Pulmonology Book

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Acute Bronchitis

Aka: Acute Bronchitis, Bronchitis, Chest Cold
  1. See Also
    1. Chronic Bronchitis
    2. Acute Exacerbation of Chronic Bronchitis
    3. Chronic Cough
    4. Acute Cough Causes
  2. Definition
    1. Infection of trachea, Bronchi, or Bronchioles
    2. Acute Bronchitis is most often of viral etiology
      1. Chronic Bronchitis exacerbation is usually bacterial
  3. Epidemiology
    1. Acute Bronchitis is most common cause of acute cough
      1. Cough is most common presenting symptom in primary care
  4. Etiology: Most common causes by age
    1. Age under one year
      1. Respiratory Syncytial Virus (winter to spring)
      2. Parainfluenza Virus (fall)
      3. Coronavirus (winter to spring)
    2. Age one to 10 years
      1. Parainfluenza Virus (fall)
      2. Enterovirus (fall)
      3. Respiratory Syncytial Virus (winter to spring)
      4. Rhinovirus (fall)
    3. Age over 10 years
      1. Influenza virus (winter to spring)
      2. Respiratory Syncytial Virus (winter to spring)
      3. Adenovirus
  5. Etiology: By Category
    1. Viral Causes (represent >90% of causes)
      1. Adenovirus
      2. Coronavirus
      3. Influenza
      4. Metapneumovirus
      5. Parainfluenza virus
      6. Respiratory Syncytial Virus (RSV)
      7. Rhinovirus
    2. Bacterial causes
      1. Streptococcus Pneumoniae (Pneumococcus)
      2. HaemophilusInfluenzae
      3. Moraxella catarrhalis (Branhamella catarrhalis)
      4. Bordetella pertussis (and parapertussis)
    3. Atypical Bacterial causes
      1. Mycoplasma pneumoniae
      2. Chlamydia pneumoniae
      3. Legionella
    4. Yeast or fungi
      1. Blastomyces dermatitidis
      2. Candida albicans (and tropicalis)
      3. Coccidioides immitis
      4. Cryptococcus neoformans
      5. Histoplasma capsulatum
    5. Environmental irritants (noninfectious triggers)
      1. Air Pollution
      2. Ammonia
      3. Marijuana
      4. Tobacco smoke
  6. Symptoms
    1. Cough (onset within 2 days in 85% of Acute Bronchitis)
      1. Cough often dry, non-productive
      2. Cough may be productive of variably colored Sputum (does not distinguish from Pneumonia)
    2. Dyspnea
    3. Wheezing
    4. Chest Pain
    5. Hoarseness
    6. Constitutional symptoms
      1. Fever
      2. Myalgias
      3. Fatigue
  7. Signs
    1. Low grade fever
      1. High fever suggests Pneumonia or Influenza
    2. Lung auscultation
      1. Rales or Rhonchi variably present
      2. Prolonged expiration
      3. No signs of consolidation (Pneumonia)
        1. Lung sounds symmetric
        2. No focal rales
  8. Diagnostics
    1. Sputum exam not indicated unless Pneumonia suspected
    2. Pulse oximetry may be indicated in severe illness
    3. Peak Flow values may be indicated in Asthma history
    4. C-Reactive Protein (CRP)
      1. Value <20 suggests Bronchitis (instead of Pneumonia)
      2. Hopstaken (2003) Br J Gen Pract 53:358-64
  9. Radiology: Chest XRay Indications
    1. Red flags
      1. High fever
      2. Tachypnea
      3. Tachycardia
      4. Asymmetric lung sounds
    2. Pulmonary cause of cough suspected
      1. Pneumonia
      2. Congestive Heart Failure
    3. Serious comorbid condition
      1. Elderly patient
      2. Chronic Obstructive Lung Disease
      3. Immunocompromised patient
      4. Malignancy history
      5. Recent history of pulmonary process
        1. Pneumonia
        2. Tuberculosis
  10. Differential Diagnosis
    1. See Acute Cough Causes
    2. Asthma
    3. Rhinitis or Sinusitis with post-nasal drainage
    4. Pneumonia
      1. Predictors
        1. C-Reactive Protein >20
        2. Erythrocyte sedimentaion rate increased
        3. Dry cough with Diarrhea, Nausea
        4. Temperature >38 C (>100.4 F)
      2. References
        1. Hopstaken (2003) Br J Gen Pract 53:358-64
