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Bronchitis
Muhammad Ahsan Ejaz
Introduction of Bronchitis
Bronchitis is an inflammation of the air passages between the nose and the lungs, including the windpipe or trachea and the larger airtubes of the lung that bring air in from the trachea (bronchi).
• Acute bronchitis is usually caused by a viral infection, but can also be caused by a bacterial infection and can heal without complications.
• Chronic bronchitis is a sign of serious lung disease that may be slowed but cannot be cured.
Acute and chronic bronchitis
Acute bronchitis is most prevalent in winter. It usually follows a viral infection, such as a cold or the flu, and can be accompanied by a secondary bacterial infection. Acute bronchitis resolves within two weeks, although the cough may persist longer. Acute bronchitis, can increase a person's likelihood of developing pneumonia.
In chronic bronchitis, these symptoms are present for at least three months in each of two consecutive years.
Chronic bronchitis is caused by inhaling bronchial irritants, especially cigarette smoke. Until recently, more men than women developed chronic bronchitis, but as the number of women who smoke has increased, so has their rate of chronic bronchitis.
Because this disease progresses slowly, middle aged and older people are more likely to be diagnosed with chronic bronchitis.
Causes of acute bronchitis
Viral infectionRhinovirus, Adenovirus,
Influenza virus
Bacterial infection
Mycoplasma pneumoniae, Chlamydophila pneumoniae
Causes of chronic bronchitis
smoking Chemical fumes
Air pollution
Environmental
irritants
Mold and dust
Sign and symptomsWheezing Cough with yellow or
green mucous
Chest tightness, Shortness of breath
Low fever
Contd..Chronic bronchitis shows the
same sign and symptoms Additionally the cough and
sputum continue for more than three consecutive months for more than two years
Mostly suspected above 40 years of age
Diagnosis
Physical examinatio
n
Pulmonary functional
test
Sputum culture
Radiography
Treatment of Acute Bronchitis
Air flow optimizationAntibiotic therapy
Air flow optimizationExpectorants Acefyl cough (Acefylline, Piperazine, Diphenhydramine)
Acetyl (Acetylcysteine 200mg)
Diminol (Ammonium cholride, Diphenhydramine HCl , Ephedrine HCl )
Bronchodilators They don’t alter the lung function but they improve symptoms of the disease Anticholinergic ( Ipratropium bromide
2-4 puffs every 6 hour)
Beta-2 agonist (Albuterol)
Corticosteroids
Beclomethasone (inhaled)
Prednisone (oral)
Antibiotics First line agents DoxycyclineAmoxicillin2nd line agents Co-amoxicalvClarithromycinCefixime
Treatment of chronic bronchitisSmoking cessation
Oxygen therapy (supplemental oxygen for patients with resting hypoxemia)
BronchodilatorsThey don’t alter the lung function but they improve symptoms of the disease Anticholinergic ( ipratropium bromide
2-4 puffs every 6 hour)Beta-2 agonist (albuterol) Ipratropium bromide is preferred over beta-2 angonists because of Long duration of actionNo sympathomimitic side effects
Long acting Beta-agonists (Formoterol, Salmeterol , Alformeterol )
Equilent or superior to Ipratopium and albuterol but superior effeicacy in advanced disease.
Corticosterids In combination with long acting beta-2 agonistInhaled corticosteroids are
preffered because oral corticosteroids have marked adverse effects.
TheophyllineImprove hemoglobin saturation in patients with sleep related breathing disorders.It providesBronchodilationAnti-inflammatory effectDiaphragm strengthNotes Due to narrow therapeutic window ,it is used in carefully selected patients.
AntibioticsAntibiotic are prescribed to treat
acute exacerbations.Option includeDoxycycline 100mg every 12 hour Azithromycin 500mg followed by
250 mg for 5 days.Co-amoxiclav 1000mg every 12 hourCiprofloxicin 500mg every 12 hourDuration of therapy 3-7 days
Other measures Aerobic physical exercise(walking 20 min. or bicycling )Adequate systemic hydration
increases the mobilization of secretions.
REFERENCES Current Medical Diagnosis and Treatment (2014)
Clinical Pharmacy and Therapeutics by Roger Walker and Cate Whittlesea
National Heart, Lung and Blood Institute. (USA) http://www.nhlbi.nih.gov .
Diagnosis and Treatment of Acute Bronchitis ROSS H. ALBERT, MD, PhD, Hartford Hospital, Hartford, Connecticut
Acute Bronchitis Richard P. Wenzel, M.D., and Alpha A. Fowler III, M.D. The New England Journal of Medicine