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BRONCHITIS

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Definition

Acute bronchitis is a clinical syndrome produced byinflammation of the trachea, bronchi, and

bronchioles

In children, acute bronchitis usually occurs inassociation with viral respiratory tract infection

Symptoms of acute bronchitis usually includeproductive cough and sometimes retrosternal painduring deep breathing or coughing. Generally, theclinical course of acute bronchitis is self-limited, with

complete healing and full return to function typicallyseen within 10-1 days following symptom onset

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!ough is the most common symptom bringing

patients to the primary care physician"s office, andacute bronchitis is usually the diagnosis in thesepatients

Acute bronchitis should be differentiated from other

common diagnoses, such as pneumonia andasthma, because these conditions may need specifictherapies not indicated for bronchitis. Symptoms ofbronchitis typically last about three wee#s

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!hronic bronchitis is recurring inflammationand degeneration of the bronchial tubes that

may be associated with active infection$atients with chronic bronchitis have more

mucus than normal because of eitherincreased production or decreased clearance!oughing is the mechanism by which e%cess

secretion is cleared!hronic bronchitis is often associated with

asthma, cystic fibrosis, foreign body

aspiration, or e%posure to an airway irritant

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&he diagnosis of chronic bronchitis isreserved for patients who have cough and

sputum production on most days of themonth for at least ' months of the yearduring ( consecutive years

!hronic bronchitis has also been definedas a comple% of symptoms that includescough that lasts more than 1 month orrecurrent productive cough that may be

associated with whee)ing or crac#les onauscultation

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Etiology

&he presence or absence of colored *e.g.,

green+ sputum does not reliablydifferentiate between bacterial and virallower respiratory tract infections

iruses are responsible for more than 0percent of acute bronchitis infections

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Etiologi

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Patfis

Acute bronchitis is thought to reflect an inflammatoryresponse to infections of the epithelium of the bronchi,mucous membrane becomes hyperemic andedematous, diminishing bronchial mucociliary functionpithelial-cell des/uamation and denuding of the airway

to the level of the basement membrane in associationwith the presence of a lymphocytic cellular infiltrate

!onse/uently, the air passages become clogged bydebris and irritation increases. In response, copioussecretion of mucus develops, which causes thecharacteristic cough of bronchitisicroscopical e%amination has shown thic#ening of the

bronchial and tracheal mucosa corresponding to theinflamed areas

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$neumonia can usually be ruled out in

patients without fever, tachypnea,tachycardia, or clinical lung findingssuggestive of pneumonia on e%amination

&he presence or absence of colored *e.g.,green+ sputum does not reliably differentiatebetween bacterial and viral lower respiratorytract infections.

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&esting for pertussis should be consideredin patients who are unvaccinated2 patients

with a cough that is paro%ysmal, has a3whooping4 sound, or has lasted longerthan three wee#s2 and patients who havebeen e%posed to pertussis or unvaccinatedpersons

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Treatment

&he American !ollege of !hest $hysicians *A!!$+does not recommend routine antibiotics for

patients with acute bronchitis, and suggests thatthe reasoning for this be e%plained to patientsbecause many e%pect a prescriptionAlthough antibiotics are not recommended for

routine use in patients with bronchitis, they maybe considered in certain situations. 5henpertussis is suspected as the etiology of cough,initiation of a macrolide antibiotic is recommendedas soon as possible to reduce transmission

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American Academy of $ediatrics and the 67A to recommend againstthe use of antitussive medications in children younger than two yearsAlthough they are commonly used and suggested by physicians,

e%pectorants and inhaler medications are not recommended forroutine use in patients with bronchitis8esults of a !ochrane review do not support the routine use of beta-

agonist inhalers in patients with acute bronchitis2 however, thesubset of patients with whee)ing during the illness responded to thistherapy

!ochrane review suggests that there may be some benefit to high-dose, episodic inhaled corticosteroids, but no benefit occurred withlow-dose, preventive therapy. 9owever, there are no data to supportthe use of oral corticosteroids in patients with acute bronchitis andno asthma

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