  11. Management: Symptomatic
    1. Supportive care for viral illness
    2. Inhaled Bronchodilator (e.g. Albuterol)
      1. More recent reviews suggest no benefit in Bronchitis unless Wheezing
        1. Direct use to those with Wheezing on examination
        2. Schroeder (2004) Cochrane Database Syst Rev CD001831
      2. Initial review suggested benefit in shortening Bronchitis course
        1. Hueston (1994) J Fam Pract 39:437-40
    3. Inhaled Corticosteroids (high dose) for episode
      1. McKean (2000) Cochrane Database Syst Rev CD001107
    4. Symptomatic relief of cough (especially nighttime)
      1. Cough suppression risks worsening bronchospasm
      2. Dextromethorphan is not effective in children with Bronchitis
        1. Paul (2004) Pediatrics 114(1):e85-90
      3. See Cough Suppressant (Antitussive)
      4. Avoid Albuterol Syrup (Not helpful)
        1. Littenberg 1996 J Fam Pract 42:49-53)
    5. Pelargonium sidoides (herbal product)
      1. Decreases overall symptoms compared with Placebo
      2. Return to work 2 days earlier compared with Placebo
      3. Matthys (2003) Phytomedicine 10:7-17
  12. Management: Specific Circumstances
    1. Treat suspected underlying cause of cough
      1. See Cough Management
      2. See Chronic Cough
    2. Persistent post-Bronchitic cough
      1. Bronchodilators reduce symptom severity and duration
      2. Consider Inhaled Corticosteroid (e.g. Azmacort)
  13. Management: Antibiotics
    1. Most cases are viral and do not require antibiotics
      1. Most studies show minimal if any antibiotic benefit
        1. No benefit with Azithromycin
        2. Evans (2002) Lancet 359:1648-54
      2. Patients with cough under 1 week showed no benefit
      3. Most patients improve with or without antibiotics
      4. See Antibiotic Resistance for Patient Education
    2. Productive cough short duration (<1 week)
      1. Avoid antibiotics
      2. Treat symptomatically as above
    3. Productive cough longer than 1-2 weeks
      1. Evaluate for treatable and serious causes of cough
        1. Pneumonia (consider Chest XRay)
        2. Acute Sinusitis
        3. Bordatella Pertussis
        4. Influenza A (treat within first 36 hours of symptoms)
        5. Tuberculosis (consider PPD)
      2. Reassurance
        1. Observation is reasonable if otherwise healthy
        2. Bronchitis often lasts >2 weeks (see course below)
        3. Consider Inhaled Corticosteroid
      3. Antibiotic protocol
        1. Consider using acute phase reactant markers to distinguish higher risk cases
          1. Procalcitonin
            1. Christ-Crain (2004) Lancet 363(9409):600-7
          2. C-Reactive Protein
            1. Cals (2009) BMJ 338: b1374
        2. Consider treating high risk groups
          1. Age over 65 years
          2. Chronic Obstructive Lung Disease
            1. See Acute Exacerbation of Chronic Bronchitis
        3. Antibiotics have no benefit empirically in Bronchitis
          1. Evans (2002) Lancet 359(9318): 1648-54
          2. Smucny (1998) J Fam Pract 47(6): 453-60
        4. Antibiotic selection (empiric use not recommended)
          1. Adult under age 50 years
            1. Macrolide antibiotic or
            2. Doxycycline
          2. Adult over age 50 years
            1. Third Generation Fluoroquinolone (e.g. Levaquin)
  14. Precautions
    1. Avoid suppressing cough if possible
      1. Cough intended to clear lungs, protect from Pneumonia
  15. Course
    1. Cough persists for >2 weeks in 25% of patients
    2. Cough may persist as long as 8 weeks in some patients
  16. Resources: Patient Education
    1. Information from your Family Doctor
      1. http://www.familydoctor.org/handouts/677.html
  17. References
    1. Albert (2010) Am Fam Physician 82(11): 1345-50
    2. Knutson (2002) Am Fam Physician 65(10):2039-44

