BRONCHITIS SCHEMATIC DIAGRAM PATHOPHYSIOLOGY Etiologic Agent: Bacteria Virus Predisposing Factors: Precipitating Factors: #ospitalization $nad%isable En%ironment

!mo"ing &alnutrition Elderly Immobilization Immune Deficiency Long erm Illness !mo"ing

Microorganism enter respiratory tract by droplet inhalation Widespread inflammation occurs (Increased goblet cells, squamous metaplasia of columnar epithelium, acute leukotic and lymphocytic infiltration of bronchial walls) Thin mucous lining of the bronchi can become irritated and swollen Cells that make up this inflammation Coughing as a refle that !l"eolar fluid increase #arrowing of airways $entilation decreases as Mucus within the airways cause se"ere "entilation% lining may leak fluids in response to the

works to clear secretions from the lungs

secretion thickens produces resistance in small airways and can perfusion imbalance

http&''nurseslabs(com

Bronchitis is one of the top conditions for which patients seek medical care. It is characterized by inflammation of the bronchial tubes (or bronchi), the air passages that extend from the trachea into the small airways and alveoli. ( ee !linical "resentation.) !hronic bronchitis is defined clinically as cough with sputum expectoration for at least # months a year during a period of $ consecutive years. !hronic bronchitis is associated with hypertrophy of the mucus%producing glands found in the mucosa of large cartilaginous airways. &s the disease advances, progressive airflow limitation occurs, usually in association with pathologic changes of emphysema. 'his condition is called chronic obstructive pulmonary disease. ( ee !linical "resentation.) (hen a stable patient experiences sudden clinical deterioration with increased sputum volume, sputum purulence, and)or worsening of shortness of breath, this is referred to as an acute exacerbation of chronic bronchitis, as long as conditions other than acute tracheobronchitis are ruled out. ( ee *iagnosis.) 'riggers of bronchitis may be infectious agents, such as viruses or bacteria, or noninfectious agents, such as smoking or inhalation of chemical pollutants or dust. Bronchitis typically occurs in the setting of an upper respiratory illness+ thus, it is observed more fre,uently in the winter months. ( ee -tiology.)

http&''nurseslabs(com

&llergens and irritants can produce a similar clinical picture. &sthma can be mistakenly diagnosed as acute bronchitis if the patient has no prior history of asthma. In one study, one third of patients who had been determined to have recurrent bouts of acute bronchitis were eventually identified as having asthma. .enerally, bronchitis is a diagnosis made by exclusion of other conditions such as sinusitis, pharyngitis, tonsillitis, and pneumonia. ( ee *iagnosis.) &cute bronchitis is manifested by cough and, occasionally, sputum production that last for no more than # weeks. &lthough bronchitis should not be treated with antimicrobials, it is fre,uently difficult to refrain from prescribing them. &ccurate testing and decision%making protocols regarding who might benefit from antimicrobial therapy would be useful but are not currently available. ( ee 'reatment and /anagement, as well as /edication.) 'o see complete information on "ediatric Bronchitis, please go to the main article by clicking here.

Pathophysiology
*uring an episode of acute bronchitis, the cells of the bronchial%lining tissue are irritated and the mucous membrane becomes hyperemic and edematous, diminishing bronchial mucociliary function. !onse,uently, the air passages become clogged by debris and irritation increases. In response, copious secretion of mucus develops, which causes the characteristic cough of bronchitis. In the case of mycoplasmal pneumonia, bronchial irritation results from the attachment of the organism (Mycoplasma pneumoniae) to the respiratory mucosa, with eventual sloughing of affected cells. &cute bronchitis usually lasts approximately 01 days. If the inflammation extends downward to the ends of the bronchial tree, into the small bronchi (bronchioles), and then into the air sacs, bronchopneumonia results. !hronic bronchitis is associated with excessive tracheobronchial mucus production sufficient to cause cough with expectoration for # or more months a year for at least $ consecutive years. 'he alveolar epithelium is both the target and the initiator of inflammation in chronic bronchitis. & predominance of neutrophils and the peribronchial distribution of fibrotic changes result from the action of interleukin 2, colony%stimulating factors, and other chemotactic and proinflammatory cytokines. &irway epithelial cells release these inflammatory mediators in response to toxic, infectious, and inflammatory stimuli, in addition to decreased release of regulatory products such as angiotensin%converting enzyme or neutral endopeptidase. !hronic bronchitis can be categorized as simple chronic bronchitis, chronic mucopurulent bronchitis, or chronic bronchitis with obstruction. /ucoid sputum production characterizes simple chronic bronchitis. "ersistent or recurrent purulent sputum production in the absence of localized suppurative disease, such as bronchiectasis, characterizes chronic mucopurulent bronchitis. !hronic bronchitis with obstruction must be distinguished from chronic infective asthma. 'he differentiation is based mainly on the history of the clinical illness3 patients who have chronic bronchitis with obstruction present with a long history of productive cough and a late onset of wheezing, whereas patients who have asthma with chronic obstruction have a long history of wheezing with a late onset of productive cough.
http&''nurseslabs(com

!hronic bronchitis may result from a series of attacks of acute bronchitis, or it may evolve gradually because of heavy smoking or inhalation of air contaminated with other pollutants in the environment. (hen so%called smoker4s cough is continual rather than occasional, the mucus%producing layer of the bronchial lining has probably thickened, narrowing the airways to the point where breathing becomes increasingly difficult. (ith immobilization of the cilia that sweep the air clean of foreign irritants, the bronchial passages become more vulnerable to further infection and the spread of tissue damage.

