​Kembara Xtra - Medicine - Acute Bronchitis

​Kembara Xtra - Medicine - Acute Bronchitis 

Introduction 

A common clinical illness known as acute bronchitis is defined by a persistent cough with an initial onset, either with or without sputum formation. It usually goes away on its own in one to three weeks. The focus of treatment is on patient education and supportive care because symptoms are caused by inflammation of the lower respiratory tract, which is most usually brought on by a viral infection. The majority of individuals with acute bronchitis do not require antibiotics, however they are excessively prescribed for this illness. A priority in both domestic and global health care is lowering the usage of antibiotics for acute bronchitis.
An infection of the lower respiratory tract called acute bronchitis results in reversible inflammation of the major airways without any signs of pneumonia.
The primary symptom, a persistent cough, could last up to three weeks.
Usually self-limited, with full recovery and function returning. 
If there is no underlying cardiopulmonary disease, the majority of infections are viral.

A similar term is tracheobronchitis. 

Aspects of Geriatrics 

can be severe, especially if it's accompanied by the flu and has COPD or CHF at its core.

Child Safety Considerations
Typically occurs in conjunction with various upper and lower respiratory tract disorders (the trachea is frequently affected) If attacks are frequent, a child should be checked for immunological deficiencies, respiratory anomalies, or asthma.
RSV-induced acute bronchitis has the potential to be lethal. Patients under the age of six should not take antitussive medications. 

Epidemiology (Incidence and Prevalence): Males outnumber females in terms of predominant age and gender Incidence
It accounts for around 10 percent, or 100 million visits annually, of ambulatory care visits in the US. When respiratory virus transmission is at its peak in late fall and winter, acute bronchitis is more common.

Pathophysiology and Etiology 

The majority (about 60%) of pathogens found in patients with acute bronchitis are viruses. The following viruses are the most typical causes of acute bronchitis: - Flu viruses A and B
Influenza, para.
- Rhinoviruses - Coronavirus kinds 1 through 3
two viruses: human metapneumovirus and respiratory syncytial virus
In 1-10% of instances of acute bronchitis, bacteria are found.
About 10% of individuals presenting with a cough lasting at least two weeks have signs of B. pertussis infection. Rare causes of acute bronchitis include atypical bacteria including Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Bordetella pertussis. 
Chemical allergens
Acute bronchitis damages the epithelial surfaces, increasing mucus production and thickening the bronchiole wall as a result.
Genetics
No genetic pattern is known.

Chronic bronchopulmonary diseases, chronic sinusitis, tracheostomy or endobronchial intubation, bronchopulmonary allergy, hypertrophied tonsils and adenoids in children, immunosuppression, immunoglobulin deficiency, HIV infection, alcoholism, gastroesophageal reflux disease (GERD), and environmental changes are all risk factors.


Prevention

 Steer clear of smoking and passive smoking.
Control the underlying risk factors, such as reflux, sinusitis, and asthma.
Prevent exposure, especially around childcare.
Pneumovax and influenza vaccine


The following conditions are related to allergic rhinitis: sinusitis, pharyngitis, epiglottitis (rare but quickly lethal), coryza, croup, influenza, pneumonia, asthenia, COPD/emphysema, and GERD.

Signs and Symptoms 
In most cases, the diagnosis can be made based on the history and physical examination. Acute bronchitis should be suspected in patients with an acute onset but persistent cough (often lasting 1 to 3 weeks), who do not have clinical findings suggestive of pneumonia (e.g., fever, tachypnea, rales, signs of parenchymal consolidation), and who do not have chronic obstructive pulmonary disease.
Testing is often reserved for situations when pneumonia is suspected, where the clinical diagnosis is ambiguous, or where the management will be affected by the results.


Presenting History: Long-lasting cough without signs of pneumonia, asthma attack, or COPD flare-up

The cough starts off dry and nonproductive before becoming productive; later, mucopurulent sputum is produced, which may be a sign of a secondary illness. 
Dyspnea, wheezing, and weariness may appear. Contact with people who have respiratory illnesses is possible. Cough lasts longer than five days. 
Fever may be a sign of pneumonia or influenza.

Clinical Examination: Rhonchi, wheezing, fever, tachypnea, injected pharynx, no signs of pulmonary consolidation, rales, etc.

Differential diagnosis include pneumonia, COVID-19, postnasal drip syndrome, acute sinusitis, bronchopneumonia, influenza, bacterial tracheitis, bronchiectasis, allergy, eosinophilic pneumonitis, aspiration, retained foreign body, inhalation injury, cystic fibrosis, bronchogenic carcinoma, heart failure, GERD, chronic cough, and use of ACE inhibitors.


