Bronchitis

Nov 22, 2021

Bronchitis

This is a condition in which there is inflammation (itis) in the bronchial tubes (airways in the lungs).  This can be viral or bacterial.  It can also be acute or chronic.  Air passes through the bronchia and bronchioles and into the air sacs of your lungs (NIH, 2021). 

Viral

This can be cold or influenza A and B, rhinovirus, parainfluenza (Singh, Avula, & Zahn, 2021) and can cause acute bronchitis.  There is no antibiotic course for this VIRAL infection.  Make sure you are educating your patients on symptom management. 

Bacterial 

Uncommon, but this can stem from the viral acute phase.  Causative bacteria Mycoplasma pneumonia, streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Bordetella pertussis are common.

Acute

This can be a quick recovery in less than a few days or a week and consists of more than 95% of cases.

Chronic

This lasts for several months and comes back two or more years in a row.  The lining of the bronchioles are inflamed.  The inflammation is causing mucus to form along the airways, epithelial-cell desquamation, and denudation of the basement membrane and causes constriction (bronchoconstriction) which leads to cough.  This is often part of chronic obstructive pulmonary disease (COPD).  Most often caused by smoking.

Risk factors

Smoking, polluted places, crowding, and history of asthma for acute bronchitis (Singh, Avula, & Zahn, 2021). 

Symptoms

Coughing is associated with mucous production and bronchoconstriction.  Patients may also demonstrate wheezing, shortness of breath, chest pain, or a low fever.  Check oxygen saturation, pulse rate, temperature, and respiratory rate.  If all are normal and no suggestion of pneumonia then no further testing is needed as long as the patient is less than 65 years of age.

Diagnosis

Physical assessment with good history and symptom assessment.  A chest X-ray may be ordered to rule out pneumonia. 

 Treatment

Acute

Treatment is for the management of symptoms for Acute / viral bronchitis.  This includes antitussives, beta-agonists for wheezing (SABA) NSAIDS (age-appropriate), honey, humidifier, vaccination, smoking cessation, and avoiding triggers. 

Chronic

Control of symptoms, healthy lifestyle changes, smoking cessation, medication to use for prevention or as needed for increased symptoms, oxygen therapy if needed, pulmonary rehabilitation, and possible referral to a pulmonologist. Vaccinations should be encouraged. 

Viral

NO ANTIBIOTICS!!! This is just symptom management.

Bacterial

Bacterial treatment for bronchitis involves the use of antibiotics. 

Old guidelines

Macrolides or doxycycline

New guidelines

Amoxicillin, macrolides, or doxycycline

Face book discussion

In the FB discussion, we discussed that it is usually viral and does not require antibiotics.  The self-limiting and treatment of symptoms.  If it was bacterial then you would need to give the patient antibiotics.  For the exam, if they give you a patient with acute bronchitis symptoms that started about 2-3 days ago, they most likely want you to think viral! Viral Infections typically last 10-14 days or less. If symptoms persist longer than 10-14 days, more likely bacterial. But the only way to know for sure in practice is to get a CBC with diff, sputum culture...but based on guidelines laboratory testing is not usually recommended in the evaluation of patients in the outpatient setting. Once you practice, also know when to do a CXR to r/o PNA in patients who initially presented with bronchitis.  Remember to have a hard discussion with patients for no need for antibiotics at this time.  Delayed prescribing to include recontact the office if symptoms persist,  a postdated prescription was given, a prescription was left at reception to be picked up if symptoms persisted, or patients were given a prescription and asked not to fill it unless symptoms persisted.  Overprescribing to appease patients. 

References

NIH. (2021). Bronchitis. Retrieved from National Heart, Lung, and Blood Institute: https://www.nhlbi.nih.gov/health/bronchitis

Singh, A., Avula, A., & Zahn, E. (2021). Acute Bronchitis. StatPearls (Internet). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK448067/

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