Acute Bronchitis

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Acute bronchitis is a _____________ inflammation of the bronchi, caused by ____________ inflammation.

self-limiting
upper airway

What is the etiology of acute bronchitis?

cause by microbial infection
#1 cause is VIRAL

What are some viral infections that can cause acute bronchitis?

influenza A and B
para-influenza
coronavirus
rhinovirus
RSV (typically in peds)

What are some bacterial infections that can cause acute bronchitis?

mycoplasma pneumoniae
bordatella pertussis
chlamydophila pneumoniae (rare)

Bacterial causes are RARE, except in patients with...

-tracheostomy
-ET tubes
-chronic bronchitis
-immunocompromised pts

What is a common bacteria found in the sputum of pts with trach or on the vent?

MRSA, MSSA

What are the signs and symptoms of acute bronchitis?

-s/sx of the "common cold"
-cough
-fatigue/malaise
-fever (less common)
-dyspnea/bronchospasm

What are the characteristics of a cough with acute bronchitis?

-lasting > 5 days
-typically last 10-20 days
-sputum - purulent in 50%

True or false: Thick, yellowish sputum suggests a bacterial cause of acute bronchitis.

False.

Even if sputum is thick and yellowish, the most common cause is still usually viral.

True or False: A CXR is usually normal in acute bronchitis.

True

but they may have an underlying lung disease, so still need to get CXR in some cases

What are 3 cases when you should order a CXR for acute bronchitis?

-abnormal VS
-rales on chest exam
-advanced age ( >75)

What diagnostic tests should you order for acute bronchitis?

-CXR
-sputum culture (but this is non-diagnostic)
-culture posterior nasopharynx (if cough >2 weeks, or if you suspect pertussis or MRSA)
-influenza A and B titers

What might be in the Ddx for acute bronchitis?

- chronic bronchitis with A/E
-pneumonia
-postnasal drip syndrome
-asthma
-GERD

The most common cause of antibiotic abuse is....

acute bronchitis (b/c most are viral).

If you prescribe antibiotics for a patient, you should also prescribe (or advise them to get) ________ in order to prevent ________.

probiotics

c.diff (also yeast infections in women)

What are 4 possible types of medications used for treatment of acute bronchitis?

1. antibiotics???
2. cough suppressant
3. cough expectorant
4. bronchodilators

Cough suppressants should only be taken.....

at night

(d/t risk of drowsiness, danger driving, etc)

In pts with acute bronchitis who are bronchospastic, you can give them ________.

albuterol

(but usually only for a couple weeks)

What can you use for symptomatic treatment of acute bronchitis?

NSAIDs
Nasal decongestants
? 7-day course of inhaled or oral steroids +/- albuterol

typically self-limiting so just treat symptomatically

Per the ACP and CDC, _______ is the ONLY indication for antibiotics with acute bronchitis.

pertussis

Per NICE recommendations, you should only use Abx in acute bronchitis in:

patients >65 plus 2 of the following, or patients >85 plus one:
-hospitalized in past yr
-T1 or T2 DM
-Hx of CHF
-use of oral steroids

"Whooping cough" is caused by......

bordatella pertussis

(a gram neg coccobacillus)

What are the three stages of pertussis?

1. catarrhal phase (~1wk)
2. Paroxysmal phase (several weeks)
3. Convalescent phase (up to 1 month)

The first stage of pertussis may be missed because it can mask as ______

a viral URI or bronchitis

In the _________ stage of pertussis, people may cough so hard that they bring up gastric contents, causing vomiting and possible aspiration, known as

paroxysmal

posttussive emesis

pertussis is most common in children age _______

< 6 months

_________ of adults can have sweats with pertussis.

40-50%

What are 4 treatment options for pertussis?

-erythromycin (7-14 days)
-zithromax
-clarithromycin (500mg BID x 7 days)
-Bactrim DS (BID x 14 days)

If a person received a pertussis vaccine as a child but you suspect it clinically, what would be important to ask?

Have they received a booster?

Which people have indications for a pertussis booster (Dtap)?

everyone, but especially health care workers, elderly exposed to infants/children (like grandparents)

Acute bronchitis can often lead to _______, which can be fatal.

pneumonia

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