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Acute Bronchitis

Acute airway course inflammation (bronchitis) by irritants

Acute bronchitis is a common, acute inflammation of the bronchi, with fever and a productive cough.


Presentation

Cardiovascular

There may be chest tightness involved depending on the severity. Although acute bronchitis is usually self-limiting with frequent bouts can lead to chronic bronchitis and possibly COPD and heart failure.

Musculoskeletal

The main symptom in this category would be muscle aches due to the chills and fever, and chest discomfort from the coughing.

Respiratory

Production of sputum that is usually white and clear, but can also be yellowish-grey or green in color, occurs. Occasionally, but rarely, it can be streaked with blood. There may also be shortness of breath due to the inflammation of the bronchial tubes and not being able to get enough air flow to the lungs. Tachypnea may be present. Productive cough of more than 5 days duration may already be suggestive of bronchitis [5].

Systemic

Sometimes there can be a slight fever and chills, as in flu like symptoms. If the acute bronchitis is from a bacterial infection, it possibly, but rarely can get into the blood stream and cause bacteremia.

Cough
  • Pertussis should be suspected in patients with cough persisting for more than two weeks that is accompanied by symptoms such as paroxysmal cough, whooping cough, and post-tussive emesis, or recent pertussis exposure.[ncbi.nlm.nih.gov]
  • Children and adult patients with confirmed and probable whooping cough should receive a macrolide antibiotic and should be isolated for 5 days from the start of treatment; early treatment within the first few weeks will diminish the coughing paroxysms[ncbi.nlm.nih.gov]
  • There were no significant differences in daily cough scores nor in the number of patients still coughing after seven days (control rate 73%; RR 0.77, 95% CI 0.54-1.09).[ncbi.nlm.nih.gov]
  • There were no significant differences in daily cough scores nor in the number of patients still coughing after seven days (control rate 73%; relative risks (RR) 0.77, 95% CI 0.54 to 1.09).[ncbi.nlm.nih.gov]
  • There is no evidence to support the use of beta2-agonists in children with acute cough who do not have evidence of airflow obstruction. There is also little evidence that the routine use of beta2-agonists is helpful for adults with acute cough.[ncbi.nlm.nih.gov]
Pneumonia
  • We conclude that C. pneumoniae can be a major cause of acute bronchitis.[ncbi.nlm.nih.gov]
  • The respective areas under the curve (AUCs) were calculated and compared with that of body temperature, an acknowledged clinical sign to differentiate pneumonia from acute bronchitis in primary care. 11 of 95 patients had radiographically confirmed pneumonia[ncbi.nlm.nih.gov]
  • Pneumonia should be suspected in patients with tachypnea, tachycardia, dyspnea, or lung findings suggestive of pneumonia, and radiography is warranted.[ncbi.nlm.nih.gov]
  • Little is known of the inflammatory characteristics of acute infections of the respiratory tract caused by virus and unusual bacteria such as Chlamydia pneumoniae.[ncbi.nlm.nih.gov]
  • A total of 435 patients were diagnosed as having acute bronchitis (vs. probable pneumonia, n 75), and 1.8% (n 8) were positive for atypical pathogens (Bordetella pertussis, n 3; B. parapertussis, n 0; Mycoplasma pneumoniae, n 1; Chlamydophila pneumoniae[ncbi.nlm.nih.gov]
Sputum
  • These observations suggest that sputum might be useful to monitor an inflammatory/immune response of the airway in acute infections.[ncbi.nlm.nih.gov]
  • To evaluate the efficacy of oral anti-inflammatory or antibiotic treatment compared with placebo in the resolution of cough in patients with uncomplicated acute bronchitis and discoloured sputum.[ncbi.nlm.nih.gov]
  • Sputum specimens were collected for polymerase chain reaction (PCR) and culture of microorganisms. Of the 811 enrolled patients, 291 had acceptable sputum specimens that were included for analysis of the etiologic distribution.[ncbi.nlm.nih.gov]
  • In otherwise healthy people, green sputum is often present during viral infections .[pulmccm.org]
  • Acute bronchitis is a self-limiting infectious disease characterized by acute cough with or without sputum but without signs of pneumonia. About 90% of cases are caused by viruses.[ncbi.nlm.nih.gov]
Sore Throat
  • Bronchitis may also cause a sore throat, wheezing and a blocked nose. The symptoms of bronchitis. The main symptom of bronchitis is a hacking cough.[emedmd.com]
  • You should also call your doctor if your symptoms (sore throat, wheezing, coughing, chest congestion, body aches) last more than two weeks and/or if you experience any of the following symptoms: coughing or wheezing that worsens when you lie down or exercise[sharecare.com]
  • throat nasal congestion and runny nose Physical exam pulmonary auscultation wheezes rhonchi Studies Making the diagnosis based on history and physical exam imaging is not necessary Differential Pneumonia differentiating factor a cough with fever, tachypnea[medbullets.com]
