | ||
**Cough >3wk suggests asthma, [[COPD]], pertussis, postnasal drip, GERD | **Cough >3wk suggests [[asthma]], [[COPD]], [[pertussis]], postnasal drip, [[GERD]] | ||
*Often follows [[URI]] | *Often follows [[URI]] | ||
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{{Cough DDX}} | {{Cough DDX}} | ||
== | ==Evaluation== | ||
[[File:MildPerihilarairwaycuffing.png|thumb|Mild peri hilar cuffing as seen in a viral bronchitis. [[CXR]] may alternatively be negative and is not required for diagnosis.]] | |||
*Clinical diagnosis | *Clinical diagnosis | ||
*CXR only indicated in elderly or suspicion for [[ | *[[CXR]] only indicated in elderly or suspicion for [[pneumonia]] | ||
==Management== | ==Management== | ||
===American College of Chest Physicians 2006 Guidelines<ref>Braman SS. Chronic cough due to chronic bronchitis: ACCP evidence-based clinical practice guidelines. Chest. Jan 2006;129(1 Suppl):104S-115S.</ref>=== | ===American College of Chest Physicians 2006 Guidelines<ref>Braman SS. Chronic cough due to chronic bronchitis: ACCP evidence-based clinical practice guidelines. Chest. Jan 2006;129(1 Suppl):104S-115S.</ref>=== | ||
*Routine treatment with antibiotics is NOT necessary | *Routine treatment with antibiotics is NOT necessary | ||
*Antitussive agents can be useful ([[codeine]], dextromethorphan) | *Antitussive agents can be useful ([[codeine]], [[dextromethorphan]]) | ||
*In individuals without comorbidities antibiotics have NO IMPROVEMENT in symptoms or duration <ref>Aagaard E, Gonzales R. Management of acute bronchitis in healthy adults. Infect Dis Clin North Am. Dec 2004;18(4):919-37</ref> | *In individuals without comorbidities, antibiotics have NO IMPROVEMENT in symptoms or duration <ref>Aagaard E, Gonzales R. Management of acute bronchitis in healthy adults. Infect Dis Clin North Am. Dec 2004;18(4):919-37</ref> | ||
*Do not treat patients with antibiotics unless:<ref>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</ref> | *Do not treat patients with antibiotics unless:<ref>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</ref> | ||
**older than 65 years | **older than 65 years | ||
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;Despite the recommendations for no antibiotics in the non complicated course of acute bronchitis, patients continue to receive antibiotic prescriptions<ref>Barnett, Michael. Jeffrey A. Linder. Antibiotic Prescribing for Adults With Acute Bronchitis in the United States, 1996-2010. May 21, 2014, 311(19)</ref> | ;Despite the recommendations for no antibiotics in the non complicated course of acute bronchitis, patients continue to receive antibiotic prescriptions<ref>Barnett, Michael. Jeffrey A. Linder. Antibiotic Prescribing for Adults With Acute Bronchitis in the United States, 1996-2010. May 21, 2014, 311(19)</ref> | ||
*Oral Steroids do not reduce duration or severity of symptoms in patients with acute bronchitis <ref>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)</ref> | |||
==Disposition== | ==Disposition== | ||
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[[Category:Pulmonary]] | [[Category:Pulmonary]] | ||
[[Category:ID]] | |||
Latest revision as of 20:38, 24 April 2024
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)