acute bronchitis
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Etiology
- virus
- rhinovirus is most common
- influenza virus
- parainfluenza virus
- respiratory syncytial virus (RSV)
- adenovirus
- atypical organisms
- bacteria (normal oral flora)
- 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
- cough - generally productive, worse in morning
- yellow-green sputum may be purulent
- does not necessarily indicate bacterial infection
- fever, mild to moderate, generally without chills
- dyspnea, generally mild
- symptoms of upper respiratory tract infection may be present or precede episode of acute bronchitis: rhinorrhea, pharyngitis, cervical lymphadenopathy
- wheezing or rhonchi extinguished after coughing may be present[13]
Laboratory
- sputum Gram's stain & culture generally not useful
- blood tests not indicated
Radiology
- chest X-ray is normal
- distinguish bronchitis from pneumonia
Differential diagnosis
- lower respiratory tract infection
- pneumonia
- bronchiolitis (young children)
- cough with upper respiratory tract infection
- sinusitis, acute or chronic
- nasopharyngitis
- cough from non-infectious causes
Management
- supportive treatment
- beta-adrenergic receptor agonists: albuterol nebulizer, MDI
- cough suppressants
- antibiotics not recommended*[5][9][10]
- amoxicillin not effective[3]
- amoxicillin clavulanate not effective[4]
- expectorants not shown to be useful
- NSAIDs not effective[4]
- avoid antihistamines: dry secretions
- hydration
- smoking cessation
* despite recommendations, antibiotic use is ~70%[7]
More general terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 120-121
- ↑ Journal Watch 21(3):22, 2001 Gonzales & Sande, Ann Intern Med 133:981, 2000
- ↑ 3.0 3.1 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: https://www.ncbi.nlm.nih.gov/pubmed/23265995 - ↑ 4.0 4.1 4.2 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24097128 <Internet> http://www.bmj.com/content/347/bmj.f5762
- ↑ 5.0 5.1 Medical Knowledge Self Assessment Program (MKSAP) 16, 17. American College of Physicians, Philadelphia 2012, 2015.
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/11255532
- ↑ 7.0 7.1 Barnett ML and Linder JA Antibiotic Prescribing for Adults With Acute Bronchitis in the United States, 1996-2010. JAMA. 2014;311(19):2020-2022 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24846041 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1872806
- ↑ 8.0 8.1 Braman SS Chronic cough due to acute bronchitis: ACCP evidence-based clinical practice guidelines. Chest. 2006 Jan;129(1 Suppl):95S-103S. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16428698
- ↑ 9.0 9.1 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: https://www.ncbi.nlm.nih.gov/pubmed/24585130 - ↑ 10.0 10.1 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26785402 <Internet> http://annals.org/article.aspx?articleid=2481815
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/26333656
- ↑ Kinkade S, Long NA. Acute bronchitis. Am Fam Physician 2016 Oct 1; 94:560 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27929206 Free article
- ↑ 13.0 13.1 13.2 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: https://www.ncbi.nlm.nih.gov/pubmed/32092323
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/34210668
- ↑ Acute Cough Illness (Acute Bronchitis) http://www.cdc.gov/getsmart/campaign-materials/info-sheets/adult-acute-cough-illness.pdf