Etiology
5espiratory viruses are the most common causes of acute bronchitis, and cigarette smoking is indisputably the predominant cause of chronic bronchitis.

Viral and becterial infections in acute bronchitis

'he most common viruses include influenza & and B, parainfluenza, respiratory syncytial virus, and coronavirus, although an etiologic agent is identified only in a minority of cases.607 &cute bronchitis is usually caused by infections, such as those caused by Mycoplasma species, Chlamydia pneumoniae, Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae, and by viruses, such as influenza, parainfluenza, adenovirus, rhinovirus, and respiratory syncytial virus. -xposure to irritants, such as pollution, chemicals, and tobacco smoke, may also cause acute bronchial irritation. Bordetella pertussis should be considered in children who are incompletely vaccinated, though studies increasingly report this bacterium as the causative agent in adults as well.6$7

Smoking and other causes of chronic bronchitis

!igarette smoking is indisputably the predominant cause of chronic bronchitis. !ommon risk factors for acute exacerbations of chronic bronchitis are advanced age and low forced expiratory volume in one second (8-90).6#7 /ost (:1%21;) acute exacerbations of chronic bronchitis are estimated to be due to respiratory infections.6<7 -stimates suggest that cigarette smoking accounts for 2=%>1; of chronic bronchitis and chronic obstructive pulmonary disease. tudies indicate that smoking pipes, cigars, and mari?uana causes similar damage. moking impairs ciliary movement, inhibits the function of alveolar macrophages, and leads to hypertrophy and hyperplasia of mucus%secreting glands. moking can also increase airway resistance via vagally mediated smooth muscle constriction. @nless some other factor can be isolated as the irritant that produces the symptoms, the first step in dealing with chronic bronchitis is for the patient to stop smoking. &ir pollution levels have been associated with increased respiratory health problems among people living in affected areas. 'he &ir "ollution and 5espiratory Aealth Branch of the Bational !enter for -nvironmental Aealth directs the fight of the @ !enters for *isease !ontrol and "revention against respiratory illness associated with air pollution.

http&''nurseslabs(com

&ccording to the Healthy People 2000 report, each year in the @nited tates, health costs of human exposure to outdoor air pollutants range from C<1 to C=1 billion, and an estimated =1,111 to 0$1,111 premature deaths are associated with exposure to air pollutants. In addition, the report states that those with asthma experience more than 011 million days of restricted activity, costs related to asthma exceed C< billion, and about <,111 people die of the condition each year. & growing body of literature has demonstrated that specific occupational exposures are associated with the symptoms of chronic bronchitis. 'he list of agents includes coal, manufactured vitreous fibers, oil mist, cement, silica, silicates, osmium, vanadium, welding fumes, organic dusts, engine exhausts, fire smoke, and secondhand cigarette smoke.

Epidemiology
&ccording to estimates from national interviews taken by the Bational !enter for Aealth tatistics in $11D, approximately >.= million people, or <; of the population, were diagnosed with chronic bronchitis. 'hese statistics may underestimate the prevalence of chronic obstructive pulmonary disease by as much as =1;, because many patients underreport their symptoms, and their conditions remain undiagnosed. &n overdiagnosis of chronic bronchitis by patients and clinicians has also been suggested, however. 'he term bronchitis is often used as a common descriptor for a nonspecific and self%limited cough, thereby falsely increasing its incidence even though the patient does not meet the criteria for diagnosis. In one study, acute bronchitis affected << of 0111 adults annually, and 2$; of episodes occurred in fall or winter.6=7 By way of comparison, >0 million cases of influenza, DD million cases of the common cold, and #0 million cases of other acute upper respiratory tract infections occurred that year. &cute bronchitis is common throughout the world and is one of the top = reasons for seeking medical care in countries that collect such data. Bo difference in racial distribution is reported, though bronchitis occurs more fre,uently in populations with a low socioeconomic status and in people who live in urban and highly industrialized areas. In terms of gender%specific incidence, bronchitis affects males more than females. In the @nited tates, up to two thirds of men and one fourth of women have emphysema at death. &lthough found in all age groups, acute bronchitis is most fre,uently diagnosed in children younger than = years, whereas chronic bronchitis is more prevalent in people older than =1 years.

Prognosis
"atients with acute bronchitis have a good prognosis. Bronchitis is almost always self%limited in individuals who are otherwise healthy, although it may result in absenteeism from work and school. evere cases occasionally produce deterioration in patients with significant underlying cardiopulmonary disease or other comorbidities.

Complications
!omplications occur in approximately 01; of patients with acute bronchitis and include the following3
http&''nurseslabs(com

Bacterial superinfection "neumonia develops in about =; of patients with bronchitis (incidence of subse,uent pneumonia, unaffected by antibiotic treatment) !hronic bronchitis may develop with repeated episodes of acute bronchitis 5eactive airway disease can occur as a result of acute bronchitis Aemoptysis

Patient Education
"atient education is essential in the prevention and treatment of acute bronchitis. @nfortunately, health care providers usually underemphasize education. "atients should be counseled to take the following measures3

&void smoking and secondhand smoke Eive in a clean environment 5eceive the influenza vaccine yearly between Fctober and *ecember 5eceive the pneumonia vaccine every =%01 years if aged D= years or older or with chronic disease

