Acute bronchitis is swelling and irritation in
child's air passages.
This irritation may cause him to cough or
have other breathing problems.
Acute bronchitis often starts because of
another illness, such as a cold or the flu.
The illness spreads from your child's nose
and throat to his windpipe and airways
Acute bronchitis lasts about 2 weeks and is
usually not a serious illness.
Acute bronchitis leads to the hacking cough and phlegm production that often follows upper
respiratory tract infection. This occurs because of the inflammatory response of the mucous
membranes within the lungs' bronchial passages. Viruses, acting alone or together, account for
most of these infections.
Mucociliary clearance is an important primary innate defense mechanism that protects the
lungs from the harmful effects of inhaled pollutants, allergens, and pathogens
The mucociliary apparatus consists of 3 functional compartments: the cilia, a protective mucus
layer, and an airway surface liquid (ASL) layer, which work together to remove inhaled particles
from the lung
insult to the airway epithelium, such as recurrent aspiration or repeated viral infection, may
contribute to chronic bronchitis in childhood. Following damage to the airway lining, chronic
infection with commonly isolated airway organisms may occur.
The most common bacterial pathogen that causes lower respiratory tract infections in children
of all age groups is Streptococcus pneumoniae. Nontypeable Haemophilus
influenzae and Moraxella catarrhalis may be significant pathogens in preschoolers (age < 5 y),
whereas Mycoplasma pneumoniae may be significant in school-aged children (ages 6-18 y).
Children with tracheostomies are often colonized with an array of flora, including alpha-
hemolytic streptococci and gamma-hemolytic streptococci. With acute exacerbations of
tracheobronchitis in these patients, pathogenic flora may includePseudomonas
aeruginosa and Staphylococcus aureus (including methicillin-resistant strains), among other
pathogens. Children predisposed to oropharyngeal aspiration, particularly those with
compromised protective airway mechanisms, may become infected with oral anaerobic strains
Infection: Acute bronchitis is most often caused by a type of germ called a virus. It may also be
caused by other germs, such as bacteria, yeast, or a fungus.
Viral :Adenovirus, Influenza, Parainfluenza, Respiratory syncytial virus, Rhinovirus, Human
bocavirus, Coxsackievirus, Herpes simplex virus
Bacterial :S pneumoniae, M catarrhalis, H influenzae , Chlamydia
pneumoniae , Mycoplasma species
Polluted air: Acute bronchitis can be caused when your child breathes air that has chemical
fumes, dust, or pollution.
Cigarette smoke: If you smoke around your child, he may be at higher risk for acute bronchitis.
Medical problems: Your child may be more likely to get bronchitis if he has other medical
problems. Examples include asthma, frequent swollen tonsils, allergies, or heart problems.
Premature birth: Babies who are premature (born too early) may be at higher risk for
retrosternal pain during deep breathing or coughing.
Generally, the clinical course of acute bronchitis is self-limited, with
complete healing and full return to function typically seen within 10-14
days following symptom onset.
constant cough. The cough may last up to a month. Cough may be
dry, or cough up with mucus. Mucus may be green, yellow, white, or
have streaks of blood in it. Chest pain may appear when he coughs or
takes a deep breath.
fever, body aches, and chills.
sore throat and a runny or stuffy nose.
short of breath and wheezes (makes a high-pitched noise) when
Tiredness more than usual.
Caption: Acute bronchitis.
Bronchoscope view of the two
bronchi at the bottom of the
windpipe (trachea) of a patient
with acute bronchitis. The
mucosal lining of these airways
is inflamed and coated with a
thick secretion called sputum.
Lungs may sound normal.
Crackles, rhonchi, or large airway
wheezing, if any, tend to be scattered and
The pharynx may be injected.
History of :
Retained foreign body
serum C-reactive protein screen,
serum cold agglutinin
Obtain a blood or sputum culture if antibiotic
therapy is under consideration.
test nasopharyngeal, using antigen or
polymerase chain reaction testing
for Chlamydia species and respiratory
syncytial, parainfluenza, and influenza viruses or
Gram stain, chlamydial and viral antigen
assays, and bacterial and viral cultures.
Asthma Testing. clinical response to daily high-dose oral corticosteroids
,Evidence of reversible airflow obstruction revealed by pulmonary
Cystic Fibrosis Testing. A negative sweat test result exclude cystic
Immunodeficiency . measurement of total serum immunoglobulins,
immunoglobulin G (IgG) subclasses, and specific antibody production is
Chest Radiography. Chest films generally appear normal in patients with
uncomplicated bronchitis. Focal consolidation is not usually present.
Pulmonary Function . show airflow obstruction that is reversible with
Bronchoscopy. diagnosis of chronic bronchitis is suggested if the
airways appear erythematous and friable.
Medical therapy generally targets symptoms and includes use of
analgesics and antipyretics. Antitussives and expectorants are
The prototype antitussive, codeine, has been successful in some
chronic-cough and induced-cough models, such asguaifenesin
Bronchodilators ,albuterol may be worthwhile, as it may provide
significant relief of symptoms for some patients.
Antibiotics. When bacterial etiology is suspected or as
prophylaxis to secondary infections.
Antivirals. When viral etiology is suspected.
Referral to a pediatric pulmonologist may be
helpful for patients experiencing persistent or
recurrent symptoms and whose histories
suggest the possibility of tracheobronchial
foreign body aspiration, cystic
fibrosis, immunodeficiency, or persistent
asthma for which appropriate first-line
symptom or controller therapies have failed.
Complications are extremely rare and should
prompt evaluation for anomalies of the
respiratory tract, including immune
deficiencies. Complications may include the
Acute respiratory failure
Instruct older patients regarding the need for
immunization against pertussis, diphtheria, and
influenza, which reduces the risk of bronchitis due to the
Instruct these patients to avoid passive environmental
tobacco smoke; to avoid air pollutants, such as wood
smoke, solvents, and cleaners; and to obtain medical
attention for prolonged respiratory infections.
Instruct parents that children may attend school or
daycare without restrictions except during episodes of
acute bronchitis with fever. Also instruct parents that
children may return to school or daycare when signs of
infection have decreased, appetite returns, and
alertness, strength, and a feeling of well-being allow.
Acute bronchitis is almost always a self-limited
process in the otherwise healthy child.
However, it frequently results in absenteeism from
school and, in older patients, work.
Chronic bronchitis is manageable with proper
treatment and avoidance of known triggers
(eg, tobacco smoke).
Proper management of any underlying disease
process, such as asthma, cystic
fibrosis, immunodeficiency, heart
failure, bronchiectasis, or tuberculosis, is also key.
These patients need careful periodic monitoring to
minimize further lung damage and progression to
chronic irreversible lung disease.