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acute bronchitis

Etiology: 1) virus a) rhinovirus is most common b) influenza virus c) parainfluenza virus d) respiratory syncytial virus (RSV) e) adenovirus 2) atypical organisms a) Mycoplasma pneumoniae b) Chlamydophila pneumoniae 3) bacteria (normal oral flora) a) Haemophilus influenzae b) Streptococcus pneumoniae c) Moraxella catarrhalis d) Bordetella pertussis 4) risk factors - smoking - passive & active Epidemiology: - seasonal - more common in winter - age - more common in younger children & older adults Pathology: - acute inflammation of the tracheobronchial tree Clinical manifestations: 1) cough - generally productive, worse in morning - lasting up to 3 weeks [8] - presentation 7-10 days after onset of cough not unusual [13] 2) yellow-green sputum may be purulent - does not necessarily indicate bacterial infection 3) fever, mild to moderate, generally without chills 4) dyspnea, generally mild 5) symptoms of upper respiratory tract infection may be present or precede episode of acute bronchitis: rhinorrhea, pharyngitis, cervical lymphadenopathy 6) wheezing or rhonchi extinguished after coughing may be present [13] Laboratory: 1) sputum Gram's stain & culture generally not useful 2) blood tests not indicated Radiology: - chest X-ray is normal - distinguish bronchitis from pneumonia Differential diagnosis: 1) lower respiratory tract infection a) pneumonia b) bronchiolitis (young children) 2) cough with upper respiratory tract infection a) sinusitis, acute or chronic b) nasopharyngitis 3) cough from non-infectious causes a) asthma b) medications c) neoplasm Management: 1) supportive treatment 2) beta-adrenergic receptor agonists: albuterol nebulizer, MDI 3) cough suppressants a) dextromethorphan b) codeine 4) antibiotics not recommended* [5,9,10] - amoxicillin not effective [3] - amoxicillin clavulanate not effective [4] 5) expectorants not shown to be useful 6) NSAIDs not effective [4] 7) avoid antihistamines: dry secretions 8) hydration 9) smoking cessation * despite recommendations, antibiotic use is ~70% [7]

General

bronchitis

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 120-121
  2. Journal Watch 21(3):22, 2001 Gonzales & Sande, Ann Intern Med 133:981, 2000
  3. Journal Watch. Jan 24, 2013 Massachusetts Medical Society - Little P et al. Amoxicillin for acute lower-respiratory-tract infection in primary care when pneumonia is not suspected: A 12-country, randomised, placebo-controlled trial. Lancet Infect Dis 2013 Feb; 13:123. PMID: 23265995
  4. Llor C et al Efficacy of anti-inflammatory or antibiotic treatment in patients with non-complicated acute bronchitis and discoloured sputum: randomised placebo controlled trial. BMJ 2013;347:f5762 PMID: 24097128 http://www.bmj.com/content/347/bmj.f5762
  5. Medical Knowledge Self Assessment Program (MKSAP) 16, 17. American College of Physicians, Philadelphia 2012, 2015.
  6. Gonzales R, Bartlett JG, Besser RE et al Principles of appropriate antibiotic use for treatment of uncomplicated acute bronchitis: background. Ann Intern Med. 2001 Mar 20;134(6):521-9. PMID: 11255532
  7. Barnett ML and Linder JA Antibiotic Prescribing for Adults With Acute Bronchitis in the United States, 1996-2010. JAMA. 2014;311(19):2020-2022 PMID: 24846041 http://jama.jamanetwork.com/article.aspx?articleid=1872806
  8. Braman SS Chronic cough due to acute bronchitis: ACCP evidence-based clinical practice guidelines. Chest. 2006 Jan;129(1 Suppl):95S-103S. PMID: 16428698
  9. The NNT: Antibiotics for the Treatment of Acute Bronchitis in Adults. http://www.thennt.com/nnt/antibiotics-for-acute-bronchitis/ - Smith SM, Fahey T, Smucny J, Becker LA. Antibiotics for acute bronchitis. Cochrane Database of Systematic Reviews 2014, 3:CD000245 PMID: 24585130
  10. Harris AM, Hicks LA, Qaseem A et al Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. Published online 19 January 2016 PMID: 26785402 http://annals.org/article.aspx?articleid=2481815
  11. Becker LA, Hom J, Villasis-Keever M, van der Wouden JC. Beta2-agonists for acute cough or a clinical diagnosis of acute bronchitis. Cochrane Database Syst Rev 2015. PMID: 26333656
  12. Kinkade S, Long NA. Acute bronchitis. Am Fam Physician 2016 Oct 1; 94:560 PMID: 27929206 Free article
  13. Smith MP, Lown M, Singh S, et al; CHEST Expert Cough Panel. Acute cough due to acute bronchitis in immunocompetent adult outpatients: CHEST Expert Panel report. Chest. 2020;157:1256-1265. PMID: 32092323
  14. Johnson MC, Hulgan T, Cooke RG, et al. Operationalising outpatient antimicrobial stewardship to reduce system-wide antibiotics for acute bronchitis. BMJ Open Qual. 2021;10. PMID: 34210668
  15. Acute Cough Illness (Acute Bronchitis) http://www.cdc.gov/getsmart/campaign-materials/info-sheets/adult-acute-cough-illness.pdf