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What is the mainstay of treatment for acute bronchitis?
What is the mainstay of treatment for acute bronchitis?
Patients older than 75 years are more likely to have fever or tachycardia when presenting with pneumonia symptoms.
Patients older than 75 years are more likely to have fever or tachycardia when presenting with pneumonia symptoms.
False
What is the purpose of antitussives in the treatment of cough symptoms?
What is the purpose of antitussives in the treatment of cough symptoms?
Reduce the cough reflex
________ was associated with an increased likelihood of pneumonia in a large primary care trial.
________ was associated with an increased likelihood of pneumonia in a large primary care trial.
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Match the following with their purpose in the treatment of acute cough symptoms:
Match the following with their purpose in the treatment of acute cough symptoms:
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What is the most common reason for ambulatory care visits in the United States?
What is the most common reason for ambulatory care visits in the United States?
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What is the typical duration of the cough associated with acute bronchitis?
What is the typical duration of the cough associated with acute bronchitis?
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Antibiotics are indicated for patients with acute bronchitis without chronic lung disease.
Antibiotics are indicated for patients with acute bronchitis without chronic lung disease.
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Acute bronchitis is characterized by cough due to acute inflammation of the trachea and large airways without evidence of _______.
Acute bronchitis is characterized by cough due to acute inflammation of the trachea and large airways without evidence of _______.
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Match the virus with its identification in cases of acute bronchitis:
Match the virus with its identification in cases of acute bronchitis:
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Which of the following is true regarding the use of antibiotics for acute bronchitis?
Which of the following is true regarding the use of antibiotics for acute bronchitis?
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Over-the-counter medications have been proven to be effective as a first-line treatment for acute cough.
Over-the-counter medications have been proven to be effective as a first-line treatment for acute cough.
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Antitussives work by reducing the ______ reflex.
Antitussives work by reducing the ______ reflex.
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Which illness-related reason accounts for the most ambulatory care visits in the United States?
Which illness-related reason accounts for the most ambulatory care visits in the United States?
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What should be suspected in patients with cough persisting for more than two weeks accompanied by symptoms like whooping cough and post-tussive emesis?
What should be suspected in patients with cough persisting for more than two weeks accompanied by symptoms like whooping cough and post-tussive emesis?
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Is pneumonia indicated in patients with signs such as tachypnea and tachycardia?
Is pneumonia indicated in patients with signs such as tachypnea and tachycardia?
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Acute bronchitis is typically caused by __________.
Acute bronchitis is typically caused by __________.
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Match the viruses with their association with acute bronchitis:
Match the viruses with their association with acute bronchitis:
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What percentage of acute bronchitis episodes are viral in origin?
What percentage of acute bronchitis episodes are viral in origin?
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What was the result of a recent study on antibiotic prescribing trends from 1996 to 2010 for acute bronchitis?
What was the result of a recent study on antibiotic prescribing trends from 1996 to 2010 for acute bronchitis?
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What is the mechanism by which many patients with acute bronchitis have impaired airflow?
What is the mechanism by which many patients with acute bronchitis have impaired airflow?
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What was the result of the second trial using guaifenesin in children older than one year?
What was the result of the second trial using guaifenesin in children older than one year?
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What percentage of visits for acute bronchitis resulted in antibiotic prescriptions according to a recent study?
What percentage of visits for acute bronchitis resulted in antibiotic prescriptions according to a recent study?
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What was the result of the third trial using an extended-release formulation of guaifenesin?
What was the result of the third trial using an extended-release formulation of guaifenesin?
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What is the significance of a C-reactive protein level of less than 50 mcg per mL in patients with respiratory tract infections?
What is the significance of a C-reactive protein level of less than 50 mcg per mL in patients with respiratory tract infections?
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What is the recommendation of the American Academy of Pediatrics regarding antibiotic use for apparent viral respiratory illnesses?
What is the recommendation of the American Academy of Pediatrics regarding antibiotic use for apparent viral respiratory illnesses?
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What is the role of procalcitonin testing in patients with lower respiratory tract infections?
What is the role of procalcitonin testing in patients with lower respiratory tract infections?
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What is the typical approach to managing acute cough in patients with lower respiratory tract infections?
