Acute bronchitis

Definition
- An acute inflammation of the bronchial mucosa, typically resulting from infections, occurs
without affecting the pulmonary parenchyma, specifically the alveoli
- This condition, which commonly exhibits a benign progression, may take a more severe
course particularly in extreme age groups
Epidemiology
- The most common acute lower respiratory tract infection (ALRTI)
- Major public health issues
- Causes numerous medical consultations and therapeutic prescriptions, leading to
significant school and work absenteeism
- Moreover it’s more frequent during the winter season
- It can also occur in spring or autumn
- May present as isolated cases or in small outbreaks
- It can lead to pandemic risk
- Acute bronchitis can manifest:
➢ In individuals previously in good health or impact those with risk factors
- It can complicate chronic bronchitis irrespective of its stage, leading to
exacerbations in chronic obstructive pulmonary disease (COPD)
Pathophysiology
A. Causative agents (mostly viruses)
➔ Rhinovirus
➔ Influenza and parainfluenza viruses
➔ Respiratory Syncytial virus (RSV)
➔ Coronavirus, adenovirus, enterovirus, and some herpes viruses
B. Risk factors
➔ Smoking (inflammation of bronchial epithelium)
➔ Exposure to air pollution (the particles can cause irritation at bronchial epithelium
➔ Occupational contact with irritants (people who work at the mine fields)
➔ Low socioeconomic status
➔ Immunodeficiency state (HIV, medications which decrease the level of immunity:
immunosuppressants, corticosteroids)
C. Pathogenesis (involves an initial engagement of the upper airways before
progressing to the bronchi)
➔ The typical progression goes through 2 phases
➢ The dry phase: representing the initial phase
➢ The wet phase
Pathological anatomy
- Extensive epithelial damage, with the potential for ulceration of the basement
membrane
- This is accompanied by seromucous hypersecretion, inflammatory edema
- Fortunately, complete restitution occurs in all cases
- Therefore, it takes a few weeks for resolution
- Tracheobronchial inflammation:
 Inflammatory edema
Obstruction arising from challenges in clearing viscous secretions
Destruction of bronchial epithelium
Cellular migration accompanied by vasodilation and mucus hypersecretions
- The consequences of this condition:
❖ Increased bronchial sensitivity to external aggressions, especially bacterial,
with an elevated risk of superinfection
❖ It may lead to hyper bronchial reactivity, particularly wheezing, especially in the
case of children
Clinical study
A. Description type: simple viral acute bronchitis in young adult
➢ This type of bronchitis constitutes 50 to 90% of cases in both adults and children
with acute bronchitis
➢ It frequently occurs during winter epidemics
➢ The most commonly associated viruses include:
- Myxoviruses such as Influenza and Parainfluenza as well as Rhinovirus,
Coronavirus, Respiratory Syncytial Virus(RSV), Adenovirus
1. Clinical signs
● General manifestations such as fever (>38°C)
- Constantly present in cases of influenza or adenovirus, but rare in cases
of rhinovirus

🚨It is important to note that a fever ≥ 38.5° C persistent beyond 3 days need us to
● Additional General signs encompass: headaches, myalgia

reconsider the diagnosis (think of superinfection)

During the dry phase
Functional signs:
● A dry cough, sometimes disruptive sleep
● Occasionally preceded by an upper respiratory tract infection
● Dyspnea
● Retro external pain that looks like a bilateral thoracic burning sensation and is increased
with coughing
Physical signs (generally rare)
● Presence of wheezing
● Despite the symptoms, the general condition usually remains preserved
During the wet phase
Functional signs
● The resolution of General symptoms and dyspnea
● This phase is characterized by a productive cough with seromucous or sometimes

🚨In acute bronchitis, it is emphasized that the purulent appearance is not synonymous
mucopurulent expectorations

with bacterial infection but rather indicates necrosis of the bronchial epithelium (ronchi)
Physical signs
● Normal auscultation and the presence of sonorous rhonchi
 ● In acute bronchitis, there are no focal signs suggesting parenchymal involvement
2. Paraclinical examination for this condition are typically not required
- X-ray is unnecessary unless there is doubt with pneumonia, especially in the
case of smokers
- Bacteriology is generally unnecessary
- Virology isn't necessary as well (can be useful for epidemiological studies)

Absence of focal signs in the chest exam and absence of radiological opacity
+
Usually a benign state
=
Key elements of the diagnosis

B. Clinical forms
1. Etiological forms
a. Bacterial Bronchitis involves superinfection especially in smoker with
pathogens like
- Streptococcus pneumoniae and Haemophilus influenza
- Atypical pathogens like: Mycoplasma pneumoniae, Chlamydia, and
Bordetella pertussis (10-15% of pertussis cases that occur in adults can
also contribute to this form)
- Risk factors: dental abscess, maxillary sinusitis, a suppurative focus in the

