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What is the main symptom of acute broncihitis?
When does acute bronchitis most commonly occur?
Approx ______ of adults are affected per year.
Symptoms of acute bronchitis usually resolves in _____ days, but cough duration can last ______ up to ______
What are the 6 most common causative organisms of acute bronchitis? What % do they account for?
1) Common cold viruses (Rhinovirus, coronavirus)
3) Respiratory syncytial virus (RSV)
6) Human metapneumovirus
What are the 3 most likely pathogens in patients <1yo?
What are the 3 most likely pathogens in patients 1-10 yo?
What are the 6 most likely pathogens in patients >10 yo?
What percentage of acute bronchitis is caused by bacteria?
What are 3 bacteria that can cause acute bronchitis?
1) Mycoplasma pneumonia
2) Chlamydia pneumonia
3) Bordetella pertussis
What are 2 possible non-infectious causes of acute bronchitis?
Inhalation of :
What is the usual quality of cough and how long does it last in 50% of cases?
- May or may not be productive
- Can have green sputum (due to peroxidase release from leukocytes leading to inflammation)
- > 3 weeks
What are 3 other general symptoms of acute bronchitis?
What sounds may be heard upon auscultation?
Coarse, moist, bilateral rales
Vital signs and CXR are usually ________
What are 3 goals of therapy for acute bronchitis?
1) Decrease symptoms
2) Treat associated dehydration and respiratory compromise if present
3) Minimize unnecessary use of antibiotics
What are the 2 main treatment options?
1) Non drug measures
What is the role of OTC cough and cold preparations in treatment of acute bronchitis?
Lack of evidence of efficacy, and should NOT be used in children <6.
What are 2 antitussive that may be used?
When should antitussives be used?
For relief of persistent, bothersome, non-productive cough
Who cannot use antitussives?
Can Guaifenesin be used in acute bronchitis?
Can beta2 agonist be used?
Only if benefit outweights adverse effects (eg if Hx of asthma)
What is the role of antibiotics in treatment of acute bronchitis?
Not recommend as routine use. (Most are viral infections!)
Use only if persistent fever and/or signs of concurrent bacterial infection
What is chronic bronchitis?
Irreversible reduction in maximal airflow velocity
Chronic bronchitis involves productive cough on most days of the month for ___ months over ___consecutive years.
What are 4 contributing factors of chronic bronchitis?
1) Cigarette smoking
4) Bacterial/viral infections
Chronic bronchitis, in addition to ____________ and _____________ are components of __________
What is acute exacerbation of Chronic bronchitis (AECB)?
Period of unstable lung function with worsening airflow and other symptoms (dyspnea, cough, sputum production).
____% of AECB are due to infection and ____% are due to _________
20; noninfectious causes
What are the 3 types of infections that can cause AECB?
Bacteria (most common)
What are 2 noninfectious causes of AECB?
What are 3 goals of therapy for AECB?
1) Reduce severity of chronic and acute symptoms
2) Decrease frequency and severity of acute exacerbations
3) Achieve prolonged infection-free intervals
What are 4 non-pharm treatment strategies for AECB?
1) Reduce patient exposure to irritants
2) "Pulmonary toilet": chest physical therapy
3) Oxygen therapy
What are 3 possible pharmacological options for AECB?
Give an example of a bronchodialtor that can be used, and regimen
1-2 puffs TID-QID
What are 5 positive end points for using systemic corticosteroids
1) Faster improvements in pulmonary function test (PFT)
2) Decreased treatment failures
3) Decreased hospitalization rates
4) Decreased likelihood of relapse
5) Prolongation of time to the next exacerbation
What are 4 limitations of systemic corticosteroids?
1) Most performed in ERs or hospitals
2) Patients with moderate to severe underlying disease
3) Dose and duration of CCS therapy varied widely
4) Unable to determine dose, duration, impact in patients with mild disease
What is the recommend guidelines for using systemic CCS? (drug and regimen)
Prednisone 30-40mg PO daily X 10-14 days
- can split dose BID
- No advantage to using IV
- No role in maintenance therapy
What 2 out 3 indications must be present in order to use antimicrobials for AECB?
1) Increased dyspnea
2) Increased sputum
3) Severe exacerbation requiring mechanical ventilation
What are the 4 board categories of bugs that can cause AEBC?
2) Gram (+)
3) Easy gram (-)
4) Hard gram (-)
Give an example of gram (+) that can cause AECB.
What are 3 easy gram (-) that can cause AECB
1) Haemophilus influenzae
2) Moraxella catharralis
3) Klebiella pneumoniae
What are the hard Gram (-)?
What are 6 antibiotic options for AECB without risk factors?
3) 2nd gen cephalosporin
4) Clarithro, or Azithromycin
6) Co-trimox (TMP/SMX)
What is the addtional criteria of AECB with risk factors?
1 or more of:
- FEV1 <50%
- Cardiac disease
- Home O2
- Oral steroids
- Abx in past 3 months
What are the 4 antibiotic options for AECB with risk factors?
2) Resp FQ
3) 3rd gen cephalosporins
Give the regimen for amox and amox/clav
Amox: 500mg TID
Amox/Clav: 875mg BID
Give the regiment for Co-trimoxazole.
Give the regimen for doxycycline
100mg BID X 1 day,
then 100mg OD X 4 days
Give 2 examples and their regimen for the 2nd gen cephalosporins.
Give the regimen for Azithromycin
500mg X 1 day, then 250mg daily X 4 days
500mg daily X 3 days
Give the regimen for clarithromycin
500mg PO BID
Give the regiment for ciprofloxacin
500mg PO BID
Give the regimens for the resp. fluoroquinolones.
Levofloxacin: 750mg PO daily
Moxifloxacin: 400mg PO daily
What should the treatment duration be for all antibiotics for chronic bronchitis?
What 3 signs and symptoms that should be monitored?
exercise tolerance daily
What are 3 other parameters to monitor?
1) PFT every 1-12 months
2) Number of Acute exacerbations per year
3) Adverse drug reactions from medications
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