Fbtain a complete history, including information on exposure to toxic substances and smoking. "atients with chronic bronchitis are often overweight and cyanotic. Initially, cough is present in the winter months. Fver the years, the cough progresses from hibernal to perennial, and mucopurulent relapses increase in fre,uency, the duration and severity of which increase to the point of exertional dyspnea. !ough is the most commonly observed symptom. It begins early in the course of many acute respiratory tract infections and becomes more prominent as the disease progresses. &cute bronchitis may be indistinguishable from an upper respiratory tract infection during the first few days, though cough lasting greater than = days may suggest acute bronchitis.6D7 In patients with acute bronchitis, cough generally lasts from 01%$1 days. putum production is reported in approximately half the patients in whom cough occurred. putum may be clear, yellow, green, or even blood% tinged. "urulent sputum is reported in =1; of persons with acute bronchitis. !hanges in sputum color are due to peroxidase released by leukocytes in sputum+ therefore, color alone cannot be considered indicative of bacterial infection. 8ever is a relatively unusual sign and, when accompanied by cough, suggests either influenza or pneumonia. Bausea, vomiting, and diarrhea are rare. evere cases may cause general malaise and chest pain. (ith severe tracheal involvement, symptoms include burning, substernal chest pain associated with respiration, and coughing. *yspnea and cyanosis are not observed in adults unless the patient has underlying chronic obstructive pulmonary disease or another condition that impairs lung function.
http&''nurseslabs(com

Fther symptoms of acute bronchitis include the following3

ore throat 5unny or stuffy nose Aeadache /uscle aches -xtreme fatigue

Physical Examination
'he physical examination findings in acute bronchitis can vary from normal%to%pharyngeal erythema, localized lymphadenopathy, and rhinorrhea to coarse rhonchi and wheezes that change in location and intensity after a deep and productive cough. *iffuse wheezes, high%pitched continuous sounds, and the use of accessory muscles can be observed in severe cases. Fccasionally, diffuse diminution of air intake or inspiratory stridor occurs+ these findings indicate obstruction of a ma?or bronchi or the trachea, which re,uires se,uentially vigorous coughing, suctioning, and, possibly, intubation or even tracheostomy. ustained heave along the left sternal border indicates right ventricular hypertrophy secondary to chronic bronchitis. !lubbing on the digits and peripheral cyanosis indicate cystic fibrosis. Bullous myringitis may suggest mycoplasmal pneumonia. !on?unctivitis, adenopathy, and rhinorrhea suggest adenovirus infection. treptococcal pharyngitis is most commonly caused by group & streptococci (<=;) and anaerobes (02;), which often occur as a co%infection. /uch of the concern about diagnosing streptococcal pharyngitis is related to the complications of infection, particularly acute rheumatic fever and poststreptococcal glomerulonephritis as a late complication. 'herefore, maintaining a high level of suspicion for streptococci group & in the presence of pharyngitis is advisable. Fther medical issues)problems to consider include the following3

-xercise%induced asthma Bacterial tracheitis !ough !ystic fibrosis Influenza Ayperreactive airway disease 5etained foreign body 'onsillitis
http&''nurseslabs(com

Fccupational exposures

Differential Diagnoses

&lpha0%&ntitrypsin *eficiency &sthma Bronchiectasis Bronchiolitis !hronic Bronchitis !hronic Fbstructive "ulmonary *isease .astroesophageal 5eflux *isease Influenza "haryngitis, Bacterial "haryngitis, 9iral inusitis, &cute inusitis, !hronic treptococcus .roup & Infections

Approach Considerations
Bronchitis may be suspected in patients with an acute respiratory infection with cough+ yet, because many more serious diseases of the lower respiratory tract cause cough, bronchitis must be considered a diagnosis of exclusion. & complete blood count with differential may be obtained.

Cultures and Staining

Fbtain cultures of respiratory secretions for influenza virus, Mycoplasmapneumoniae, and Bordetella pertussis when these organisms are suspected. !ulture methods and immunofluorescence tests have been developed for laboratory diagnosis of C pneumoniaeinfection. Fbtain a throat swab. !ulture and gram stain of sputum is often performed, though these tests usually show no growth or only normal respiratory florae.607 Blood culture may be helpful if bacterial superinfection is suspected.

Procalcitonin Levels
http&''nurseslabs(com

"rocalcitonin levels may be useful to distinguish bacterial infections from nonbacterial infections. 'rials from $112 and $11> have shown that they may help guide therapy and reduce antibiotic use.6:, 27

Sputum Cytology
putum cytology may be helpful if the cough is persistent.

Chest adiography
!hest radiography should be performed in those patients whose physical examination findings suggest pneumonia. -lderly patients may have no signs of pneumonia+ therefore, chest radiography may be warranted in these patients, even without other clinical signs of infection.

!ronchoscopy
Bronchoscopy may be needed to exclude foreign body aspiration, tuberculosis, tumors, and other chronic diseases of the tracheobronchial tree and lungs.

"nfluen#a $esting
Influenza tests may be useful. &dditional serologic tests, such as that for atypical pneumonia, are not indicated.

Spirometry
pirometry may be useful because patients with acute bronchitis often have significant bronchospasm, with a large reduction in forced expiratory volume in one second (8-90). 'his generally resolves over <%D weeks.

Laryngoscopy
Earyngoscopy can exclude epiglottitis.

%istologic &indings
.oblet cell hyperplasia, mucosal and submucosal inflammatory cells, edema, peribronchial fibrosis, intraluminal mucous plugs, and increased smooth muscle are characteristic findings in small airways in chronic obstructive lung disease. 'herapy is generally focused on alleviation of symptoms.'oward this goal, a doctor may prescribe a combination of medications that open obstructed bronchial airways and thin obstructive mucus so that it can be coughed up more easily. !are for acute bronchitis is primarily supportive and should ensure that the patient is oxygenating ade,uately. Bed rest is recommended.

http&''nurseslabs(com

'he most effective means for controlling cough and sputum production in patients with chronic bronchitis is the avoidance of environmental irritants, especially cigarette smoke. 'o see complete information on "ediatric Bronchitis, please go to the main article by clicking here.

