1Likes
Acute Bronchitis
Acute Bronchitis
Bronchitis refers to an inflammatory condition of the large elements of the tracheobronchial tree that is usually associated with a generalized respiratory infection. The inflammatory process does not extend to include the alveoli.
Pathophysiology
Respiratory viruses are by far the most common infectious agents associated with acute bronchitis. The common cold viruses, rhinovirus and coronavirus, and lower respiratory tract pathogens, including influenza virus, adenovirus, and respiratory syncytial virus, account for the majority of cases.
Mycoplasma pneumoniae also appears to be a frequent cause of acute bronchitis. Other bacterial causes include Chlamydia pneumoniae and Bordetella pertussis.
Clinical Presentation
Bronchitis is primarily a self-limiting illness and rarely a cause of death. Acute bronchitis usually begins as an upper respiratory infection. The patient typically has nonspecific complaints such as malaise and headache and sore throat.
Cough is the hallmark of acute bronchitis. It occurs early and will persist despite the resolution of nasal or nasopharyngeal complaints. Frequently, the cough is initially nonproductive but progresses, yielding mucopurulent sputum.
Treatment
The treatment of acute bronchitis is symptomatic and supportive in nature. Reassurance and antipyretics alone are often sufficient. Bedrest and mild analgesic-antipyretic therapy are often helpful in relieving the associated lethargy, malaise, and fever. Patients should be encouraged to drink fluids to prevent dehydration and possibly decrease the viscosity of
respiratory secretions.
• Aspirin or acetaminophen (650 mg in adults or 10 to 15 mg/kg per dose in children with a maximum daily adult dose of 4 g and 60 mg/kg for children)
Ibuprofen (200 to 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 4 to 6 hours.
In children, aspirin should be avoided and acetaminophen used as the preferred agent because of the possible association between aspirin use and the development of Reye’s syndrome.
Mist therapy and/or the use of a vaporizer may further promote the thinning and loosening of respiratory secretions.
Persistent, mild cough, which may be bothersome, may be treated with
dextromethorphan; more severe coughs may require intermittent codeine or other similar agents.
Routine use of antibiotics in the treatment of acute bronchitis is discouraged; however, in patients who exhibit persistent fever or respiratory symptomatology for more than 4 to 6 days, the possibility of a concurrent bacterial infection should be suspected.
M. pneumoniae, if suspected by history or positive cold agglutinins (titers greater than or equal to 1:32) or if confirmed by culture or serology, may be treated with azithromycin. Also, a fluoroquinolone with activity against these pathogens (levofloxacin) may be used in adults.
During known epidemics involving the influenza A virus, amantadine or
rimantadine may be effective in minimizing associated symptomatology if administered early in the course of the disease.
Reply With Quote
Originally Posted by Nik 