Bronchitis (C0006277)

Definition (MSH) Inflammation of the large airways in the lung including any part of the BRONCHI, from the PRIMARY BRONCHI to the TERTIARY BRONCHI.
Definition (NCI) An acute or chronic inflammatory process affecting the bronchi.
Definition (NCI) A disorder characterized by an infectious process involving the bronchi.
Definition (MEDLINEPLUS)

Bronchitis is an inflammation of the main air passages (bronchi) to your lungs. It causes a cough, shortness of breath and chest tightness. Coughing often brings up yellow or greenish mucus. There are two main types of bronchitis: acute and chronic.

Acute bronchitis is often caused by the same viruses that cause colds. It usually starts as a sore throat, runny nose or sinus infection, then spreads to your airways. It can cause a lingering dry cough, but it usually goes away on its own.

Chronic bronchitis is one type of COPD (chronic obstructive pulmonary disease). The inflamed bronchi produce a lot of mucus. This leads to cough and difficulty getting air in and out of the lungs. Cigarette smoking is the most common cause. Breathing in other fumes and dusts over a long period of time may also cause chronic bronchitis. Treatment will help your symptoms, but chronic bronchitis is a long-term condition that keeps coming back or never goes away completely.

NIH: National Heart, Lung, and Blood Institute
Definition (NCI) Inflammation (swelling and reddening) of the bronchi.
Concepts Disease or Syndrome (T047)
MSH D001991
ICD9 490
ICD10 J40
SnomedCT 195936003, 155616009, 195940007, 266354009, 32398004
English Bronchitides, Bronchitis, Bronchitis, not specified as acute or chronic, BRONCHITIS, Bronchitis, NOS, Bronchitis NOS, Bronchitis unspecified, bronchitis (diagnosis), bronchitis, Bronchitis: [unspecified (& chest infection)] or [recurrent wheezy] (disorder), Bronchitis NOS (disorder), Bronchitis unspecified (disorder), Bronchial infection, Bronchitis [Disease/Finding], Bronchitis (disorder), Bronchitis: [unspecified (& chest infection)] or [recurrent wheezy], Recurrent wheezy bronchitis
French BRONCHITE, Bronchite, non précisée comme aiguë ou chronique, Bronchite SAI, Bronchite
Portuguese BRONQUITE, Bronquite NE se aguda ou crónica, Bronquite NE, Bronquite
Spanish BRONQUITIS, Bronquitis NEOM, Bronquitis no especificada como aguda o crónica, Bronchitis: [unspecified (& chest infection)] or [recurrent wheezy], Chest infection - unspecified bronchitis, Bronchitis unspecified, Recurrent wheezy bronchitis, Bronchitis NOS, bronquitis (trastorno), bronquitis no especificada (trastorno), bronquitis no especificada, bronquitis, SAI (trastorno), bronquitis, SAI, bronquitis, Bronquitis
German BRONCHITIS, Bronchitis NNB, Bronchitis, nicht spezifiziert als akut oder chronisch, Bronchitis, nicht als akut oder chronisch bezeichnet, Bronchialkatarrh, Bronchitis
Dutch bronchitis NAO, bronchitis, niet-gespecificeerd als acuut of chronisch, Bronchitis, niet gespecificeerd als acuut of chronisch, bronchitis, Bronchitis
Italian Bronchite NAS, Bronchite, non specificata se acuta o cronica, Bronchite
Japanese 気管支炎、急性または慢性不明, 気管支炎ＮＯＳ, 気管支炎, ｷｶﾝｼｴﾝ, ｷｶﾝｼｴﾝNOS, ｷｶﾝｼｴﾝｷｭｳｾｲﾏﾀﾊﾏﾝｾｲﾌﾒｲ
Swedish Luftrörskatarr
Czech bronchitida, průdušky - zánět, zánět průdušek, Bronchitida NOS, Bronchitida, neurčená jako akutní nebo chronická, Bronchitida
Finnish Keuhkoputkitulehdus
Russian BRONKHIT, БРОНХИТ
Korean 급성인지 만성인지 명시되지 않은 기관지염
Croatian BRONHITIS
Polish Zapalenie oskrzeli
Hungarian bronchitis, bronchitis, nem meghatározva, hogy acut vagy chronicus, bronchitis k.m.n.
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Acute bronchitis (C0149514)

