Acute bronchitis

Background

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

Epidemiology

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

Diagnosis

• Cough, with or without sputum, without e/o PNA, 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

Work-Up

• CXR only indicated in elderly or suspicion for PNA

Treatment

• American College of Chest Physicians 2006 Guidelines
  • Routine treatment w/ abx is not justified
  • Antitussive agents can be useful (codeine, DM)
  • Little evidence pro or con regarding mucolytics
  • Bronchodilators only useful if there is wheezing

Source

Tintinalli