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## Bronchitis Bronchitis is inflammation of the trachea and bronchi (tracheobronchial tree) and is common in children to age 4. It often occurs as a progression of an upper respiratory infection, so upper respiratory symptoms may also be evident. Bronchitis is usually caused by viruses, but can al...

## Bronchitis Bronchitis is inflammation of the trachea and bronchi (tracheobronchial tree) and is common in children to age 4. It often occurs as a progression of an upper respiratory infection, so upper respiratory symptoms may also be evident. Bronchitis is usually caused by viruses, but can also be caused by bacteria and fungi. *Mycoplasma pneumoniae* is often implicated in children over age 6. Viral bronchitis is usually essentially a mild, self-limiting disorder characterized by a dry, hacking cough that usually worsens at night and is productive within 2-3 days of onset. It clears within 5-10 days. Bronchitis of longer duration may not be viral and should be evaluated with sputum cultures. Treatment is usually symptomatic and includes: - Analgesics - Antipyretics - Cough suppressants and cough expectorants. Cough suppressants should be used sparingly at night to allow rest, but may thicken secretions and prolong symptoms. - *Note: Antibiotics are NOT indicated for viral bronchitis.* ## Chronic Bronchitis Chronic bronchitis is a pulmonary airway disease characterized by severe cough with sputum production for at least 2 consecutive years. In children, it usually relates to an underlying disease, such as cystic fibrosis, recurrent viral infection, aspiration, or asthma. Irritation of the airways (such as from second-hand smoke, infections) can cause an inflammatory response, increasing the number of mucus-secreting glands and goblet cells while ciliary function decreases so that the extra mucus plugs the airways. The bronchial walls thicken and alveoli near the inflamed bronchioles become fibrotic, and alveolar macrophages cannot function properly, increasing susceptibility to infections. Symptoms include: - Persistent cough with increasing sputum - Dyspnea - Frequent respiratory infections Treatment includes: - Bronchodilators (albuterol, metaproterenol, or theophylline) - Antipyretics (acetaminophen, ibuprofen) - Antibiotics or antivirals as indicated - Systemic corticosteroids (1-2 mg/day p.o. in one or two divided doses to maximum of 80 mg/d) for 3-10 days may be used for acute episodes if inadequate response to bronchodilators - Inhaled corticosteroids (beclomethasone, fluticasone) ## Acute Respiratory Infections Pediatric manifestations of acute respiratory infections are fever and inflammation. Fever is usually absent in neonates but is highest in those from 6 months to 3 years of age, and may reach 103-105°F. Sudden temperature rises to 104° may result in seizures in children