Symptomatic $reatment
Based on $11D &merican !ollege of !hest "hysicians (&!!") guidelines,6>, 017 central cough suppressants such as codeine and dextromethorphan are recommended for short%term symptomatic relief of coughing in patients with acute and chronic bronchitis.6007 &lso based on $11D &!!" guidelines, therapy with short%acting beta%agonists ipratropium bromide and theophylline can be used to control symptoms such as bronchospasm, dyspnea, and chronic cough in stable patients with chronic bronchitis. 8or this group, treatment with a long%acting beta%agonist, when coupled with an inhaled corticosteroid, can be offered to control chronic cough. 8or details on these guidelines, see !hronic cough due to chronic bronchitis3 &!!" evidence%based clinical practice guidelines and !hronic cough due to acute bronchitis3 &!!" evidence%based clinical practice guidelines. 8or patients with an acute exacerbation of chronic bronchitis, therapy with short%acting agonists or anticholinergic bronchodilators should be administered during the acute exacerbation. In addition, a short course of systemic corticosteroid therapy may be given and has been proven to be effective. In acute bronchitis, treatment with beta$%agonist bronchodilators may be useful in patients who have associated wheezing with cough and underlying lung disease. Eittle evidence indicates that the routine use of beta$% agonists is otherwise helpful in adults with acute cough.60$7 Bonsteroidal anti%inflammatory drugs are helpful in treating constitutional symptoms of acute bronchitis, including mild%to%moderate pain. &lbuterol and guaifenesin products treat cough, dyspnea, and wheezing. In patients with chronic bronchitis or chronic obstructive pulmonary disease (!F"*), treatment with mucolytics has been associated with a small reduction in acute exacerbations and a reduction in the total number of days of disability. 'his benefit may be greater in individuals who have fre,uent or prolonged exacerbations.60#7 /ucolytics should be considered in patients with moderate%to%severe !F"*, especially in the winter months.6#7

Antibiotic $herapy
&mong otherwise healthy individuals, antibiotics have not demonstrated any consistent benefit in the symptomatology or natural history of acute bronchitis.60<, 0=7 /ost reports have shown that D=%21; of patients with acute bronchitis receive an antibiotic despite evidence indicating that, with few exceptions, they are ineffective. &n exception is with cases of acute bronchitis caused by suspected or confirmed pertussis infection. 'he most recent recommendations on whether to treat patients with acute bronchitis with antibiotics are from the Bational Institute for Aealth and !linical -xcellence in the @nited Gingdom. 'hey recommend not treating acute bronchitis with antibiotics unless a risk of serious complications exists because of comorbid conditions.
http&''nurseslabs(com

&ntibiotics, however, are recommended in patients older than D= years with acute cough if they have had a hospitalization in the past year, have diabetes mellitus or congestive heart failure, or are on steroids.60D7 In patients with acute exacerbations of chronic bronchitis, the use of antibiotics is recommended. 'rials have shown that antibiotics improve clinical outcomes in such cases, including a reduction in mortality. 60:, 027 & meta%analysis found no difference in treatment success for acute exacerbations of chronic bronchitis with macrolides, ,uinolones, or amoxicillin)clavulanate.60>7 &nother meta%analysis comparing the effectiveness of semisynthetic penicillins to trimethoprim%based regimens found no difference in treatment success or toxicity. 6$17 'hese findings support earlier studies that have shown antibiotics to be useful in exacerbations of chronic bronchitis, regardless of the agent used. In addition, a short course of antibiotics (= d) is as effective as the traditional longer treatments (H= d) in these patients.6$07 "atients with severe exacerbations and those with more severe airflow obstruction at baseline are the most likely to benefit. In stable patients with chronic bronchitis, long%term prophylactic therapy with antibiotics is not indicated.

"nfluen#a Vaccinations
'he influenza vaccine may reduce the incidence of upper respiratory tract infections and, subse,uently, reduce the incidence of acute bacterial bronchitis. 'he influenza vaccine may be less effective in preventing illness than it is in preventing serious complications and death.6$$7 In the @nited tates, the flu season usually occurs from approximately Fctober to &pril. 'he !enters for *isease !ontrol and "revention (!*!) provisional recommendations for the $101%$100 influenza season recommend vaccination for all people aged D months and older. 'he $101I$100 vaccine will be a trivalent vaccine, which will cover A0B0. In certain situations, such as in nursing homes, consider administration of oseltamivir or zanamivir when an index case is found until the vaccine has had a chance to take effect. "neumococcal vaccination is recommended in patients with chronic bronchitis.

'inc
everal studies have shown conflicting results on the use of zinc as an ad?unct treatment against influenza &. /ost studies demonstrated favorable results, but participants complained of a bad taste and significant nausea. Fn June 0D, $11>, the @ 8ood and *rug &dministration (8*&) issued a public health advisory and notified consumers and health care providers to discontinue use of intranasal zinc products. 'he intranasal zinc products (Kicam Basal .el)Basal wab products by /atrixx Initiatives) are herbal cold remedies that claim to reduce the duration and severity of cold symptoms and are sold without a prescription. 'he 8*& received more than 0#1 reports of anosmia (inability to detect odors) associated with intranasal zinc. /any of the reports described the loss of the sense of smell with the first dose.6$#7

Consultations
http&''nurseslabs(com

"rimary care providers can usually treat acute bronchitis unless severe complications occur or the patient has underlying pulmonary disease or immunodeficiency. "ulmonary medicine specialists and infectious disease specialists also may need to be consulted.

