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Acute Bronchitis
Etiology, Clinical Features, Diagnosis,
Investigations, Management, Prevention
Prof. Imran Iqbal
Fellowship in Pediatric Neurology (Australia)
Prof of Paediatrics (2003-2018)
Prof of Pediatrics Emeritus, CHICH
Prof of Pediatrics, CIMS
Multan, Pakistan
(God speaking to Prophet Muhammad (PBUH)
And HE (Allah) raised the heavens and imposed the balance.
So that you do not transgress in the balance.
Keep the balance with justice and do not reduce the measure
Al Quran surah Al-Rehman 55:7-9
Case scenario
• A 4 years old child presents to OPD with cough and fever for
the last 3 days. Mother says, he is having wet cough which
comes many times a day.
• On examination, his respiration is 35 per minute and chest
indrawing is not present. On auscultation of chest, few
ronchi and few scattered crepitations are heard. His
temperature is 100 F. His ears and throat are normal.
• How will you classify this child in IMNCI ?
• What is your most likely diagnosis ?
IMNCI – Cough or Difficult Breathing
Classification at first level of care
IMNCI
Treat Cough or Difficult Breathing
• Severe Pneumonia or Very Severe Disease –
Referral / Admit
• Pneumonia -- Amoxycillin (oral)
-- Paracetamol (if fever)
-- Salbutamol (if wheezing)
• Cough and Cold -- Salbutamol (if wheezing)
-- safe, soothing remedies for cough
Acute bronchitis
Acute bronchitis
• Can be seen at all ages
• Causes can be VIRAL, BACTERIAL or AIR pollution
• Viral infection can be followed by Bacterial infection
Etiology
VIRAL infections
• Influenza
• Parainfluenza
• RSV
• Adeno
Bacterial infections
• Streptococcus pneumoniae
• Haemophilus influenzae
• Streptococcus pyogenes
• Staphylococcus aureus
• Moraxella catarrhalis
• Mycoplasma pneumoniae
Other causes
• Atmospheric Pollution
• Dust
• Chemical irritants
• Tobacco smoke
• Allergens
• GERD
Clinical Features
• Symptoms
• Runny nose (viral infections)
• Cough – dry (viral infections), wet (bacterial infection)
• Wheeze (allergy)
• Fever (low to high)
• Muscle pains (viral infections)
• Signs on Examination
• Harsh vesicular breathing
• Rhonchi
• Crepitations
Diagnosis
• Clinical symptoms
• Chest examination signs
• Type of cough
• Investigations
Differential Diagnosis
• Allergic rhinitis
• Asthma
• Bronchiolitis
• Pneumonia
• Whooping Cough
• Foreign body bronchus
• Aspiration of GI contents (swallowing problems)
• Chronic bronchitis (due to irritants, pollution)
Investigations
• CBC
• CRP
• Chest X-ray
• Sputum cultures
MANAGEMENT
• Supportive management –
• Hydration - extra fluids
• Nutrition – small frequent feeds
• Symptomatic management –
• Bronchodilators
• Anti-pyretics (paracetamol / ibuprofen)
• Cough suppressants (dry cough) / home remedies (honey, tea)
• Specific management – Antibiotics (bacterial infections)
– Amoxycillin OR Co-amoxiclav OR Azithromycin
– Moxifloxacin (adolescents)
Prevention of
Acute Respiratory Infections
• Vaccination –
Penta (DPT, Hib, Hep B),
Pneumococcal, Measles,
Influenza, Covid 19
• Breastfeeding, Nutrition, Micronutrients
• Masks and Social Distancing
• Hand washing,
• Control of smoking, air pollution, cold air
Thank You

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Acute bronchitis in children 2021

  • 1. Acute Bronchitis Etiology, Clinical Features, Diagnosis, Investigations, Management, Prevention Prof. Imran Iqbal Fellowship in Pediatric Neurology (Australia) Prof of Paediatrics (2003-2018) Prof of Pediatrics Emeritus, CHICH Prof of Pediatrics, CIMS Multan, Pakistan
  • 2. (God speaking to Prophet Muhammad (PBUH) And HE (Allah) raised the heavens and imposed the balance. So that you do not transgress in the balance. Keep the balance with justice and do not reduce the measure Al Quran surah Al-Rehman 55:7-9
  • 3. Case scenario • A 4 years old child presents to OPD with cough and fever for the last 3 days. Mother says, he is having wet cough which comes many times a day. • On examination, his respiration is 35 per minute and chest indrawing is not present. On auscultation of chest, few ronchi and few scattered crepitations are heard. His temperature is 100 F. His ears and throat are normal. • How will you classify this child in IMNCI ? • What is your most likely diagnosis ?
  • 4. IMNCI – Cough or Difficult Breathing Classification at first level of care
  • 5. IMNCI Treat Cough or Difficult Breathing • Severe Pneumonia or Very Severe Disease – Referral / Admit • Pneumonia -- Amoxycillin (oral) -- Paracetamol (if fever) -- Salbutamol (if wheezing) • Cough and Cold -- Salbutamol (if wheezing) -- safe, soothing remedies for cough
  • 7. Acute bronchitis • Can be seen at all ages • Causes can be VIRAL, BACTERIAL or AIR pollution • Viral infection can be followed by Bacterial infection
  • 8. Etiology VIRAL infections • Influenza • Parainfluenza • RSV • Adeno Bacterial infections • Streptococcus pneumoniae • Haemophilus influenzae • Streptococcus pyogenes • Staphylococcus aureus • Moraxella catarrhalis • Mycoplasma pneumoniae
  • 9. Other causes • Atmospheric Pollution • Dust • Chemical irritants • Tobacco smoke • Allergens • GERD
  • 10. Clinical Features • Symptoms • Runny nose (viral infections) • Cough – dry (viral infections), wet (bacterial infection) • Wheeze (allergy) • Fever (low to high) • Muscle pains (viral infections) • Signs on Examination • Harsh vesicular breathing • Rhonchi • Crepitations
  • 11. Diagnosis • Clinical symptoms • Chest examination signs • Type of cough • Investigations
  • 12. Differential Diagnosis • Allergic rhinitis • Asthma • Bronchiolitis • Pneumonia • Whooping Cough • Foreign body bronchus • Aspiration of GI contents (swallowing problems) • Chronic bronchitis (due to irritants, pollution)
  • 13. Investigations • CBC • CRP • Chest X-ray • Sputum cultures
  • 14. MANAGEMENT • Supportive management – • Hydration - extra fluids • Nutrition – small frequent feeds • Symptomatic management – • Bronchodilators • Anti-pyretics (paracetamol / ibuprofen) • Cough suppressants (dry cough) / home remedies (honey, tea) • Specific management – Antibiotics (bacterial infections) – Amoxycillin OR Co-amoxiclav OR Azithromycin – Moxifloxacin (adolescents)
  • 15. Prevention of Acute Respiratory Infections • Vaccination – Penta (DPT, Hib, Hep B), Pneumococcal, Measles, Influenza, Covid 19 • Breastfeeding, Nutrition, Micronutrients • Masks and Social Distancing • Hand washing, • Control of smoking, air pollution, cold air