Acute Bronchitis

Introduction

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. The disease entity is frequently classified as either acute or chronic. Acute bronchitis occurs in all ages, whereas chronic bronchitis primarily affects adults.

• Acute bronchitis most commonly occurs during the winter months. Cold, damp climates and/or the presence of high concentrations of irritating substances such as air pollution or cigarette smoke may precipitate attacks.

Clinical Presentation

• Acute bronchitis usually begins as an upper respiratory infection. The patient typically has nonspecific complaints, such as malaise and headache, coryza, 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.
• Chest examination may reveal rhonchi and coarse, moist rales bilaterally. Chest radiographs, when performed, are usually normal.
• Bacterial cultures of expectorated sputum are generally of limited utility because of the inability to avoid normal nasopharyngeal flora by the sampling technique. Viral antigen detection tests can be used when a specific diagnosis is necessary. Cultures, polymerase chain reaction (PCR), or serologic diagnosis of M. pneumoniae and culture, direct fluorescent antibody detection, or PCR for B. pertussis should be obtained in prolonged or severe cases when epidemiologic considerations would suggest their involvement.

Treatment

• Goals of Therapy: The goal is to provide comfort to the patient and, in the unusually severe case, to treat associated dehydration and respiratory compromise.
• The treatment of acute bronchitis is symptomatic and supportive in nature. Reassurance and antipyretics alone are often sufficient. Bed rest 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 10–15 mg/kg per dose in children with a maximum daily adult dose of (200–800 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.
• Persistent, mild cough, which may be bothersome, may be treated with dextromethorphan; more severe coughs may require intermittent codeine or other similar agents.
• M. pneumoniae, if suspected by history or if confirmed by culture, serology, or PCR may be treated with azithromycin. Also, a fluoroquinolone with activity against these pathogens (levofloxacin) may be used in adults