Acute bronchitis: Difference between revisions

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==Background==
==Background==
*Inflammation of large airways of the lung  
*Inflammation of large airways of the lung  
*[[PNA]] must be excluded by clinical evaluation or by CXR
*[[Pneumonia]] must be excluded by clinical evaluation or by CXR
**If all 5 are negative PNA is safely excluded:
*If all 5 are negative pneumonia is safely excluded:
***1. HR >100
*#HR >100
***2. RR >24
*#RR >24
***3. Temp >38 (100.4)
*#Temperature >38 (100.4)
***4. Exam findings c/w focal consolidation, egophony, or fremitus
*#Exam findings consistent with focal consolidation, egophony, or fremitus
***5. Age >64yr
*#Age >64yr


==Epidemiology==
===Epidemiology===
*Viruses are most common cause
*Viruses are most common cause
**Influenza, paraflu, RSV, corona, adeno, rhino
**[[Influenza]], paraflu, RSV, corona, adeno, rhino
*Bacterial cause occurs in <10% of cases
*Bacterial cause occurs in <10% of cases
**Mycoplasma, C. pneumoniae, pertussis (1% of bronchitis cases)
**[[Mycoplasma]], [[C. pneumoniae]], [[pertussis]] (1% of bronchitis cases)


==Diagnosis==
==Clinical Features==
*Cough, with or without sputum, without e/o [[PNA]], common cold, or [[Asthma]]  
*[[Cough]], with or without sputum, without evidence of [[pneumonia]], common cold, or [[Asthma]]  
**Cough >5d is more suggestive of bronchitis than common cold
**Cough >5d is more suggestive of bronchitis than common cold
**Cough may persist for 10-20d
**Cough may persist for 10-20d
**Cough >3wk suggests asthma, [[COPD]], pertussis, postnasal drip, GERD
**Cough >3wk suggests asthma, [[COPD]], pertussis, postnasal drip, GERD
*Often follows URI
*Often follows [[URI]]


==Work-Up==
==Differential Diagnosis==
*CXR only indicated in elderly or suspicion for PNA
{{Cough DDX}}


==Treatment==
==Evaluation==
*American College of Chest Physicians 2006 Guidelines<ref>Braman SS. Chronic cough due to chronic bronchitis: ACCP evidence-based clinical practice guidelines. Chest. Jan 2006;129(1 Suppl):104S-115S.</ref>
*Clinical diagnosis
**Routine treatment w/ abx is not justified
*[[CXR]] only indicated in elderly or suspicion for [[pneumonia]]
**Antitussive agents can be useful (codeine, dextromethorphan)
 
**In individuals without comorbidities antibiotics have no improvement in symptoms or duration <ref>Aagaard E, Gonzales R. Management of acute bronchitis in healthy adults. Infect Dis Clin North Am. Dec 2004;18(4):919-37</ref>
==Management==
**Don not treat patients with antibiotics unless:<ref>Tan T, Little P, Stokes T. Antibiotic prescribing for self limiting respiratory tract infections in primary care: summary of NICE guidance. BMJ. Jul 23 2008;337</ref>
===American College of Chest Physicians 2006 Guidelines<ref>Braman SS. Chronic cough due to chronic bronchitis: ACCP evidence-based clinical practice guidelines. Chest. Jan 2006;129(1 Suppl):104S-115S.</ref>===
***older than 65 years  
*Routine treatment with antibiotics is NOT necessary
***recent hospitalizations in the past year
*Antitussive agents can be useful ([[codeine]], dextromethorphan)
***Diabetes
*In individuals without comorbidities antibiotics have NO IMPROVEMENT in symptoms or duration <ref>Aagaard E, Gonzales R. Management of acute bronchitis in healthy adults. Infect Dis Clin North Am. Dec 2004;18(4):919-37</ref>
***On chronic steroids
*Do not treat patients with antibiotics unless:<ref>Tan T, Little P, Stokes T. Antibiotic prescribing for self limiting respiratory tract infections in primary care: summary of NICE guidance. BMJ. Jul 23 2008;337</ref>
**older than 65 years  
**Recent hospitalizations in the past year
**Diabetes
**On chronic steroids
**If treating based upon the above criteria then a 5 day treatment is preferred <ref> El Moussaoui R, Roede BM, Speelman P, Bresser P, Prins JM, Bossuyt PM. Short-course antibiotic treatment in acute exacerbations of chronic bronchitis and COPD: a meta-analysis of double-blind studies. Thorax. May 2008;63(5):415-22</ref>
**Bronchodilators only useful if there is wheezing
**Bronchodilators only useful if there is wheezing
**If treating based upon the above criteria then a 5 day treatment is preferred <ref> El Moussaoui R, Roede BM, Speelman P, Bresser P, Prins JM, Bossuyt PM. Short-course antibiotic treatment in acute exacerbations of chronic bronchitis and COPD: a meta-analysis of double-blind studies. Thorax. May 2008;63(5):415-22</ref>