Definition (CSP) sudden inflammation of the tracheobronchial tree, which comprises the trachea, or windpipe, and the bronchi; typically associated with a viral upper respiratory tract infection, such as the common cold, and is usually mild; in patients with chronic lung or heart disease, acute bronchitis is more severe, and can become chronic and progress to pneumonia.
Concepts Disease or Syndrome (T047)
ICD9 466.0
ICD10 J20, J20.9
SnomedCT 155515002, 195733000, 10509002, 35301006, 155512004, 195713004, 266380005
English Acute bronchitis, BRONCHITIS, ACUTE, ACUTE BRONCHITIS, Acute bronchitis, NOS, BRONCHITIS ACUTE, Acute bronchitis NOS, Acute bronchitis, unspecified, Bronchitis acute NOS, Bronchitis acute, acute bronchitis (diagnosis), acute bronchitis, acute tracheobronchitis, acute tracheobronchitis (diagnosis), Acute bronchitis NOS (disorder), Bronchitis;acute, Acute tracheobronchitis, Acute bronchitis (disorder), Acute tracheobronchitis (disorder), bronchitis, bronchitis; acute, acute; bronchitis, acute; tracheobronchitis, Bronchitis - acute, Acute chest infections, Tracheobronchitis - acute, Acute Bronchitis, Tracheobronchitis, acute
Dutch acute tracheobronchitis, acute bronchitis, bronchitis acuut, bronchitis acuut NAO, acuut; bronchitis, acuut; tracheobronchitis, bronchitis; acuut, Acute bronchitis, niet gespecificeerd, Acute bronchitis
French Trachéobronchite aiguë, Bronchite aiguë, Bronchite aiguë SAI
German akute Tracheobronchitis, akute Bronchitis, Bronchitis akut NNB, Akute Bronchitis, nicht naeher bezeichnet, Akute Bronchitis
Italian Tracheobronchite acuta, Bronchite acuta, Bronchite acuta NAS
Portuguese Traqueobronquite aguda, Bronquite aguda NE, Bronquite aguda
Spanish Traqueobronquitis aguda, Bronquitis aguda NEOM, Bronquitis aguda, Acute bronchitis, Acute tracheobronchitis, Acute chest infections, Tracheobronchitis - acute, Bronchitis - acute, Acute bronchitis NOS, bronquitis aguda (trastorno), bronquitis aguda, traqueobronquitis aguda (trastorno), traqueobronquitis aguda, bronquitis aguda, SAI (trastorno), bronquitis aguda, SAI
Japanese 急性気管気管支炎, ｷｭｳｾｲｷｶﾝｼｴﾝ, 急性気管支炎, 急性気管支炎ＮＯＳ, ｷｭｳｾｲｷｶﾝｼｴﾝNOS, ｷｭｳｾｲｷｶﾝｷｶﾝｼｴﾝ
Czech Akutní bronchitida NOS, Akutní tracheobronchitida, Bronchitida akutní, Akutní bronchitida
Korean 급성 기관지염, 상세불명의 급성 기관지염
Hungarian Acut bronchitis, Acut tracheobronchitis, acut bronchitis k.m.n., acut bronchitis
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Lower respiratory tract infection (C0149725)

