Acute bronchitis in children


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Acute bronchitis in children

  1. 1. KSMU – Pediatric Department Fabio Grubba 2013
  2. 2.  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.
  3. 3.  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 of streptococci.
  4. 4.  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 bronchitis.
  5. 5.  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 breathing.  Tiredness more than usual.
  6. 6. 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.
  7. 7.  Lungs may sound normal.  Crackles, rhonchi, or large airway wheezing, if any, tend to be scattered and bilateral.  The pharynx may be injected.
  8. 8. History of :  Retained foreign body  Bronchopulmonary allergy  Immunosuppression  Previous infections
  9. 9.  serum C-reactive protein screen,  respiratory culture,  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 viral culture.  Gram stain, chlamydial and viral antigen assays, and bacterial and viral cultures.
  10. 10.  Asthma Testing. clinical response to daily high-dose oral corticosteroids ,Evidence of reversible airflow obstruction revealed by pulmonary function testing.  Cystic Fibrosis Testing. A negative sweat test result exclude cystic fibrosis.  Immunodeficiency . measurement of total serum immunoglobulins, immunoglobulin G (IgG) subclasses, and specific antibody production is recommended.  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 bronchodilators  Bronchoscopy. diagnosis of chronic bronchitis is suggested if the airways appear erythematous and friable.
  11. 11.  Medical therapy generally targets symptoms and includes use of analgesics and antipyretics. Antitussives and expectorants are often prescribed  The prototype antitussive, codeine, has been successful in some chronic-cough and induced-cough models, such asguaifenesin or dextromethorphan.  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.  Corticoids inhalative
  12. 12.  Analgesic and antipyretic agents Acetaminophen (Tylenol, Aspirin-Free Anacin, Feverall) Ibuprofen (Ibuprin, Advil, Motrin)  Corticosteroids, systemic Prednisolone (Pediapred, Orapred) Prednisone (Sterapred)  Bronchodilators Albuterol sulfate (Proventil, Ventolin) Metaproterenol Theophylline (Theo-24, Uniphyl)  Antibiotics Erythromycin (EES, E-Mycin, Ery-Tab) Clarithromycin (Biaxin) Azithromycin (Zithromax) Tetracycline (Sumycin) Doxycycline (Vibramycin) Amoxicillin-clavulanic acid (Augmentin)  Antivirals Oseltamivir (Tamiflu) Zanamivir (Relenza)  Corticosteroids, inhaled Beclomethasone (Qvar) Fluticasone (Flovent HFA, Flovent Diskus) Budesonide inhaled (Pulmicort Flexhaler, Pulmicort Respules)
  13. 13.  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.
  14. 14.  Complications are extremely rare and should prompt evaluation for anomalies of the respiratory tract, including immune deficiencies. Complications may include the following:  Bronchiectasis  Bronchopneumonia  Acute respiratory failure
  15. 15.  Instruct older patients regarding the need for immunization against pertussis, diphtheria, and influenza, which reduces the risk of bronchitis due to the causative organisms.  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.
  16. 16.  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.
  17. 17.   children.html  care-in-india/bronchitis-in-children.html   symptoms-information/  bronchitis-viral-with-high-fever/  t/AcuteBronchitis.aspx
  18. 18. THE END