What is the typical approach to managing acute cough in patients with lower respiratory tract infections?
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What is the significance of an elevated C-reactive protein level in patients with respiratory tract infections?
What is the significance of an elevated C-reactive protein level in patients with respiratory tract infections?
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What is the recommendation of major guidelines on bronchitis regarding antibiotic use?
What is the recommendation of major guidelines on bronchitis regarding antibiotic use?
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What is the significance of a clinical decision rule for pneumonia developed by Swiss researchers?
What is the significance of a clinical decision rule for pneumonia developed by Swiss researchers?
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What is the purpose of biomarkers as point-of-care tests in guiding prescription of antibiotics in patients with acute respiratory infections in primary care?
What is the purpose of biomarkers as point-of-care tests in guiding prescription of antibiotics in patients with acute respiratory infections in primary care?
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Why are antibiotics often prescribed for acute bronchitis despite recommendations against their use?
Why are antibiotics often prescribed for acute bronchitis despite recommendations against their use?
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According to the ACCP evidence-based clinical practice guidelines, what is the recommended approach for the treatment of acute bronchitis in adults?
According to the ACCP evidence-based clinical practice guidelines, what is the recommended approach for the treatment of acute bronchitis in adults?
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What is the primary benefit of delayed antibiotic prescribing strategies for respiratory tract infections in primary care?
What is the primary benefit of delayed antibiotic prescribing strategies for respiratory tract infections in primary care?
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What is the primary purpose of using serum C reactive protein and procalcitonin concentrations in addition to symptoms and signs to predict pneumonia in patients presenting to primary care with acute cough?
What is the primary purpose of using serum C reactive protein and procalcitonin concentrations in addition to symptoms and signs to predict pneumonia in patients presenting to primary care with acute cough?
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According to the Cochrane Database Syst Rev, what is the recommended approach for the treatment of acute bronchitis in adults?
According to the Cochrane Database Syst Rev, what is the recommended approach for the treatment of acute bronchitis in adults?
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What is the primary benefit of calling acute bronchitis a 'chest cold' in patients with acute bronchitis?
What is the primary benefit of calling acute bronchitis a 'chest cold' in patients with acute bronchitis?
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What is the primary purpose of using diagnostic aids to rule out pneumonia in adults with cough and feeling of fever?
What is the primary purpose of using diagnostic aids to rule out pneumonia in adults with cough and feeling of fever?
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According to the GRACE Consortium, what is the primary benefit of using serum C reactive protein and procalcitonin concentrations in addition to symptoms and signs to predict pneumonia in patients presenting to primary care with acute cough?
According to the GRACE Consortium, what is the primary benefit of using serum C reactive protein and procalcitonin concentrations in addition to symptoms and signs to predict pneumonia in patients presenting to primary care with acute cough?
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What is the primary goal of educating patients about the expected duration of illness in acute bronchitis?
What is the primary goal of educating patients about the expected duration of illness in acute bronchitis?
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What is the benefit of describing the infection as a viral illness or chest cold to patients with acute bronchitis?
What is the benefit of describing the infection as a viral illness or chest cold to patients with acute bronchitis?
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What is the purpose of discussing the treatment plan with patients, including the use of nonantibiotic medications to control symptoms?
What is the purpose of discussing the treatment plan with patients, including the use of nonantibiotic medications to control symptoms?
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What is the consequence of using antibiotics in patients with acute bronchitis?
What is the consequence of using antibiotics in patients with acute bronchitis?
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What is the purpose of using delayed prescription strategies in patients with acute bronchitis?
What is the purpose of using delayed prescription strategies in patients with acute bronchitis?
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What is the benefit of explaining to patients that antibiotics do not significantly shorten the duration of illness in acute bronchitis?
What is the benefit of explaining to patients that antibiotics do not significantly shorten the duration of illness in acute bronchitis?
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What is the purpose of addressing patient concerns in a compassionate manner in patients with acute bronchitis?
What is the purpose of addressing patient concerns in a compassionate manner in patients with acute bronchitis?
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What is the primary focus of strategies to reduce antibiotic use in acute bronchitis?
What is the primary focus of strategies to reduce antibiotic use in acute bronchitis?
