Acute Bronchitis

HMS Chandra Kusuma

Pediatric Departement Of Fac. Med. Brawijaya Univ. Saiful Anwar General Hospital

INTRODUCTION
Acute bronchitis: Is one of the most common conditions encountered in clinical practice Is also one of the most common causes of antibiotic abuse Is generally caused by a virus. Most reports indicate that more than 60 to 70 percent of patients with acute bronchitis who seek care are given antibiotics.

MICROBIOLOGY
The usual causes of acute bronchitis are viral infections of the upper airways: Influenza A and B Parainfluenza Coronavirus (types 1-3) Rhinovirus Respiratory syncytial virus Human metapneumovirus

The bacterial pathogens that cause acute bronchitis: Streptococcus pneumoniae Haemophilus influenzae Staphylococcus aureus Moraxella catarrhalis Gram-negative bacilli

Other pathogens
Other pathogens that can cause acute bronchitis, although less commonly than viruses, include: Mycoplasma pneumoniae Chlamydophila (formerly Chlamydia) pneumoniae Bordetella pertussis

CLINICAL FEATURES
Acute bronchitis is characterized by: Self-limited inflammation of the bronchi Clinically expressed as cough Usually with sputum production Evidence of concurrent upper airway infection Acute bronchitis is suggested by the persistence of cough for more than five days

Cough is a common symptom. The cough in patients with acute bronchitis most often lasts from 10 to 20 days. Purulent sputum is reported in 50 percent of patients with acute bronchitis. Patients with acute bronchitis often have significant:
Bronchospasm (reduced FEV1 in 40 percent ) Bronchial hyperreactivity with provocative testing . Airway hyperreactivity improves over five to six weeks

DIFFERENTIAL DIAGNOSIS
Chronic bronchitis Chronic bronchitis, by definition, is diagnosed in patients who have cough and sputum production on most days of the month for at least three months of the year during two consecutive years Pneumonia Abnormal vital signs (fever, tachypnea, or tachycardia) signs of consolidation or rales on physical examination

Postnasal drip syndrome The diagnosis: The sensation of postnasal drainage or the need to frequently clear their throat. Mucoid or mucopurulent nasal secretions Eosinophils usually can be found in the secretions.

Asthma 65 percent of patients who had two or more episodes of bronchitis over five years were found to have mild asthma Patients with an asthma syndrome often have a history of: Intermittent symptoms typical of asthma (cough, wheeze and shortness of breath) Findings of wheezing which resolve when symptoms are treated.

DIAGNOSTIC TESTS
Most patients with acute cough syndromes require no more than reassurance and symptomatic treatment. The indications for a chest x-ray in patients with an acute cough syndrome:
Abnormal vital signs (pulse >100/min respiratory rate >24) Temperature >38 c Rales Signs of consolidation on chest examination.

Other diagnostic tests: Diagnostic studies for mycoplasma: Cultures of pharyngeal washings Igm titers Seroconversion (iga, igm, or igg) Antigen detection with polymerase chain reaction, Rapid tests for the diagnosis of influenza

TREATMENT
Most patients with acute bronchitis have associated symptoms of the common cold. May benefit from symptomatic treatment : Nonsteroidal antiinflammatory drug Aspirin Acetaminophen Ipratropium Nasal decongestants.

A seven day course of inhaled or oral corticosteroids may be given with a cough that persists for more than 20 days. Beta-2-agonists were not effective There are no clinical trial data to support the role of mucolytic agents.

Lack of efficacy of routine antibiotic therapy The use of antibacterial agents do not benefit Influenza Oseltamivir or zanamivir : Must be started within 48 hours of the onset of symptoms.

Clinical trials show reduce : The duration of symptoms by about one day Viral shedding Interfamily spread Hospitalizations for influenza-related complications