Bronchitis
Bronchitis is a condition that causes the airways in
the lungs to become inflamed, leading to coughing
and sometimes mucus production
Intro
• Bronchitis frequently is classified as acute or
chronic
• Acute bronchitis occurs in individuals of all
ages, whereas chronic bronchitis primarily
affects adults
• Bronchiolitis is a disease of infancy.
ACUTE BRONCHITIS
Epidemiology and Etiology
• Winter months
• Cold, damp climates and the presence of high
concentrations of irritating substances (e.g.,
air pollution, cigarette smoke) may precipitate
attacks
Epidemiology and Etiology
• Respiratory viruses are by far the most
common infectious agents associated with
acute bronchitis
• The common cold viruses (rhinovirus and
coronavirus) and lower respiratory tract
pathogens (influenza virus and adenovirus)
account for the majority of cases
Epidemiology and Etiology
• In children, similar pathogens are observed,
with the addition of the parainfluenza viruses
• Mycoplasma pneumoniae appears to be a
frequent cause of acute bronchitis
• Additionally, Chlamydia pneumoniae and
Bordetella pertussis have been associated with
acute respiratory tract infections
Pathogenesis
• Infection of the trachea and bronchi yield
hyperemic and edematous mucous
membranes with an increase in bronchial
secretions
• Destruction of respiratory epithelium can
range from mild to extensive and may affect
bronchial mucociliary function
Pathogenesis
• In addition, the increase in bronchial
secretions, which can become thick and
tenacious, further impairs mucociliary activity
Signs and symptoms
• Cough persisting >5 days to weeks
• Coryza, sore throat, malaise, headache
• Fever rarely >39°C
Physical examination
• Rhonchi
• Purulent sputum in ~50% of patients
PHARMACOLOGIC THERAPY
• Mild analgesic–antipyretic therapy
• Acetaminophen (650 mg in adults or 10–15
mg/kg per dose in children)
• Ibuprofen (200–800 mg in adults or 10 mg/kg
per dose in children) should be administered
every 4 to 6 hours
PHARMACOLOGIC THERAPY
• Use of ibuprofen as an antipyretic has
increased
PHARMACOLOGIC THERAPY
• Patients suffering from acute bronchitis
frequently medicate themselves with
nonprescription cough and cold remedies
containing various combinations of
antihistamines, sympathomimetics, and
antitussives despite the lack of definitive
evidence supporting their effectiveness
PHARMACOLOGIC THERAPY
• Although not recommended for routine use,
persistent, mild cough, which may be
bothersome, can be treated with
Dextromethorphan
• More severe coughs may require intermittent
codeine or other similar agents
PHARMACOLOGIC THERAPY
• Routine use of antibiotics for treatment of
acute bronchitis should be discouraged !!
PHARMACOLOGIC THERAPY
• In previously healthy patients who exhibit
persistent fever or respiratory symptoms for
more than 4 to 6 days or in predisposed
patients (e.g., elderly, immunocompromised),
the possibility of a concurrent bacterial
infection should be suspected
PHARMACOLOGIC THERAPY
• During known epidemics involving the
influenza A virus
• Aamantadine or rimantadine may be effective
in minimizing associated symptoms if
administered early in the course of the disease
PHARMACOLOGIC THERAPY
• Also, the neuraminidase inhibitors (e.g.,
zanamivir and oseltamivir) are active against both
influenza A and B viral infections and may reduce
the severity and duration of the influenza episode
if administered promptly during the onset of the
viral infection
• Unfortunately, the incidence of influenzae virus
resistance to available antiviral drugs is increasing
Chronic Bronchitis
Definition
• Chronic bronchitis is a disease of the bronchi
that is manifested by cough and excessive
sputum expectoration that occurs on most
days of the week for a minimum of 3
consecutive months per year for at least 2
consecutive years that is unrelated to other
pulmonary or cardiac disease
Risk factors
• Cigarette smoking
• Exposure to occupational dusts, fumes, and
environmental pollution
• Host factors
Pathogenesis
• Chronic inhalation of irritants
• Inflammation mediated through IL 1-6-8, TNF
• Scarring and fibrosis
CP & Physical examination
• Productive cough
• Cor pulmonale
• Increased number of polymorphonuclear
granulocytes &/or eosinophils
CP & Physical examination
• Rhonchi
• Clubbing of digits
• Chest radiograph changes
• Erythrocytosis (Advanced stage)
PHARMACOLOGIC THERAPY
• β2-agonist bronchodilators (e.g., as albuterol
aerosol)
• Inhaled Anticholinergics
• Antibiotic therapy
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