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What is the primary focus of the ProREAL study?
What is the primary focus of the ProREAL study?
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What is the recommended approach to antibiotic use in patients with acute bronchitis without chronic lung disease?
What is the recommended approach to antibiotic use in patients with acute bronchitis without chronic lung disease?
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What is the significance of the 2015 Healthcare Effectiveness Data and Information Set (HEDIS) Measures?
What is the significance of the 2015 Healthcare Effectiveness Data and Information Set (HEDIS) Measures?
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What is the typical duration of the cough associated with acute bronchitis?
What is the typical duration of the cough associated with acute bronchitis?
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What is the most common reason for ambulatory care visits in the United States?
What is the most common reason for ambulatory care visits in the United States?
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Which of the following is a common feature of pneumonia in older adults?
Which of the following is a common feature of pneumonia in older adults?
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Study Notes
Acute Bronchitis
- Acute bronchitis is a clinical diagnosis characterized by cough due to acute inflammation of the trachea and large airways without evidence of pneumonia.
- Pneumonia should be suspected in patients with tachypnea, tachycardia, dyspnea, or lung findings suggestive of pneumonia, and radiography is warranted.
Causes of Acute Bronchitis
- Acute bronchitis is most often caused by viral infections, with the most commonly identified viruses being rhinovirus, enterovirus, influenza A and B, parainfluenza, coronavirus, human metapneumovirus, and respiratory syncytial virus.
- Bacteria are detected in 1% to 10% of cases of acute bronchitis, with atypical bacteria, such as Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Bordetella pertussis, being rare causes.
Symptoms of Acute Bronchitis
- Cough is the predominant and defining symptom of acute bronchitis.
- Other symptoms include sputum production, dyspnea, nasal congestion, headache, and fever.
- The first few days of an acute bronchitis infection may be indistinguishable from the common cold.
- Patients may have substernal or chest wall pain when coughing.
- Fever is not a typical finding after the first few days, and presence of a fever greater than 100°F (37.8°C) should prompt consideration of influenza or pneumonia.
Diagnosis and Testing
- Laboratory testing is usually not indicated in the evaluation of acute bronchitis.
- Leukocytosis is present in about 20% of patients; significant leukocytosis is more likely with a bacterial infection than with bronchitis.
- Rapid testing is available for some respiratory pathogens, but it is usually not necessary in the typical ambulatory care patient.
- Biomarkers may assist in identifying patients who might benefit from antibiotics.
- C-reactive protein levels and procalcitonin testing may be useful in differentiating pneumonia and acute bronchitis.
Management and Treatment
- Supportive care and symptom management are the mainstay of treatment for acute bronchitis.
- Antibiotics are not indicated in patients without chronic lung disease.
- Strategies to reduce inappropriate antibiotic use include delayed prescriptions, patient education, and calling the infection a chest cold.
- Over-the-counter medications, such as antihistamines and antitussives, are often recommended as first-line treatment for acute cough.
- Dextromethorphan, a nonopioid, synthetic derivative of morphine, may be used to decrease cough symptoms.
- Beta2 agonists should not be used for the routine treatment of acute bronchitis unless wheezing is present.
Complications and Prevention
- Patients may underestimate the time required to fully recover from acute bronchitis.
- The duration of acute bronchitis–related cough is typically two to three weeks.
- Strategies to reduce antibiotic use can help prevent the development of antibiotic resistance.
- The American Academy of Pediatrics recommends that antibiotics not be used for apparent viral respiratory illnesses, including sinusitis, pharyngitis, and bronchitis.
Acute Bronchitis
- Acute bronchitis is a clinical diagnosis characterized by cough due to acute inflammation of the trachea and large airways without evidence of pneumonia.
- Pneumonia should be suspected in patients with tachypnea, tachycardia, dyspnea, or lung findings suggestive of pneumonia, and radiography is warranted.
Causes of Acute Bronchitis
- Acute bronchitis is most often caused by viral infections, with the most commonly identified viruses being rhinovirus, enterovirus, influenza A and B, parainfluenza, coronavirus, human metapneumovirus, and respiratory syncytial virus.
- Bacteria are detected in 1% to 10% of cases of acute bronchitis, with atypical bacteria, such as Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Bordetella pertussis, being rare causes.
