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BRONCHITIS

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ACUTE BRONCHITIS

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  • Acute bronchitis is characterized by inflammation of the epithelium of the large airways resulting from infection or exposure to irritating environmental triggers (eg, air pollution and cigarette smoke). The disease entity is frequently classified as either acute or chronic. Acute bronchitis occurs in all ages, whereas chronic bronchitis primarily affects adults.

  • Acute bronchitis most commonly occurs during the winter months. Cold, damp climates and/or the presence of high concentrations of irritating substances such as air pollution or cigarette smoke may precipitate attacks.

  • Respiratory viruses are the predominant infectious agents associated with acute bronchitis. The most common infecting agents include influenza A and B, respiratory syncytial virus (RSV), and parainfluenza virus, whereas the common cold viruses (rhinovirus and coronavirus) and adenovirus are encountered less frequently. Common bacterial pathogens are those associated with community-acquired pneumonia (CAP), including Mycoplasma pneumoniae, Streptococcus pneumonia, Haemophilus influenzae, and Moraxella catarrhalis.

  • Infection of the trachea and bronchi causes hyperemic and edematous mucous membranes and an increase in bronchial secretions. Destruction of respiratory epithelium can range from mild to extensive and may affect bronchial mucociliary function. In addition, the increase in bronchial secretions, which can become thick and tenacious, further impairs mucociliary activity. Recurrent acute respiratory infections may be associated with increased airway hyperreactivity and possibly the pathogenesis of chronic obstructive lung disease.

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Clinical Presentation
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  • Acute bronchitis usually begins as an upper respiratory infection. Cough is the hallmark of acute bronchitis. It occurs early and will persist despite the resolution of nasal or nasopharyngeal complaints. Frequently, the cough is initially nonproductive but progresses, yielding mucopurulent sputum.

  • Bacterial cultures of expectorated sputum are generally of limited utility because of the inability to avoid normal nasopharyngeal flora by the sampling technique. Similarly, viral cultures are unnecessary. For the vast majority of affected patients, an etiologic diagnosis is unnecessary and will not change the prescribing of routine supportive care for the management of these patients.

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Treatment
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  • Goals of Therapy: The goal is to provide comfort to the patient and, in the unusually severe case, to treat associated dehydration and respiratory compromise.

  • The treatment of acute bronchitis is symptomatic and supportive in nature. Reassurance and antipyretics alone are often sufficient. Bed rest and mild analgesic-antipyretic therapy are often helpful in relieving the associated lethargy, malaise, and fever. Patients should be encouraged to drink fluids to prevent dehydration and possibly decrease the viscosity of respiratory secretions.

  • Aspirin or acetaminophen (650 mg in adults or 10–15 mg/kg per dose in children with a maximum daily adult dose of <4 g and 60 mg/kg for children) or ibuprofen (200–800 mg in adults or 10 mg/kg per dose in children with a maximum daily dose of 3.2 g for adults and 40 mg/kg for children) is administered every 4 to 6 hours.

  • In children, aspirin should be avoided and acetaminophen used as the preferred agent because of the possible association between aspirin use ...

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