PULMONOLOGY1

ACUTE BRONCHITIS
Inflammatory dz of lower respiratory tract 2/2 acute infection. Viral agents responsible for overwhelming majority of cases. Mycoplasma pneumoniae and Chlamydia pneumoniae found in up to !"

infection. ;ypothesized that asthma symptoms in these patients actually represent a chronic Chlamydia bronchitis infection.

$ts e&perience )6: along with in the severity of cough or character of the sputum. <hese types of episodes are categorized as an acute e&acerbation of chronic bronchitis, which should not #ot all pts w/viral respiratory infections have acute be confused with acute bronchitis in an otherwise bronchitis. Interaction between an infectious agent and healthy person. a susceptible host. Pathophysiology $ts w/pre%e&isting bronchial irritation from sources such as cigarettes or occupational e&posures and those with $atients with chronic bronchitis have7 =aily productive cough for more than 4 months/yr a predisposition to reactive airways are more li'ely to for 2 consecutive years. e&hibit symptoms consistent with acute bronchitis during a viral respiratory infection. (&perience irreversible bronchial wall thic'ening and hypertrophy of underlying mucous glands Pathophysiology secondary to prolonged e&posure to bronchial (&cessive mucus production and airway narrowing irritants such as cigarette smo'e. (&cessive mucus associated with acute inflammation )ymptoms. secretion results in the daily sputum production that )pirometry reversible airway obstruction * typifies chronic bronchitis. asthmatics. +s acute bronchitis episode resolves, :ecause of the e&cessive mucus production and poor spirometry revert to normal. mucociliary clearance, patients with chronic bronchitis often e&perience superinfection with Clinical presentation bacteria and are more susceptible to respiratory often accompany those of -.I viruses. :ecause the mucus present in the bronchial / 0ow%grade fever tree is an ideal culture medium for bacteria, the 2/ $roductive cough that worsens with e&ercise or bacteria found in sputum often do not represent an reclining. 1enerally lasts %2 wee's, although up to acute infection9 rather, they are colonizers. <here is no 22" of patients may cough for 3 month simple way to differentiate colonization from 4/ #ight cough superinfection, however. 5/ 6cc. audible wheezing. 2/ Variable colored sputum7 usually clear or white but $iagnosis may be yellow, green, or blood%tinged. Color is not +cute e&acerbation of chronic bronchitis is defined as accurate predictor of whether bacteria are involved changes in respiratory status and sputum appearance in the infection. without evidence of underlying pneumonia. 8/ Minor blood%strea'ing of sputum. Caused by inflammatory changes in the bronchial tree. 0arge )ymptoms7 amounts of bleeding or a cough producing blood respiratory distress or clots should prompt evaluation for other sources of worsened dyspnea in the presence of bleeding. change in the color or consistency of sputum, or severity CXR7 )hould be limited to pts in whom $#+ is strongly of cough usually are sufficient to ma'e the diagnosis. suspected. #ot indicated if pt does not have a high fever or signs of $#+ on $(. :ecause of the compromised respiratory status of May be useful if pt has hemoptysis and is at high patients with chronic bronchitis, a chest radiograph ris' for bronchogenic malignancies9 however, in may be useful to e&clude pneumonia as the cause of high%ris' patients, cancer is not e&cluded by a these symptoms. normal chest film. Ca"sati%e &gents7 CBC and Gram s stain o! the sp"t"m7 not useful in 1ram>s stain of sputum is not useful in directing therapy ma'ing the diagnosis or guiding treatment. because many organisms may colonize the respiratory tract in pts with chronic bronchitis, #reatment7 / M. pneumonia :ecause 3 " of cases of acute bronchitis caused by a 2/ ;aemophilus influenzae virus, +b& not effective 4/ )treptococcus pneumoniae )ymptomatic treatment7 5/ :ranhamella catarrhalis / bronchodilators7 pts treated with active drug were Many acute e&acerbations actually may be viral in origin almost twice as li'ely to have stopped coughing in . wee' as those treated with antibiotics or placebo. 2/ cough suppressants7 useful in patients w/cough that #reatment interferes with their ability to wor' or rest. Codeine% =ue to underlying bacteria in respiratory tract of pts containing cough medications are effective agents. w/chronic bronchitis ? difficulty in deciding when a bacterial infection is present, most acute e&acerbations Complications of chronic bronchitis are treated with +b&. #early all pts w/acute bronchitis have resolution of their &nti'iotic selection7 symptoms within 2 wee's. =ifficult offending organism is not usually small proportion continue to cough for month or identified. +lthough multiple suggestions have been longer. Chronic use of a bronchodilator may offered to guide +b& selection, the original studies alleviate their symptoms. that demonstrated improvement all used either $ossible Mycoplasma, :ortadella pertussis or tetracycline analogues, amo&icillin, or Chlamydia infection7 0ittle evidence to substantiate sulfametho&azole%trimethoprim @)MA%<M$/. that bacterial infections are more li'ely in patients :ecause there is no evidence that cephalosporins, with chronic cough. #evertheless, empirical use of Buinolones, or macrolides are superior to these drugs a macrolide when coughing for a month may be and all are more e&pensive, treatment with more cost effective than pursuing other laboratory tetracycline/do&ycycline or amo&icillin, or )MA%<M$ or radiologic tests. (hort co"rses o! corticosteroids7 +dult%onset asthma7 large proportion have $rednisone7 may shorten the course and severity of serologic evidence of previous C. pneumoniae acute e&acerbations of chronic bronchitis.

CHRONIC BRONCHITIS

)PULMONOLOGY
+cute e&acerbations may also afford another opportunity to counsel tobacco%using patients about the need to discontinue smo'ing.

Complications
.espiratory failure ? need for mechanical ventilation are rare but can occur in pts w/very limited respiratory reserve.

Pre%ention
)mo'ing cessation is the first 'ey to reducing progression of chronic bronchitis and ris' of an e&acerbation. +nnual influenza vaccination