  • Before you know it, the virus that triggered mucus production in your sinuses or caused a sore throat invades your bronchial tubes. All of sudden, you've got a pretty nasty, phlegmy cough.[health.com]
  • Sinus congestion Chest congestion Shortness of breath Wheezing Fatigue Body aches or chills Chest discomfort from coughing Acute Bronchitis The typical progression of bronchitis symptoms starts with a runny nose, sore throat, productive cough and low-grade[verywell.com]
Productive Cough
  • There were no significant differences regarding the presence of night cough, productive cough, or activity limitations at follow up, or in the mean duration of activity limitations.[ncbi.nlm.nih.gov]
  • The differences in presence of a productive cough at follow-up and MD of productive cough did not reach statistical significance.Antibiotic-treated patients were more likely to be unimproved according to clinician's global assessment (six studies with[ncbi.nlm.nih.gov]
  • The differences in presence of a productive cough at follow-up and MD of productive cough did not reach statistical significance.Antibiotic-treated participants were more likely to be improved according to clinician's global assessment (6 studies with[ncbi.nlm.nih.gov]
  • Ambulatory adults with productive cough of or 2 weeks at out-patient respiratory disease clinics in Nairobi, Kenya, were recruited and assessed for clinical response to therapy.[ncbi.nlm.nih.gov]
  • A total of 2099 patients aged 0-93 years with productive cough for less than six days without indication for treatment with antibiotics were given EPs 7630-solution in an age-dependent dosage for 14 days.[ncbi.nlm.nih.gov]
Fever
  • Musculoskeletal The main symptom in this category would be muscle aches due to the chills and fever, and chest discomfort from the coughing.[symptoma.com]
  • As a therapy for AB, TRQ has potentially beneficial effect in improving effective rates, reducing the time to resolution of fever, cough, crackles and absorption of shadows on X-ray.[ncbi.nlm.nih.gov]
  • You have a high fever that does not come down after taking a fever-relieving medication, such as acetaminophen or aspirin. If a fever lasts more than three days. Any time you have chest pain, you should call your doctor for advice.[health.harvard.edu]
  • He denies any subjective fever, acid reflux, and has not had his influenza vaccination. On physical exam, there are wheezes and rhonchi on pulmonary auscultation.[medbullets.com]
  • Non-specific disease symptoms (loss of appetite, diarrhoea, headache, vomiting, and fever) were also recorded, together with adverse events and overall ratings of efficacy and tolerability.[ncbi.nlm.nih.gov]
Dutch
  • Dutch GPs prescribe antibiotics in the majority of elderly patients with acute bronchitis and in half of the episodes of exacerbations of COPD.[ncbi.nlm.nih.gov]
Chest Pain
  • Wheezing and chest pain were associated with higher ABSS values, whereas irrelevant clinical variables were not.[ncbi.nlm.nih.gov]
  • The BSS subscales cough, sputum, rhales/rhonchi, chest pain during coughing, and dyspnoea improved to a similar extent in both treatment groups.[ncbi.nlm.nih.gov]
  • There were also marked improvements in the individual symptoms, which are the components of BSS - cough, chest pain on coughing, sputum, rales/rhonchi and dyspnoea - in the treatment group, relative to placebo. Patient satisfaction was very good.[ncbi.nlm.nih.gov]
  • The primary outcome criterion was the mean change of the Bronchitis Severity Score (BSS: cough, sputum, rales/rhonchi, chest pain at cough, dyspnoea) from baseline to patient's individual last observation.[ncbi.nlm.nih.gov]
Tachycardia
  • Pneumonia should be suspected in patients with tachypnea, tachycardia, dyspnea, or lung findings suggestive of pneumonia, and radiography is warranted.[ncbi.nlm.nih.gov]
  • […] nasal congestion and runny nose Physical exam pulmonary auscultation wheezes rhonchi Studies Making the diagnosis based on history and physical exam imaging is not necessary Differential Pneumonia differentiating factor a cough with fever, tachypnea, or tachycardia[medbullets.com]
  • Symptoms of acute bronchitis typically persist for approximately three weeks. 3 Pneumonia can usually be ruled out in patients without fever, tachypnea, tachycardia, or clinical lung findings suggestive of pneumonia on examination. 4 However, cough may[aafp.org]
  • During an epidemic of influenza, the finding of both cough and fever was reported to have a positive predictive value of 79% for this condition. 27 Diagnostic Testing At the bedside, cough in the absence of fever, tachycardia, and tachypnea suggests bronchitis[nejm.org]
Myalgia
  • The history should focus on type and length of symptoms, paying particular attention to worrisome systemic symptoms (such as fevers, myalgia, dyspnea) more commonly seen in pneumonia.[journals.lww.com]