==Source==
;Despite the recommendations for no antibiotics in the non complicated course of acute bronchitis, patients continue to receive antibiotic prescriptions<ref>Barnett, Michael. Jeffrey A. Linder. Antibiotic Prescribing for Adults With Acute Bronchitis in the United States, 1996-2010. May 21, 2014, 311(19)</ref>
 
==Disposition==
*Typically outpatient
 
==See Also==
 
==References==
<references/>
<references/>


[[Category:Pulm]]
[[Category:Pulmonary]]

Revision as of 07:29, 9 September 2016

Background

  • Inflammation of large airways of the lung
  • Pneumonia must be excluded by clinical evaluation or by CXR
  • If all 5 are negative pneumonia is safely excluded:
    1. HR >100
    2. RR >24
    3. Temperature >38 (100.4)
    4. Exam findings consistent with focal consolidation, egophony, or fremitus
    5. Age >64yr

Epidemiology

Clinical Features

  • Cough, with or without sputum, without evidence of pneumonia, common cold, or Asthma
    • Cough >5d is more suggestive of bronchitis than common cold
    • Cough may persist for 10-20d
    • Cough >3wk suggests asthma, COPD, pertussis, postnasal drip, GERD
  • Often follows URI

Differential Diagnosis

Cough

Acute (< 3 wks)

Chronic (> 8 wks)

Evaluation

  • Clinical diagnosis
  • CXR only indicated in elderly or suspicion for pneumonia

Management

American College of Chest Physicians 2006 Guidelines[1]

  • Routine treatment with antibiotics is NOT necessary
  • Antitussive agents can be useful (codeine, dextromethorphan)
  • In individuals without comorbidities antibiotics have NO IMPROVEMENT in symptoms or duration [2]
  • Do not treat patients with antibiotics unless:[3]
    • older than 65 years
    • Recent hospitalizations in the past year
    • Diabetes
    • On chronic steroids
    • If treating based upon the above criteria then a 5 day treatment is preferred [4]
    • Bronchodilators only useful if there is wheezing
Despite the recommendations for no antibiotics in the non complicated course of acute bronchitis, patients continue to receive antibiotic prescriptions[5]

Disposition

  • Typically outpatient

See Also

References

  1. Braman SS. Chronic cough due to chronic bronchitis: ACCP evidence-based clinical practice guidelines. Chest. Jan 2006;129(1 Suppl):104S-115S.
  2. Aagaard E, Gonzales R. Management of acute bronchitis in healthy adults. Infect Dis Clin North Am. Dec 2004;18(4):919-37
  3. Tan T, Little P, Stokes T. Antibiotic prescribing for self limiting respiratory tract infections in primary care: summary of NICE guidance. BMJ. Jul 23 2008;337
  4. El Moussaoui R, Roede BM, Speelman P, Bresser P, Prins JM, Bossuyt PM. Short-course antibiotic treatment in acute exacerbations of chronic bronchitis and COPD: a meta-analysis of double-blind studies. Thorax. May 2008;63(5):415-22
  5. Barnett, Michael. Jeffrey A. Linder. Antibiotic Prescribing for Adults With Acute Bronchitis in the United States, 1996-2010. May 21, 2014, 311(19)