Pulmonology Book

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Acute BronchitisAka: Bronchitis, Chest Cold

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  1. See Also
    1. Chronic Bronchitis
    2. Acute Exacerbation of Chronic Bronchitis
    3. Chronic Cough
  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. Etiology: Viral Causes (most common)
    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
  4. Etiology: Other Causes
    1. Bacterial causes
      1. Streptococcus Pneumoniae (Pneumococcus)
      2. Haemophilus Influenzae
      3. Moraxella catarrhalis (Branhamella catarrhalis)
      4. Bordetella pertussis (and parapertussis)
    2. Atypical Bacterial causes
      1. Mycoplasma pneumoniae
      2. Chlamydia pneumoniae
      3. Legionella
    3. Yeast or fungi
      1. Blastomyces dermatitidis
      2. Candida albicans (and tropicalis)
      3. Coccidioides immitis
      4. Cryptococcus neoformans
      5. Histoplasma capsulatum
    4. Environmental irritants (noninfectious triggers)
      1. Air Pollution
      2. Ammonia
      3. Marijuana
      4. Tobacco smoke
  5. 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
    2. Dyspnea
    3. Wheezing
    4. Chest Pain
    5. Hoarseness
    6. Constitutional symptoms
      1. Fever
      2. Myalgias
      3. Fatigue
  6. 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
  7. 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
  8. Radiology: Chest XRay Indications
    1. Pulmonary cause of cough suspected
      1. Pneumonia
      2. Congestive Heart Failure
    2. 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
  9. Differential Diagnosis
    1. Asthma
    2. Rhinitis or Sinusitis with post-nasal drainage
    3. 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
  10. Management: Symptomatic
    1. Supportive care for viral illness
    2. Inhaled Bronchodilator (e.g. Albuterol)
      1. May shorten bronchitis course to less than 1 week
      2. Hueston (1994) J Fam Pract 39:437
    3. Symptomatic relief of cough (especially nighttime)
      1. Cough suppression risks worsening bronchospasm
      2. See Cough Suppressant (Antitussive)
      3. Avoid Albuterol Syrup (Not helpful)
        1. (Littenberg 1996 J Fam Pract 42:49-53) :
    4. 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
  11. 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)
  12. 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
      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 other causes of cough
        1. Pneumonia (consider Chest XRay)
        2. Acute Sinusitis
        3. Allergic Rhinitis
        4. 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 (if used; controversial)
        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)
        3. Chronic Obstructive Lung Disease
          1. See Acute Exacerbation of Chronic Bronchitis
  13. Precautions
    1. Avoid suppressing cough if possible
      1. Cough intended to clear lungs, protect from Pneumonia
  14. Course
    1. Cough persists for >2 weeks in 25% of patients
    2. Cough may persist as long as 8 weeks in some patients
  15. Resources: Patient Education
    1. Information from your Family Doctor
      1. http://www.familydoctor.org/handouts/677.html
  16. References
    1. Knutson (2002) Am Fam Physician 65(10):2039

Bronchitis (C0006277)

Definition (NCI)(bron-KYE-tis) Inflammation (swelling and reddening) of the bronchi.
ConceptsDisease or Syndrome (T047)
ICD9490
MSHD001991
EnglishBronchitides, Bronchitis, Bronchitis unspecified, Recurrent wheezy bronchitis
Spanishbronquitis, bronquitis no especificada
Parent ConceptsBronchial Diseases (C0006261), Infection (C0021311), Lung diseases (C0024115), Bronchus and Bronchiole (C0549578), CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND ALLIED CONDITIONS (C0178278), Respiratory Tract Infections (C0035243), Lung Diseases, Obstructive (C0600260), Non-Neoplastic Lung Disorder (C1335019), Bronchitis (C0006277), Inflammation of specific body organs (C1285331), Inflammatory disorder of lower respiratory tract (C1290890), Ambiguous concept (C1274012), Duplicate concept (C1274013)
SourcesAOD, COSTAR, CST, DXP, ICD9CM, LCH, MEDLINEPLUS, MSH, MTH, NCI, NDFRT, OMIM, SCTSPA, SNOMEDCT
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.
ConceptsDisease or Syndrome (T047)
ICD9466.0
EnglishAcute bronchitis, Bronchitis - acute, BRONCHITIS ACUTE
Spanishbronquitis aguda
Parent ConceptsRespiratory Tract Infections (C0035243), Bronchial Diseases (C0006261), Acute bronchitis and bronchiolitis (C0155820), Bronchitis (C0006277), Infectious disease of lung (C0876973), Acute bronchitis (C0149514), Acute inflammatory disease (C1290885), Duplicate concept (C1274013)
SourcesCCS, COSTAR, CSP, CST, DXP, ICD9CM, MTH, NCI, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Lower respiratory tract infection (C0149725)

ConceptsDisease or Syndrome (T047)
EnglishChest cold, CHEST INFECTION, CI - Chest infection, Infection of lower respiratory tract, Lower resp tract infection, Lower respiratory infection, Lower respiratory tract infection, Lower respiratory tract infections, LRTI - Lower respiratory tract infection
Spanishcatarro bronquial, infeccion de vias respiratorias inferiores, infeccion del torax, infeccion toracica
Parent ConceptsInfectious disease of lung (C0876973), Respiratory Tract Infections (C0035243), Thoracic Diseases (C0039978), Lower respiratory tract infection (C0149725), Lower respiratory tract finding (C0577910), Viral respiratory infection (C0729531), Disorder of lower respiratory system (C1290325), Disorder of body cavity (C1302710), Ambiguous concept (C1274012), Duplicate concept (C1274013)
SourcesCOSTAR, DXP, MTH, NCI, OMIM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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