Workup

  • The first thing that the healthcare provider will be to ask questions regarding health history, such as smoking, second hand smoke or working in noxious inhalants.
  • The healthcare provider will then listen to the lungs for air exchange and wheezing. They will listen for the presence of rhonchi, prolonged expiration and wheezing.
  • The sputum can be tested for the presence of bacteria.
  • Oxygen saturation percentage will be measured with a pulse oximeter.
  • Chest x-ray may be done to rule out the presence of pneumonia.
  • Blood tests may be performed.
  • If necessary, pulmonary function tests and spirometry may be done, but these are performed when other diseases are suspected, such as COPD.

Treatment

The recommended treatment for acute bronchitis leans more towards palliative care, such as ibuprofen or acetaminophen for chills and fever, plenty of fluids and antitussives. Acute bronchitis is self-limiting and resolves on its own, although the cough may continue for a few more weeks. Antibiotics usually are not recommended as typically it is caused by a viral infection [6].

Antibiotic therapy may be given to high risk patients like those with asthma, smokers and Chronic Obstructive Pulmonary Disease (COPD), coupling it with bronchodilators significantly reduces hospital stay [7]. Studies further supports that using antibiotics in bronchitis cases can reduce hospital re-visits of patients from 76.8% to 27% in a 3 year period [8].

Occasionally a short-term dose of steroids may help with the inflammation of the bronchial tubes. Oral anti-inflammatory agents has been used to control the inflammation in acute bronchitis [9].

Prognosis

Acute bronchitis is almost always self limiting and clears up usually in 2 to 3 weeks without antibiotics. Some people, including infants, the elderly and those with pre-existing lung or cardiovascular diseases may be at higher risk of complications.

Although the main course of the acute bronchitis will subside quickly, the cough may continue for weeks after. If it lasts longer than a month, the physician may refer the patient to an otorhinolaryngologist, to see if something other than the bronchitis is causing the irritation to the lungs.

Complications

About one out of 20 people who experience acute bronchitis may develop a secondary infection which can become pneumonia.

Those that may be at risk for pneumonia are:

  • Infants, babies and the elderly where there is diminished immunity and are more susceptible to a secondary infection.
  • Patients with lung or heart conditions, these can include patients with COPD, heart failure patients and those with asthma.
  • Diabetics may complicate to Acute Respiratory Distress Syndrome if bronchitis episodes remains too long [4].
  • Smokers are more susceptible to develop chest infections, which can lead to a bacterial infection after having bronchitis.

Etiology

Acute bronchitis most often caused by a viral infection. The most common viruses are Rhinovirus, Influenza A virus, Influenza B virus, Parainfluenza virus, Corona virus and Respiratory Syncytial Virus [1]. The acute form of bronchitis can also be the result of inhaling things that can irritate the bronchial tubes such as smoke and toxic fumes, including ammonia. Smoking is one of the major causes of acute bronchitis.

Sometimes acute bronchitis can be caused by bacteria, such as Streptococcus. This can happen after a viral infection, such as a cold or the flu, which does not get better. Acute bronchitis can last 3 to 10 days, but the cough can last several weeks after the infection is gone.

Epidemiology

In the general population almost 5% will develop acute bronchitis in the US, the most occurrences happen during the fall and winter months. One of the top 5 reasons for children to see their Pediatrician is for lower respiratory infections, which include both acute and chronic bronchitis. Acute bronchitis is seen in males and females equally.