Long($erm )onitoring
5outine follow%up care is usually not necessary. If symptoms worsen (eg, shortness of breath, high fever, vomiting, persistent cough), consider an alternative diagnosis. If symptoms recur (H # episodes)y), further investigation is recommended. If symptoms persist beyond 0 month, reassess patient for other causes of cough.

)edication Summary
'herapy for patients with acute bronchitis is generally aimed toward alleviation of symptoms and includes the use of analgesics, antipyretics, antitussives, and expectorants. &mong otherwise healthy individuals, antibiotics have not demonstrated consistent benefit in the symptomatology or natural history of acute bronchitis.6>, $<7 Bonetheless, surveys from -urope, &ustralia, and the @nited tates show that 21; of patients with acute bronchitis receive antibiotics. &ntibiotic overuse contributes to the emergence of drug%resistant organisms. !ognizant of this, the !enters for *isease !ontrol and "revention recently collaborated with numerous medical societies to publish a series of articles on the ?udicious use of antibiotics for several common conditions, including bronchitis, and have recommended against routine antibiotic use in uncomplicated bronchitis. "atients are up to < times more likely to expect antibiotics for the diagnosis of bronchitis than for a chest cold. 'herefore, limiting use of the diagnosis of bronchitis may make reduction of antibiotic use more acceptable to patients. 5eviews have also noted that antibiotic use in smokers without chronic obstructive pulmonary disease is no more effective than use in nonsmokers.6$=7

Antimicrobials
Class Summary
tudies have focused on healthy individuals (patients with asthma excluded) or patients with chronic obstructive pulmonary disease (!F"*). &ntimicrobials appear to offer a small benefit when treating patients with !F"*, and trimethoprim%sulfamethoxazole remains a good and inexpensive choice. &moxicillin and doxycycline are also good alternatives. 'herefore, extending antimicrobial use to patients with asthma and others with limited cardiopulmonary reserve may be reasonable. 9iew full drug information

Amoxicillin and clavulanate *Augmentin+

http&''nurseslabs(com

'his agent inhibits bacterial cell wall synthesis by binding to penicillin%binding proteins. 'he addition of clavulanate inhibits beta%lactamaseIproducing bacteria. It is a good alternative antibiotic for patients allergic to or intolerant of the macrolide class. It is usually well tolerated and provides good coverage of most infectious agents, but it is not effective against /ycoplasma and Eegionella species. 'he half%life of the oral dosage is 0%0.# hours. It has good tissue penetration but does not enter the cerebrospinal fluid. 8or children older than # months, base the dosing protocol on amoxicillin content. Because of different amoxicillin)clavulanic acid ratios in the $=1%mg tab ($=1)0$=) vs the $=1%mg chewable tab ($=1)D$.=), do not use the $=1%mg tab until the child weighs more than <1 kg. 9iew full drug information

Erythromycin *E,E,S,- E()ycin- Ery($ab+

-rythromycin inhibits bacterial growth, possibly by blocking dissociation of peptidyl t5B& from ribosomes, causing 5B&%dependent protein synthesis to arrest. It is indicated for staphylococcal, streptococcal, chlamydial, and mycoplasmal infections. 9iew full drug information

A#ithromycin *'ithromax+

&zithromycin acts by binding to the =1 ribosomal subunit of susceptible microorganisms and blocks dissociation of peptidyl t5B& from ribosomes, causing 5B&%dependent protein synthesis to arrest. Bucleic acid synthesis is not affected. It concentrates in phagocytes and fibroblasts, as demonstrated by in vitro incubation techni,ues. In vivo studies suggest that the concentration in phagocytes may contribute to drug distribution to inflamed tissues. &zithromycin treats mild%to%moderate microbial infections. 9iew full drug information

$etracycline *Sumycin+

'etracycline may be an option outside the @nited tates. It treats gram%positive and gram%negative organisms, as well as mycoplasmal, chlamydial, and rickettsial infections. 'his agent inhibits bacterial protein synthesis by binding with the #1 and, possibly, the =1 ribosomal subunit(s). It is less effective than erythromycin.
http&''nurseslabs(com

9iew full drug information

Cefditoren *Spectracef+

!efditoren is a semisynthetic cephalosporin administered as a prodrug. It is hydrolyzed by esterases during absorption and is distributed in circulating blood as active cefditoren. Bactericidal activity results from inhibition of cell wall synthesis via an affinity for penicillin%binding proteins. Bo dose ad?ustment is necessary for mild renal impairment (!r!l =1%21 mE)min)0.:# m$) or mild%to%moderate hepatic impairment. It is indicated for acute exacerbation of chronic bronchitis caused by susceptible strains of pyogenes. 'he <11%mg dose is indicated for &-!B caused by susceptible strains of A influenzae, A parainfluenzae, pneumoniae (penicillin%susceptible strains only), or / catarrhalis. 9iew full drug information

$rimethoprim(sulfamethoxa#ole *!actrim DS- Septra+

'rimethoprim%sulfamethoxazole inhibits bacterial synthesis of dihydrofolic acid by competing with para% aminobenzoic acid, resulting in inhibition of bacterial growth. &ntibacterial activity of trimethoprim% sulfamethoxazole includes common urinary tract pathogens, except "seudomonas aeruginosa. &s with tetracycline, it has in vitro activity against B pertussis. It is not useful in mycoplasmal infections. 9iew full drug information

Amoxicillin *!iomox- $rimox- Amoxil+

&moxicillin interferes with synthesis of cell wall mucopeptides during active multiplication, resulting in bactericidal activity against susceptible bacteria. 9iew full drug information

