BRONCHITIS - Disease Management

Bronchitis is an inflammation of the tracheobronchial tree. It is generally self-limiting and with eventual complete healing and return of normal function. Commonly, it is mild but may become serious in debilitated patients and in those with chronic lung, or heart disease. The cause is usually infectious, but allergens and irritants can produce a similar clinical picture. Bronchitis typically occurs in the setting of an upper respiratory illness and therefore is seen more frequently In the winter.

Causes

• Virus:-Adenovirus, coronavirus, influenza A and B viruses, parainfluenza virus, respiratory syncytial virus, coxsackievirus A21, rhinovirus, and the viruses that cause rubella and measles.
• Bacteria:-Mycoplasma pneumoniae, Bordetella pertussis, and Chlamydia pneumoniae, Moraxella catarrhalis, Mycoplasma, Streptococcus pneumoniae.

Risk Factors

• Chronic pulmonary diseases
• Chronic sinusitis Bronchopulmonary allergy
• Hypertrophied tonsils and adenoids in children
• Immunocompetent
• Air pollutants
• Elderly
• Infants
• Smoking, passive smoking
• Alcoholism
• Reflux esophagitis
• Tracheostomy
• IgA deficiency
• Environmental changes

Signs and Symptoms

• Preceding respiratory tract infection, such as a common cold with coryza, malaise, chills, fever,sore throat, back and muscle pain.
• Cough, dry and productive initially later productive.
• Dyspnea.
• Rales Ronchi, wheezing.
• Infected pharynx.

DIAGNOSIS

Differential Diagnosis

• Influenza
• Bronchopneumonia
• Bronchiectasis
• Acute sinusitis
• Aspiration
• Cystic fibrosis
• Reactive airways disease
• Bacterial tracheitis

Investigations

• Chest X-ray
• Arterial blood gases should be monitored when the serious underlying chronic respiratory disease is present.
• Gram stain and sputum culture should be performed to determine the causative organism.
• Pulmonary function tests.

TREATMENT

Goal

Provide symptomatic relief and treat according to the predominant organism.

Non-Pharmacological Treatment

• Stop smoking
• Steam inhalations
• Rest

Pharmacological Treatment

Antipyretic analgesic

Antibiotics:-Antibiotics are indicated when there is pertussis infection or when purulent sputum is present, or when high fever persists

• Oral tetracycline
• Trimethoprim-sulfamethoxazole
• Amoxicillin--If M. pneumoniae or C. pneumoniae is the causative agent
• Macrolides

PATIENT EDUCATION

• Stop smoking
• Rest until the fever subsides
• Recommend oral fluids up to 3-4 L/day during the febrile course

Complications

• Bronchopneumonia
• Acute respiratory failure

Prognosis

Usually, complete healing, can be serious with elderly or debilitated patients, cough may persist for several weeks after initial improvement.