Concepts Disease or Syndrome (T047)
SnomedCT 195744008, 155625003, 155626002, 419502003, 266339003, 50417007, 266340001, 195745009
English LOWER RESPIRATORY INFECTION, CHEST INFECTION, Chest cold, NOS, Lower respiratory infection, NOS, Lower respiratory tract infection, NOS, Lower respiratory tract infectious disease, Chest infection, Chest infection NOS, Infection lower respirat tract, Infection of lower respiratory tract, Lower respiratory tract infection, Lower respiratory tract infections, Lower respiratory infection (e.g., bronchitis, pneumonia, pneumonitis, pulmonitis), LOWER RESP. TRACT INFECTION, CI - Chest infection, Chest infection (& NOS) (disorder), Infection of lower respiratory tract (disorder), LRTI - Lower resp tract infect, Lower resp tract infec, Lower resp. tract infection, Lower respiratory tract infection NOS, LRTI, RESPIRATORY TRACT INFECTION LOWER, Chest infection (disorder), Chest infection NOS (disorder), lrti, Infection;chest, chest colds, infections lower respiratory, chest cold, cold chest, lower respiratory infection, Chest cold, Lower respiratory infection, LRTI - Lower respiratory tract infection, Lower respiratory tract infection (disorder), Chest infection (& NOS), Lower resp tract infection, Lower Respiratory Tract Infection, Infection;lower resp tract, lower resp tract infection, chest infection
Italian Infezione delle basse vie aeree, Infezione delle basse vie aeree NAS, Infezione del torace, Infezione delle vie respiratorie inferiori
Dutch borstkasinfectie, lagere luchtweginfectie, onderste luchtweginfectie NAO, onderste luchtweginfectie
French Infec des voies resp inf, Infection des voies resp inf, IVRI, Infection des voies aériennes inférieures SAI, Infection thoracique, INFECTION PULMONAIRE, Infection des voies respiratoires inférieures
German Infekt der unteren Atemwege, LRTI, Infektion der unteren Atemwege NNB, Bronchieninfektion, INFEKTION DER UNTEREN ATEMWEGE, Infektion der unteren Atemwege
Portuguese Infecção das vias respiratórias inferiores NE, Infecção torácica, INFECCAO DO TRACTO RESP. INFERIOR, Infecção das vias respiratórias inferiores
Spanish Infección del tracto respiratorio bajo, Infección de las vías respiratorias bajas NEOM, Infección torácica, Chest infection (& NOS), Chest infection, Chest infection NOS, CI - Chest infection, Infection of lower respiratory tract, Lower resp tract infection, Lower respiratory tract infection, infección del tórax (trastorno), infección torácica, infección del tórax, infección de vías respiratorias inferiores (trastorno), infección de vías respiratorias inferiores, infección torácica, SAI (trastorno), infección torácica, SAI, Infección del tracto respiratorio inferior
Japanese 胸部感染, 下気道感染, 下気道感染ＮＯＳ, ｶｷﾄﾞｳｶﾝｾﾝ, ｷｮｳﾌﾞｶﾝｾﾝ, ｶｷﾄﾞｳｶﾝｾﾝNOS
Czech Infekce dolních cest dýchacích, Hrudní infekce, Infekce dolních dýchacích cest NOS, Infekce dolních dýchacích cest
Hungarian alsó légúti fertőzés k.m.n., mellkasi fertőzés, Alsó respiratorikus rendszer infectio, Alsó respiratorikus rendszer fertőzés, LRTI, alsó légúti fertőzés
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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