acute bronchits

2. Introduction
 Bronchitis is characterised by inflamation of the
bronchiole tubes
 Chronic bronchitis is defined clinically as cough with
sputum expectoration for at least 3 months a year
during a period of 2 consecutive years.

3. Epidemology
 Common throughout the world & is one of the top 5
reasons for seeking medical care in countries that
collect such data
 No difference in racial distribution
 In terms of gender specific incidence bronchitis
affects males more than female.

4. ETIOLOGY
 Respiratory viruses are the most common cause
- Influenza A & B, Parainfluenza, Respiratory syncitial
virus & corona virus
 Mycoplasma species, chlamydia pneumoniae,
Streptococcus pneumoniae, Morexella catarrhalis &
Haemophius influenzae
 Bordetella pertussis should be considered in children
who are incompletely vaccinated.

5. Etiology contd…….
 Smoking mostly causative of chronic bronchitis
 Air pollutants & dust

6. Pathophysiology
 During an episode of acute bronchitis the cells of the
bronchial lining tissue are irritated & the mucous
membrane becomes hyperemic & edematous,
diminishing bronchial mucocillary function.
 Air passages become clogged by debris & irritation
increases
 In response copious secretion of mucus develops
which causes characterstic cough of bronchitis

7. History
 Obtain a complete history including information on exposure to
toxic substances & smoking.
 Cough is the most commonly observed symptom
- lasting greater than 5 days may suggest ac. Bronchitis
- Purulent sputum is reported in 50% of persons with bronchitis
-Changes in sputum color are due to peroxidase released by
leucocytes
 Fever suggests influenzae or pneumonia
 Dyspnea & cyanosis unless has underlying COPD or other
conditions that impairs lung function.

8. Other symptoms
 Sore throat
 Runny or stuffy nose
 Headache
 Muscle aches
 Extreme fatigue

9. Physical examination
 Varies from normal-to-pharyngeal erythema,localised
lymphadenopathy
 Rhinorrhea to coarse rhonchi & wheezes that change
in location & intensity after deep & productive cough.
 Sustained heave along the left sternal border indicates
right ventricular hypertrophy secondary to chronic
bronchitis.
 Bullous myringitits may suggest mycoplasma
pneumoniae
 Conjuctivitis, adenopathy & rhinorrhoea suggest
adenovirus infection.

10. Differential diagnosis
 Asthma
 Broncheictasis
 Broncholitis
 Chronic bronchitis
 COPD
 Gastroesophageal reflux disease
 Influenzae
 Pharyngitis
 Sinusitis
 Streptoccocus Group A infections

11. Work up
 Complete blood count
 Cultures & stainings
- throat swab & sputum
- Blood culture
 Prolactin levels  useful to distinguish bacterial from non
bacterial infections
 Chest radiography if suggestive of pneumonia
 Bronchoscopy To exclude foreign body aspiration,
tuberculosis,tumors,& other chronic disease of
tracheobronchial tree & lungs.
 Spirometery

12. Work up contd…..
 Laryngoscopy to exclude epiglottis

13. Medical care
 Therapy generally focussed on allevation of symptoms
 Prescribe medications that open obstructed bronchial
airways & thin obstructive mucus so that can be
coughed up more easily
 Should ensure that patient is oxygenating adequately
 Bed rest is recommended.
 Avoidance of environmental irritants

14. Antibiotic therapy
 Not recommended unless a risk of serious
complications exist because of comorbid conditions.
 Can be used if secondary infection & suspicion of
pertussis infection

15. Long term monitoring
 If symptoms worsen consider alternative diagnosis
 If symptoms recur 3/yr requires other investigations
 If symptoms persist for more than 1 month consider
the otheer causes of chronic cough

16. Influenzae vaccinations
 Reduce incidence of upper respiratory tract infections
 Subsequently reduce the incidence of acute bacterial
bronchitis

17. Symptomatic treatment
 Beta 2 agonist bronchodilators
 NSAIDs for mild to moderate pain
 Albute3rol & guaifenesin products treat cough,dyspnea
& wheezing

18. QUERIS?