Levofloxacin *Leva.uin+

Eevofloxacin has a bacteriocidal property by inhibiting the *B& gyrase and, conse,uently, cell growth. 9iew full drug information
http&''nurseslabs(com

Clarithromycin *!iaxin+

!larithromycin is a semisynthetic macrolide antibiotic that reversibly binds to the " site of the =1 ribosomal subunit of susceptible organisms and may inhibit 5B&%dependent protein synthesis by stimulating dissociation of peptidyl t%5B& from ribosomes, causing bacterial growth inhibition. 9iew full drug information

Doxycycline *!io($ab- Doryx- Vibramycin+

*oxycycline is a broad%spectrum, synthetically derived bacteriostatic antibiotic in the tetracycline class. It is almost completely absorbed, concentrates in bile, and is excreted in urine and feces as a biologically active metabolite in high concentrations. It inhibits protein synthesis and, thus, bacterial growth by binding to #1 and possibly =1 ribosomal subunits of susceptible bacteria. It may block dissociation of peptidyl t%5B& from ribosomes, causing 5B&%dependent protein synthesis to arrest.

Antitussives/expectorants
Class Summary
parse data attest to the efficacy of expectorants outside the test tube.

0uaifenesin 1ith dextromethorphan *%umibid D)- obitussin D)+

'his agent treats minor cough resulting from bronchial and throat irritation. 9iew full drug information

Codeine/guaifenesin * obitussin AC+

'he prototype antitussive, codeine, has been used successfully in some chronic cough and induced%cough models, but scant clinical data exist for upper respiratory tract infections.

!ronchodilators
http&''nurseslabs(com

Class Summary
tudies (although limited) have shown an advantage to using bronchodilators and possible superiority to antibiotics for relieving bronchitis symptoms. 9iew full drug information

Albuterol *Proventil- Ventolin+

&lbuterol relaxes bronchial smooth muscle by action on beta$%receptors with little effect on cardiac muscle contractility.

)etaproterenol sulfate

/etaproterenol is a beta agonist for bronchospasms that relaxes bronchial smooth muscle by action on beta$ receptors with little effect on cardiac muscle contractility. 9iew full drug information

$heophylline *$heo(23- 4niphyl+

'heophylline is used to control symptoms such as bronchospasm, dyspnea, and chronic cough in stable patients with chronic bronchitis. It potentiates exogenous catecholamines and stimulates endogenous catecholamine release and diaphragmatic muscular relaxation, which, in turn, stimulates bronchodilation. 9iew full drug information

"pratropium

Ipratropium is an anticholinergic bronchodilator that is often used to control symptoms such as bronchospasm, dyspnea, and chronic cough in stable patients with chronic bronchitis.

Corticosteroids- Systemic
Class Summary
8or patients with an acute exacerbation of chronic bronchitis, a short course of systemic corticosteroid therapy may be given and has been proven to be effective.
http&''nurseslabs(com

9iew full drug information

Prednisolone *Pediapred- 5rapred+

"rednisolone works by decreasing inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability. 9iew full drug information

Prednisone *Sterapred+

"rednisone may decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear leukocyte activity. "rednisone stabilizes lysosomal membranes and suppresses lymphocytes and antibody production.

Corticosteroids- "nhaled
Class Summary
!orticosteroids are the most potent anti%inflammatory agents. Inhaled forms are topically active, poorly absorbed, and least likely to cause adverse effects. In patients who are stable with chronic bronchitis, treatment with a long%acting beta%agonist coupled with an inhaled corticosteroid may offer relief of chronic cough. 9iew full drug information

!eclomethasone *6var+

Beclomethasone inhibits bronchoconstriction mechanisms, causes direct smooth muscle relaxation, and may decrease the number and activity of inflammatory cells, which, in turn, decrease airway hyperresponsiveness. It is available in a metered%dose inhaler (/*I) that delivers <1 or 21 mcg)actuation. 9iew full drug information

&luticasone *&lovent %&A- &lovent Diskus+

8luticasone has extremely potent vasoconstrictive and anti%inflammatory activity. It is available in an /*I (<<% mcg, 001%mcg, or $$1%mcg per actuation) and *iskus powder for inhalation (=1%mcg, 011%mcg, or $=1%mcg per actuation).
http&''nurseslabs(com

9iew full drug information

!udesonide *Pulmicort &lexhaler- Pulmicort espules+

Budesonide reduces inflammation in airways by inhibiting multiple types of inflammatory cells and decreasing production of cytokines and other mediators involved in the asthmatic response. It is available as 8lexhaler powder for inhalation (>1 mcg)actuation 6delivers approximately 21 mcg)actuation7) and 5espules suspension for inhalation.

Antiviral Agents
Class Summary
Influenza vaccinations offer greater protection for the appropriate populations because they offer coverage for influenza & and B. 'he !enters for *isease !ontrol and "revention (!*!) provisional recommendations for the $101%$100 influenza season recommend expanded vaccination+ all people aged D months and older should receive annual influenza vaccine.6$D7 'he $101%$100 vaccine will be a trivalent vaccine. Influenza & viruses, including the $ subtypes A0B0 and A#B$, and influenza B viruses currently circulate worldwide, but the prevalence of each can vary among communities and within a single community over the course of an influenza season. In the $11>%$101 flu season, approximately >>; of typed influenza viruses were A0B0. In the @nited tates, < prescription antiviral medications (ie, oseltamivir, zanamivir, amantadine, rimantadine) are approved for treatment and chemoprophylaxis of influenza. 'he vast ma?ority of the $11>%$101 influenza was susceptible to oseltamivir and zanamivir but resistant to the adamantanes (amantadine, rimantadine). In addition, the 8*& issued an emergency use authorization for a third neuraminidase inhibitor, peramivir, for the treatment of hospitalized patients with A0B0 influenza who have potentially life%threatening suspected or laboratory%confirmed infection. "eramivir I9 is available through the !*! upon re,uest of a licensed physician.6$#7 !omplete recommendations are available in a !*! Aealth &dvisory. 9iew full drug information