Interpretation of Diagnostic and Laboratory Results 
Initial examinations (lab, imaging)
None are often required; a history and physical exam without postnasal drip or rales supports the diagnosis.
To simplify a complex picture, think about the following: - CBC and differential
- Influenza titers, if necessary given the season.
- SARS-CoV-2 (COVID-19) viral panel/testing is advised for all patients during the COVID-19 pandemic.
No testing is required unless pneumonia is a worry. 
If there is an underlying pulmonary disease, pulse oximetry should be performed. CXR should only be performed if there is dyspnea, bloody sputum, or rust-colored sputum.
Pulse >100 beats per minute; respiration rate >24 breaths per minute; and oral body temperature >100°F (37.8°C).
- On chest examination, focal consolidation, egophony, or fremitus 

Tests for Follow-Up and Particular Considerations

Pulmonary function tests (rarely required during acute stages): increased residual volume, decreased maximum expiratory rate, sputum culture in patients with tracheostomies or intubations, and procalcitonin 

Treatment 
Unless elderly or burdened by a serious underlying condition, outpatient therapy 
Rest, quit smoking, and steer clear of secondhand smoke.
Inhaling steam and using vaporizers
Proper hydration
Antibiotics are not advised; instead, antitussives like honey (1 tbsp every 2 to 3 hours PRN) should be used.

Treat afflictions that are related, such as GERD.

Medication Caution 
Unless a treatable pathogen has been diagnosed or major comorbidities are present, antibiotics are not advised. Patients who most likely anticipate receiving an antibiotic prescription should be informed of this.

Initial Line

 Supportive; more fluids (a cough causes more fluid loss). 
Antipyretic analgesics like aspirin, acetaminophen, or ibuprofen Decongestants if a sinus condition is present Cough suppressants for persistent cough (not in COPD); nonpharmacologic therapy includes honey (1 tbsp every 2 to 4 hours PRN), throat lozenges, and hot tea; quitting smoking and avoiding secondhand smoke is a sensible first step.

 Guaifenesin with dextromethorphan and benzonatate (Tessalon), which are not recommended for use in children under the age of six.
Mucolytic agents should not be used.
High-dose inhaled corticosteroids combined with an inhaled -agonist (such as albuterol) for the treatment of cough and bronchospasm in those with known airflow obstruction
Oseltamivir (Tamiflu), zanamivir (Relenza) (1)[B], IV peramivir (Rapivab), or baloxavir marboxil (Xofluza) if influenza is highly suspected and symptoms begin within 48 hours.
Only in cases where a curable cause (such as pertussis) is found, antibiotics.
- 500 mg of azithromycin (Zithromax) or clarithromycin (Biaxin) every 12 hours. Z-Pak for atypical or pertussis infection - Azithromycin tends to be more effective than amoxicillin or amoxicillin-clavulanic acid, but not more effective than doxycycline, in patients with acute bronchitis of a suspected bacterial cause in terms of lower incidence of treatment failure and adverse events.
If Moraxella, Chlamydia, or Mycoplasma are detected, take 100 mg of doxycycline every day for 10 days. Quinolone is used to treat more serious infections, antibiotic resistance, elderly individuals, and people with many comorbid conditions. 
Doxycycline and quinolones should not be used in pregnant women or on young children.
The effectiveness of oral contraceptives may be affected by a number of antibiotics, so take precautions.
- Infections caused by Clostridium difficile can be linked to antibiotic use.
- Children under the age of six should not use cough and cold remedies.


Secondly, should sputum culture suggest it, further antibiotics


Complications including pneumonia or respiratory failure, comorbid conditions like COPD, and cough lasting longer than three months are all reasons for referral.

Further Treatments 
Inhaled -agonist (such as albuterol) or in conjunction with high-dose inhaled corticosteroids for cough with bronchospasm are recommended as antipyretics for fever, with the exception of COVID-19 infection. Oral corticosteroids are probably not necessary.

 Lozenges for the throat are an alternative treatment for pharyngitis.

entry into a hospital 
Hypoxia—may require additional oxygen; Respiratory failure—may require CPAP or bilevel ventilation; Severe bronchospasm; Exacerbation of underlying disease; Bronchodilators if the patient is bronchospastic; IV fluids may be helpful if the patient is dehydrated. Ensure patient comfort and watch for signs of deterioration, especially if there is an underlying lung condition. 
Improvement in symptoms and comorbidities is a requirement for discharge.

Follow-up A self-limited condition that typically doesn't require follow-up, a cough can last for a few weeks.
If recurrent in youngsters, other diagnoses like asthma should be taken into account. 

Oximetry until the patient is no longer hypoxemic, then recheck for chronicity.

dietary intake
more fluid intake (3 to 4 L/day) while febrile


Prognosis: Usually complete resolution; serious in the elderly or the weak; cough may recur after an initial recovery for a number of weeks.
(Rare) Postbronchitic Reactive Airways Disease 
Organizing pneumonia with bronchiolitis obliterans (rare)

Complications include bronchopneumonia, hemoptysis, acute respiratory failure, bronchiectasis, superinfection, and chronic cough.