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SOURCE

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Source: Blackford MG, Glover ML, Reed MD. Lower respiratory tract infections. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=146071234. Accessed March 31, 2017.

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DEFINITION

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  • Inflammation of the epithelium of the large airways resulting from infection or exposure to irritating environmental triggers.

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ETIOLOGY

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  • Most commonly occurs during winter months.

  • Attacks precipitated by:

    • Cold, damp climates.

    • Presence of high concentrations of irritating substances.

      • Air pollution.

      • Cigarette smoke.

  • Most commonly caused by respiratory viruses such as rhinovirus and coronavirus.

  • Bacterial causes may include Mycoplasma pneumoniae, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Chlamydophila pneumoniae.

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PATHOPHYSIOLOGY

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  • Occurs in all ages.

  • Infection of trachea and bronchi causes:

    • Hyperemic and edematous mucous membranes.

    • Increase in bronchial secretions.

      • Impairs mucociliary activity.

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EPIDEMIOLOGY

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  • Recurrent acute respiratory infections may be associated with increased airway hyperreactivity and possibly pathogenesis of chronic obstructive lung disease.

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RISK FACTORS

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  • Cold, damp climate.

  • Air pollution.

  • Cigarette smoke.

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CLINICAL PRESENTATION

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  • Usually begins as upper respiratory infection with non-specific complaints.

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SIGNS AND SYMPTOMS
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  • Cough is hallmark symptom and occurs early.

    • Initially nonproductive but progresses to mucopurulent sputum.

    • Persists up to 3 weeks despite resolution of nasal or nasopharyngeal complaints.

  • Nonspecific complaints, such as malaise and headache, coryza, and sore throat.

  • Chest examination: rhonchi and coarse, bilateral, moist rales.

  • Mild to moderate wheezing.

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DIAGNOSIS

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MEANS OF CONFIRMATION AND DIAGNOSIS
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  • History and physical examination.

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LABORATORY TESTS
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  • Sputum cultures of limited utility.

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IMAGING
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  • Chest radiographs usually normal, not recommended.

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DIFFERENTIAL DIAGNOSIS
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DESIRED OUTCOMES

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  • Provide comfort to patient.

  • Avoid dehydration and respiratory compromise in severe cases.

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TREATMENT: GENERAL APPROACH

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  • Treatment symptomatic and supportive in nature.

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TREATMENT: NONPHARMACOLOGIC THERAPY

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  • Bedrest.

  • Analgesics.

  • Antipyretics.

  • Fluids.

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TREATMENT: PHARMACOLOGIC THERAPY

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  • Routine use of antibiotics in treatment of acute bronchitis discouraged.

    • If fever or respiratory symptoms persist for >5–7 days or predisposed patient (COPD, immunocompromised, elderly), consider possibility of concurrent bacterial infection.

      • Direct antibiotic therapy toward anticipated respiratory pathogen(s).

      • Empiric treatment with fluoroquinolone usually first line.

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MONITORING

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  • Patients should contact physician if symptoms do not resolve within 4–6 days.

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PROGNOSIS

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  • Primarily self-limiting illness and rarely cause of death.

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Date Written: March 31, 2017

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Contributor: Laura ...

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