'anamivir * elen#a+

Kanamivir is an inhibitor of neuraminidase, which is a glycoprotein on the surface of the influenza virus that destroys the infected cell4s receptor for viral hemagglutinin. By inhibiting viral neuraminidase, release of viruses from infected cells and viral spread are decreased. It is effective against both influenza & and B and is inhaled
http&''nurseslabs(com

through *iskhaler oral inhalation device. !ircular foil disks containing =%mg blisters of drug are inserted into the supplied inhalation device. 9iew full drug information

imantadine *&lumadine+

5imantadine inhibits viral replication of influenza & virus A0B0, A$B$, and A#B$ and prevents viral penetration into a host by inhibiting uncoating of influenza &. BF'-3 Because of resistance, it is not recommended by the !*! as of the $11=%$11D influenza season. Eaboratory testing by the !*! on the predominant strain of influenza (A#B$) currently circulating in the @nited tates shows that it is resistant to these drugs. 9iew full drug information

5seltamivir *$amiflu+

Fseltamivir inhibits neuraminidase, which is a glycoprotein on the surface of influenza virus that destroys an infected cell4s receptor for viral hemagglutinin. By inhibiting viral neuraminidase, this agent decreases release of viruses from infected cells and thus viral spread. It is effective in treating influenza & or B. tart within <1 hours of symptom onset. It is available as a capsule and oral suspension. 9iew full drug information

Peramivir * apiacta+

"eramivir is an investigational neuraminidase inhibitor. -mergency%use authorization has been issued by the 8*& for use of peramivir in hospitalized adult and pediatric patients with suspected or laboratory%confirmed $11> A0B0 influenza unresponsive to oseltamivir or zanamivir, in patients unable to take "F or inhaled drugs (or delivery route not dependable or feasible), or in other patients determined by clinician. 'o re,uest peramivir, see the information at www.cdc.gov)h0n0flu)eua or call (211) !*!%IB8F ($#$%<D#D).

Analgesics/antipyretics
Class Summary
&nalgesics and antipyretics are often helpful in relieving the associated lethargy, malaise, and fever associated with illness. 9iew full drug information
http&''nurseslabs(com

"buprofen *"buprin- Advil- )otrin+

Ibuprofen is usually *F! for treatment of mild to moderate pain, if no contraindications exist. 9iew full drug information

Acetaminophen *$ylenol- Panadol- Aspirin(&ree Anacin+

&cetaminophen is *F! for treatment of pain in patients who have documented hypersensitivity to aspirin or B &I*s, who have upper gastrointestinal disease, or who are taking oral anticoagulants.

'(ronic Bronc(itis '(ronic bronc(itis is defined as e)cessi%e mucus secretion in t(e bronc(i and a c(ronic or recurrent mucus* http&''nurseslabs(com

producing coug( t(at lasts t(ree or more mont(s and recurs year after year+ In diagnosing c(ronic bronc(itis, it is important to rule out (eart disease, lung infections, cancer and ot(er disorders t(at may produce bronc(itis* li"e symptoms+ '(ronic bronc(itis may result from a series of attac"s of acute bronc(itis, or it may e%ol%e gradually because of (ea%y smo"ing or t(e in(alation of air contaminated -it( ot(er pollutants in t(e en%ironment+ .(en t(e so*called smo"er/s coug( is constant rat(er t(an occasional, t(e li"eli(ood e)ists t(at t(e mucus* producing layer of t(e bronc(ial lining (as t(ic"ened, narro-ing t(e air-ays to t(e point -(ere breat(ing becomes increasingly difficult+ .it( t(e immobilization of t(e cilia t(at s-eep t(e air clean of foreign irritants, t(e bronc(ial passages become more %ulnerable to furt(er infection and t(e spread of tissue damage+ Patients -it( c(ronic coug(, but no (istory of recent upper respiratory infections s(ould be e%aluated for ot(er possible causes of coug( suc( as postnasal drip, ast(ma, and gastroesop(ageal reflu)+ Acute Bronc(itis (is is one of t(e most common disorders seen in clinical practice+ Bronc(itis is generally caused by a %irus, and does not respond to antibiotic t(erapy+ $nfortunately, se%enty percent of t(e time, t(e diagnosis usually leads to a prescription for antibiotics+ (is diagnosis is one of t(e leading causes of antibiotic abuse+ Bronc(itis often e%ol%es from a se%ere cold+ (is disorder may also follo- or accompany t(e flu, or it may begin -it(out (a%ing (ad an infection+ Bronc(itis * an inflammation of t(e bronc(ial tubes0 may be caused by smo"ing, air pollution and %iral or bacterial infections+ 'omplications of a cold or flu may lead to acute bronc(itis, -(ic( can be treated -it( o%er t(e counter cold remedies and by drin"ing plenty of fluids+ #o- can It be treated 1 !uffering from a series of acute bronc(itis attac"s, smo"ing (ea%ily or in(aling contaminated air for prolonged periods may result in c(ronic bronc(itis+ !ince c(ronic bronc(itis can be serious, it s(ould recei%e professional medical attention, no matter -(at its underlying cause+ (ere is no doubt t(at cigarette smo"ing is t(e c(ief cause of c(ronic bronc(itis, and recent studies indicate t(at smo"ing mari2uana causes similar damage+ $nless some ot(er factor can be isolated as t(e irritant t(at produces t(e symptoms, t(e first step in dealing -it( c(ronic bronc(itis is to stop smo"ing+ http&''nurseslabs(com

