Know presentation, DX and Management
Diagnoses List
1. Acute bronchitisDESCRIPTION
Acute cough due to inflammation of the bronchioles, bronchi, and
... [Show More] trachea; usually follows an upper
respiratory infection or exposure to a chemical irritant.
ETIOLOGY
Adenovirus
Rhinovirus
Influenza A and B
Parainfluenza
RISK FACTORS
Upper respiratory infection
Air pollutants
Smoking and/or secondary exposure
Reflux esophagitis
Allergy
Chronic obstructive pulmonary disease
Acute and chronic sinusitis
Infants
Older adults
Immunosuppression
ASSESSMENT FINDINGS
Cough: dry and nonproductive, then productive; may be purulent
URI symptoms
Fatigue
Fever due to bacterial infection; more common in smokers and patients with COPD
Fever due to viral cause (unusual after first few days)
Burning sensation in chest
Crackles, wheezes
Chest wall pain
DIFFERENTIAL DIAGNOSIS
Pneumonia
Tuberculosis
Asthma
DIAGNOSTIC STUDIES
Decision criteria for chest radiographs: tachypnea, hypoxia, fever, abnormal lung exam
Only consider chest X-ray if high index of suspicion for pneumonia or superimposed heart failure
Consider PPD: expect negative results
PREVENTION
Smoking cessation
Avoid known respiratory irritants
Treat underlying conditions that contribute to risk (asthma, gastroesophageal reflux disease, etc.)
Influenza immunization for high-risk populations
NONPHARMACOLOGIC MANAGEMENT
Increase fluid intake
Use humidifier
Rest
Smoking cessation
Consider honey in children older than 1 year
Patient education about disease, treatment, expected cause of cough, and emergency actions
PHARMACOLOGIC MANAGEMENT
Cough suppressants for nighttime relief
Avoid antihistamines
Antibiotics if organism is bacterial
Antivirals if influenza diagnosed
Decongestants and antihistamines are ineffective unless sinusitis or allergy is underlying
Bronchodilators if wheezing or prior history of asthma
Although antibiotics are commonly prescribed, they are NOT recommended.
ACUTE BRONCHITIS PHARMACOLOGIC MANAGEMENT
Class
Drug
Generic name
(Trade name®)
Dosage
How Supplied Comments
Cough
Suppressants
Suppress cough
in the
medullary
center of the
brain
dextromethorphan/guaifenesi
n
Adult: 10 mL q 4 hr
Max: 4 doses in 24
hours
Children 6-12
years: 5 mL q 4-6
hr;
Max: 4 doses in 24
hr
Children <6
years: not
recommended
Do not use if taking
an MAO inhibitor or
for 2 weeks after
stopping an MAO
inhibitor
Contraindicated in
Parkinson’s disease
Potential drug
interaction with
some SSRIs
Avoid in patients
who are having
difficulty clearing
Robitussin DM secretions
various generics
Dextromethorphan
10 mg/5 mL
Guaifenesin 100
mg/5 mL
Although antibiotics are commonly prescribed [Show Less]