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ACUTE BRONCHITIS

  • Bronchitis is frequently classified as either acute or chronic. 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).

  • Acute bronchitis occurs year-round, but more commonly during the winter months. Viral infections, cold, damp climates, and/or the presence of high concentrations of irritating environmental triggers 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. Bacterial pathogens are involved in a minority of cases and involve pathogens often associated with community-acquired pneumonia (CAP).

  • 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 desquamated epithelial cells and 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 asthma and chronic obstructive lung disease.

Clinical Presentation

  • Acute bronchitis usually begins as an upper respiratory infection with nonspecific complaints. Cough is the hallmark of acute bronchitis and occurs early. The onset of cough may be insidious or abrupt, and the symptoms persist despite resolution of nasal or nasopharyngeal complaints; cough may persist for up to 3 or more weeks. Frequently, the cough initially is nonproductive, but then progresses, yielding mucopurulent sputum.

  • Fever, when present, rarely exceeds 39°C (102.2°F) and appears most commonly with adenovirus, influenza virus, and Mycoplasma pneumoniae infections.

  • Bacterial cultures of expectorated sputum are generally of limited utility because of the inability to avoid normal nasopharyngeal flora by the sampling technique. 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.

Treatment

  • Goals of Treatment: 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. Reassurance and antipyretics alone are often sufficient. Bedrest for comfort may be instituted as desired. Patients should be encouraged to drink fluids to prevent dehydration and possibly to 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 6–8 hours.

  • In children under 19 years of age, aspirin should be avoided ...

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