o alle%iate any symptoms, your doctor may prescribe a combination of medications t(at -ill bot( open up obstructed bronc(ial air-ays and t(in obstructi%e mucus so t(at it can be coug(ed up more easily+ A steam %aporizer near t(e bed can also be (elpful in easing c(est congestion at nig(t+ &ean-(ile, t(e primary cause of bronc(itis is bacterial infections, but ast(matic bronc(itis is t(oug(t to be acti%ated by tiny spec"s t(at brea" t(roug( t(e safety -alls made of cilia of t(e bronc(ial tubes+ Ast(matic bronc(itis also in%ol%es congestion of t(e respiratory tract+ Bronc(ial tubes produce mucus under normal circumstances, t(is mucus co%ers t(e trac(ea, lungs and ot(er organs in t(e respiratory system+ 3onet(eless, in t(e e)istence of irritants, an o%erproduction of mucus occurs, -(ic( conse4uently obstructs t(e air-ays+ 'ontinuous mucoid obstruction of t(e respiratory tract is fairly -idespread among ast(matic bronc(itis patients+ 5eneral symptoms of ast(matic bronc(itis includes dyspnoea or difficulty of breat(ing and s(ortness of breat(, coug(, c(est discomforts, -(eezing t(at lasts for se%eral -ee"s, fatigue or general malaise, pain, -eig(t loss, a general feeling of soreness, and (ig( ris" of susceptibility to infections+ Alt(oug( t(ese are also obser%ed among common ast(matic patients, indi%iduals suffering from ast(matic bronc(itis (a%e symptoms t(at are more profound+ !ufferers are ad%ised to steer clear from irritants li"e dust, pollen, smo"e, c(emicals, and alco(ol fumes+ (ey are also ad%ised to a%oid bacterial infection, t(us t(ey s(ould a%oid cro-ds as muc( as possible+ If it is una%oidable, patients are obliged to -ear mas"s to co%er t(eir nose and mout( to pre%ent bacteria from entering t(e respiratory tract+ 6f course, if an infection de%elops, it is important to see" medical attention and begin a course of treatment -it( antibiotics, if t(e infection is bacterial+ If it is %iral, t(ere is not muc( t(at can be done e)cept to ma"e t(e patient comfortable and allo- t(e infection to run its course+ (ere are no antibiotics -(ic( can treat a %irus+ By follo-ing t(ese tec(ni4ues, it is possible to ma"e t(e pain and respiratory difficulties of Ast(matic Bronc(itis tolerable+ 'onsulting your p(ysician as soon as a problem de%elops is -ise, and li"e-ise, "eeping (im7(er informed of your progress is important too+ 5etting plenty of rest (elps t(e body to e)pend its energy in fig(ting off t(e possible infection, rat(er t(an doing ot(er -or" -(ic( mig(t -orsen t(e condition+

Pathophysiology Of Acute Bronchitis

http&''nurseslabs(com

'oug( is t(e most common of all t(e bronc(itis symptoms+ It can be dry t(e first time, because it doesn/ t produce any mucus+ After a couple of days, it mig(t bring some mucus from t(e lungs+ (e color of t(e mucus as a result of acute bronc(itis can be green, clear or yello-+ Fe%er is anot(er symptom for bronc(itis, but in t(e case of acute bronc(itis, it is a mild fe%er+ If t(e temperature is (ig(, t(at mig(t indicate pneumonia+ .(en suffering from acute bronc(itis you -ill also feel a general tiredness+ 8ou -ill also feel pain in your c(est -(en suffering from bronc(itis, -(ic( can agra%ate especially -(en you coug(+ !(ortness of breat( is also anot(er symptom t(at you mig(t (a%e -(en you (a%e acute bronc(itis+ o fully understand all t(e acute bronc(itis symptoms, you must understand -(at causes t(e disease+ .(en you de%elop acute bronc(itis, t(e tubes t(at are used to carry air to your lungs get inflamated+ Acute bronc(itis is usually caused by a %irus and also bronc(itis is t(e result of a respiratory infection t(at you probably (ad+ (is infection (as a %ery -ell determined pat(+ It mo%es from your nose, mout( to t(e bronc(ial tubes, causing bronc(itis+ 8our impro%ement in (ealt( from bronc(itis depends on a fe- factors, li"e age, if you are a smo"er or not of -(et(er t(e acute bronc(itis -as caused by a %irus or bacteria+ If bronc(itis (as been caused by a %irus, you -ill get better sooner t(an if t(e acute bronc(itis (ad been caused by bacteria+ As many of t(e lung related diseases, acute bronc(itis can also (a%e complications if not treated+ For e)ample, if a case of acute bronc(itis indicates ingcreased fatigue, a %ery (ig( temperature, serious c(est pain, it usually indicates t(at acute bronc(itis (as de%eloped into pneumonia+ Anot(er problem -ould be repeated episodes of acute bronc(itis caused by bacteria+ (is condition may lead to permanent damage of t(e bronc(ial tubes+ (is case of acute bronc(itis gone -rong usually (appens to people t(at smo"e of t(ose -(o (a%e a -ea" immune system+ !o be careful (o- you treat your bronc(itis case9

http&''nurseslabs(com