🚨It’s important to note that in acute bronchitis, a consideration is

rhinopharyngeal region particularly in children

made for ruling out tuberculosis if symptoms persist beyond 15

days in Morocco
b. Toxic Bronchitis is characterized by the inhalation of irritants in gaseous or
particulate phase, such as sulfur compounds or caustics
- This inhalation leads to acute inflammation of the bronchial mucosa and
alveolar capillary wall, often resulting in significant cough and dyspnea
- Superinfection is common in this form and may persist for a long period
c. Fungal Bronchitis involves fungal pathogens such as Candida and Aspergillus
- Predisposing factors: immunocompromised individuals, those with
neutropenia, and those who take antibiotic therapy for a long period
d. Allergic Bronchitis is characterized by exposure to allergens such as dust
mites, pollens, etc
- Episodes of recurrent acute or subacute bronchitis or tracheobronchitis
- Frequently accompanied by dyspnea
- These presentations are considered equivalent to asthma
2. Symptomatic forms
a. Acute exacerbation of chronic bronchitis (COPD)
➢ Frequently triggered by bronchial infection & these exacerbations stem from:
- Viral sources, often involving myxoviruses
 - Bacterial sources such as haemophilus influenza or streptococcus
pneumoniae
b. Serious acute bronchitis
According to the severity
- Table of diffuse severe AB: table of acute respiratory failure
- Table of suppuration: pneumonia or bronchopneumonia
- Alteration of general condition
Depending on the underlying condition of the patient
- Advanced age (>65 years)
- Subjects with co-morbidities: heart failure, hepatic, renal insufficiency, etc.
- Chronic respiratory failure
- Diabetes
- Immunosuppression: HIV, long term corticosteroid therapy, immunosuppressants
Positive diagnosis
1. Its epidemic nature
2. The following clinical features: initially a dry cough, chest pain with a burning
sensation, fever, and the production of mucous or mucopurulent sputum
3. Clinical exam including auscultation typically reveals normal findings or bronchial
rales
4. No focal signs on auscultation
5. Chest x-ray and microbiological examinations are not justified
Differential diagnosis
Cough with mucopurulent sputum
- Pulmonary tuberculosis
➢ Look for tuberculous subjects that surround the patient
➢ Generally, the signs continuous for more than 2 weeks
➢ Decrease of general state
- Bronchiectasis
➢ Symptoms are chronic, chest CT is necessary to confirm the diagnosis
- Bronchial foreign body
➢ Look for an accident of inhalation of a foreign body
- Pertussis
➢ If we have a persistent cough
Each of these conditions may present with distinctive features, and further clinical
evaluation and diagnostic tests would be necessary to differentiate and confirm the
specific diagnosis

Treatment
A. Symptomatic treatment
● Antipyretics and analgesics are recommended for managing fever, headaches,
and myalgia
● Vitamin C supplementation
● Cough suppressants, specifically opioids, are suggested when dealing with a
dry cough
 ● In case of post-viral bronchial hyperreactivity (BHR): Beta 2-agonists or
occasionally corticosteroids may be considered
● For severe cases: oxygen therapy and assisted ventilation have become
important in the therapeutic strategy
B. Empirical Antibiotic therapy (usually not recommended for AB)
1. Simple AB: NO antibiotic therapy unless
- Smokers (COPD)
- Superinfection: prolongation of purulent sputum and wet cough with
rumbling rales
2. Superinfected AB: mono antibiotic therapy for 7 days:
- Amoxicillin 2-3g/ day
- Amoxicillin + clavulanic acid (B lactamase inhibitor) 3g/day
- Macrolide: spiramycin, roxithromycin, azithromycin
- Fluoroquinolone (moxifloxacin or levofloxacin)
3. AB in COPD first line and outpatient
- Amoxicillin-Clav acid OR Macrolide OR Levofloxacin
- Duration: 10 days on average
4. Serious AB:
- Hospitalization
- Microbiological samples
- Bi-antibiotic therapy in 1st intention:
➢ Aminopenicillin-lactamase inhibitor OR 3rd generation
cephalosporin
➢ Fluoroquinolone
- Intensive care
C. Preventive care
● Smoking cessation
● Avoid pollutants, dust exposure
● Prevent contagion: cover mouth & nose with hand or tissue when coughing
● Influenza vaccination for high risk individuals (annually)
● Pneumococcal vaccination: recommended for high risk individuals to prevent bacterial
superinfection
● SARS-cov2 vaccination
Take home messages
- No need of complementary exams
- Thoracic examination is normal
- Most common cause is viral