It is also seen in children under two years of age and then again between the ages of 9 and 15. Younger children exposed to second hand smoking and polycyclic aromatic hydrocarbons are more susceptible to develop bronchitis [2]. Elder patients are more prone to bronchitis because of their relatively low Forced Expiratory Volume (FEV), thus tend to accumulate more air and bacteria compared to the younger population [3].

Sex distribution
Age distribution

Pathophysiology

Usually a viral infection, such as a cold or the flu, can turn into acute bronchitis, producing excess mucous and a cough lasting for several weeks in 50% of those affected, and 25% have the cough for a month or more.

An airway that is exposed to certain environmental agents, such as irritants or allergens, responds quickly to a cough and bronchospasm, followed by mucous production, edema and inflammation. This fact may explain why chronic bronchitis in children is actually asthma. The mucociliary clearance is a primary defense mechanism that helps protect the lungs from the damage caused by the inhalation of pollutants, pathogens and allergens.

Prevention

There is no way to prevent acute bronchitis from occurring but steps can be taken to reduce the risks. Smoking or being in a smoking environment can be a big trigger for those who have had episodes if bronchitis or whose pulmonary status is already compromised.

Receiving an annual flu shot is also recommended. Children receiving pneumonia and flu vaccines controls protracted bacterial bronchitis and prevents recurrent coughing [10]. Avoiding the inhalation of noxious irritants, especially in enclosed areas.

Summary

Viruses, bacteria, and other agents can cause inflammation of the inner lining of the bronchial tubes, a condition which is referred to as acute bronchitis. Production of mucus causes one of the main symptoms - cough. Often acute bronchitis follows an upper respiratory infection.

Patient Information

Acute bronchitis is an inflammation of the bronchial tubes, the major airways into the lungs, which may be usually caused by bacteria and viruses.

Common signs and symptoms are:

Most cases of bronchitis are caused by a viral infection and resolve themselves within a few days to weeks.

References

Article

  1. Albert RH. Diagnosis and treatment of acute bronchitis. Am Fam. Physician. 2010; 82(11):1345-50 (ISSN: 1532-0650)
  2. Ghosh R; Topinka J; Joad JP; Dostal M; Sram RJ; Hertz-Picciotto I. Air pollutants, genes and early childhood acute bronchitis. Mutat Res. 2013; 749(1-2):80-6 (ISSN: 0027-5107)
  3. Jivcu C, Gotfried M. Gemifloxacin use in the treatment of acute bacterial exacerbation of chronic bronchitis.Int J Chron Obstruct Pulmon Dis. 2009;4:291-300.
  4. Homsi S; Milojkovic N; Alawad B; Homsi Y. Prolonged period of acute bronchitis with late progression to acute respiratory distress syndrome as possible result of influenza A (H1N1) virus infection. J Ark Med Soc. 2012; 109(4):62-4 (ISSN: 0004-1858)
  5. Wenzel RP, Fowler AA 3rd. Clinical practice. Acute bronchitis. N Engl J Med. Nov 16 2006;355(20):2125-30.
  6. Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA. Sep 17 1997;278(11):901-4.
  7. Kroening-Roche JC; Soroudi A; Castillo EM; Vilke GM. Antibiotic and bronchodilator prescribing for acute bronchitis in the emergency department.J Emerg Med. 2012; 43(2):221-7 (ISSN: 0736-4679)
  8. Roth S; Gonzales R; Harding-Anderer T; Bloom FJ; Graf T; Stahl MS; Maselli JH; 
  9. Metlay JP. Unintended consequences of a quality measure for acute bronchitis. Am J Manag Care. 2012; 18(6):e217-24 (ISSN: 1936-2692)
  10. Llor C; Moragas A; Bayona C; Morros R; Pera H; Cots JM; Fernández Y; Miravitlles M; Boada A. Effectiveness of anti-inflammatory treatment versus antibiotic therapy and placebo for patients with non-complicated acute bronchitis with purulent sputum. The BAAP Study protocol.BMC Pulm Med. 2011; 11:38 (ISSN: 1471-2466)
  11. Priftis KN; Litt D; Manglani S; Anthracopoulos MB; Thickett K; Tzanakaki G; Fenton P; Syrogiannopoulos GA; Vogiatzi A; Douros K; Slack M; Everard ML. Bacterial bronchitis caused by Streptococcus pneumoniae and nontypable Haemophilus influenzae in children: the impact of vaccination.Chest. 2013; 143(1):152-7 (ISSN: 1931-3543)

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Last updated: 2018-06-22 08:51