Symptoms of Acute Bronchitis
- Cough is the predominant and defining symptom of acute bronchitis.
- Other symptoms include sputum production, dyspnea, nasal congestion, headache, and fever.
- The first few days of an acute bronchitis infection may be indistinguishable from the common cold.
- Patients may have substernal or chest wall pain when coughing.
- Fever is not a typical finding after the first few days, and presence of a fever greater than 100°F (37.8°C) should prompt consideration of influenza or pneumonia.
Diagnosis and Testing
- Laboratory testing is usually not indicated in the evaluation of acute bronchitis.
- Leukocytosis is present in about 20% of patients; significant leukocytosis is more likely with a bacterial infection than with bronchitis.
- Rapid testing is available for some respiratory pathogens, but it is usually not necessary in the typical ambulatory care patient.
- Biomarkers may assist in identifying patients who might benefit from antibiotics.
- C-reactive protein levels and procalcitonin testing may be useful in differentiating pneumonia and acute bronchitis.
Management and Treatment
- Supportive care and symptom management are the mainstay of treatment for acute bronchitis.
- Antibiotics are not indicated in patients without chronic lung disease.
- Strategies to reduce inappropriate antibiotic use include delayed prescriptions, patient education, and calling the infection a chest cold.
- Over-the-counter medications, such as antihistamines and antitussives, are often recommended as first-line treatment for acute cough.
- Dextromethorphan, a nonopioid, synthetic derivative of morphine, may be used to decrease cough symptoms.
- Beta2 agonists should not be used for the routine treatment of acute bronchitis unless wheezing is present.
Complications and Prevention
- Patients may underestimate the time required to fully recover from acute bronchitis.
- The duration of acute bronchitis–related cough is typically two to three weeks.
- Strategies to reduce antibiotic use can help prevent the development of antibiotic resistance.
- The American Academy of Pediatrics recommends that antibiotics not be used for apparent viral respiratory illnesses, including sinusitis, pharyngitis, and bronchitis.
Acute Bronchitis
- Studies on using C-reactive protein levels to guide antibiotic use in patients with respiratory tract infections are inconclusive.
- Elevated C-reactive protein levels are associated with an increased likelihood of pneumonia in primary care trials.
- A clinical decision rule for pneumonia was developed and validated by Swiss researchers, which found that pneumonia could be ruled out in patients with a C-reactive protein level of less than 50 mcg per mL and no dyspnea or daily fever.
Antibiotics in Acute Bronchitis
- Most major guidelines, including those from the American College of Chest Physicians, recommend against using antibiotics for acute bronchitis unless the patient has a known pertussis infection.
- The American Academy of Pediatrics recommends that antibiotics not be used for apparent viral respiratory illnesses, including sinusitis, pharyngitis, and bronchitis.
- Despite these recommendations, antibiotics are often prescribed for acute bronchitis.
- At least 90% of acute bronchitis episodes are viral, yet antibiotics are commonly prescribed, resulting in adverse effects, rising health care costs, and antimicrobial resistance.
Over-the-Counter Medications
- Over-the-counter medications are often recommended as first-line treatment for acute cough.
- Guaifenesin has been shown to reduce cough frequency and improve cough severity in patients with lower respiratory tract infections.
- An extended-release formulation of guaifenesin has also been shown to improve symptom severity at day 4.
Strategies to Reduce Antibiotic Use
- Delayed prescription strategies, such as asking patients to call for or pick up an antibiotic or to hold an antibiotic prescription for a set amount of time, can help reduce antibiotic use.
- Addressing patient concerns in a compassionate manner and discussing the expected course of illness and cough duration (two to three weeks) can also help reduce antibiotic use.
- Explaining that antibiotics do not significantly shorten illness duration and are associated with adverse effects and antibiotic resistance can also help reduce antibiotic use.
- Describing the infection as a viral illness or chest cold and explaining the treatment plan, including the use of nonantibiotic medications to control symptoms, can also help reduce antibiotic use.
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Description
This quiz covers the diagnosis and characteristics of acute bronchitis, a clinical diagnosis characterized by cough due to acute inflammation of the trachea and large airways without evidence of pneumonia.
