Know presentation, DX and Management Diagnoses List
1. Acute bronchitis- DESCRIPTION
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 secretions
Robitussin DM various generics
Dextromethorphan 10 mg/5 mL
Guaifenesin 100 mg/5 mL
Although antibiotics are commonly prescribed, they are NOT recommended.
ACUTE BRONCHITIS PHARMACOLOGIC MANAGEMENT
Dextromethorphan
Adult and ≥12 years: 10 mL q 6-8 hr prn for cough Max: 4 doses in 24 hr
Children 6-12
years: 5 mL every 6- 8 hr prn for cough Max: 4 doses in 24 hr
4-6 years: 2.5 mL every 6-8 hr prn for cough
Max: 4 doses in 24 hr
• Do not use if taking an MAO inhibitor or for 2 weeks after stopping an MAO inhibitor
• Contraindicated in Parkinson’s disease
• Potential drug
intervention with some SSRIs
• Avoid in patients who are having difficulty clearing secretions
• Do not use if on a sodium restricted diet
Delsym
Dextromethorphan 15 mg/5 mL (alcohol free/orange or grape flavor)
Adult: 10 mL q 12 hr
Children 6-12
years: 5 mL q 12 hr
Children 4-6
years: 2.5 mL q 12 hr
codeine/guaifenesin
Adults and children
≥ 12 years: 10 mL q 4 hr prn cough
Max: 6 doses in 24 hr
Children 6-12
years: 5 mL q 4 hr prn cough
Max: 6 doses in 24
• 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
Although antibiotics are commonly prescribed, they are NOT recommended.
ACUTE BRONCHITIS PHARMACOLOGIC MANAGEMENT
hr
some SSRIs
• Schedule V medication
• Avoid in patients
who are having difficulty clearing secretions
• Avoid narcotic cough suppressants in patient with COPD or asthma
• May be habit forming
• May aggravate
constipation
Robitussin AC
Each 5 mL contains 100 mg guaifenesin and
10 mg codeine
Antitussives Topical anesthetic effect on the respiratory stretch receptors
benzonatate
Adults and children
> 10 years:
100-200 mg TID prn cough
Max: 600 mg daily
• Do not break or chew capsule - can produce local anesthesia and may reduce patient’s gag reflex
• Monitor for dizziness, drowsiness and visual changes
• Begins to act in 15- 20 minutes and lasts for 3-8 hours
• Avoid use in patients sensitive to or taking agents with PABA - possible adverse CNS effects
Tessalon
Caps: 100 mg, 200 mg
Expectorants
guaifenesin
Adult: 200-400 mg PO q 4 hr prn
Max: 2400 mg/day
Children 2-5
• Caution if nephrolithiasis
• Caution in patients
Although antibiotics are commonly prescribed, they are NOT recommended.
ACUTE BRONCHITIS PHARMACOLOGIC MANAGEMENT
years: 50-100 mg. PO q 4 hr prn Max: 600mg/ day Children 6-11
years: 100-200 mg PO q 4 hr prn Max: 1200 mg/day Children ≥12 years: 200-400 mg PO q 4 hr prn; Max: 2400 mg/day.
under 6 years
• Take with plenty of water; do not cut/crush/chew ER tab
Short-Acting Bronchodilator s
albuterol
Inhalation: Adult
Dose: metered-dose inhaler (MDI) or dry powder inhaler (90
mcg/actuation): 2
inhalations q 4 to 6 hr as needed Metered-dose inhaler (100 mcg/actuation): Acute treatment: 1
to 2 inhalations; additional inhalations may be necessary if inadequate relief however patients should be advised to promptly consult health care provider or seek medical attention if no relief from acute treatment Maintenance (in combination with corticosteroid therapy): 1 to 2 inhalations TID-QID
• Inhalation:
o Metered- dose inhalers: Shake well before use; prime prior to first use, and whenever inhaler has not been used for >2 weeks or when it has been dropped, by releasing 3
to 4 test sprays into the air (away from face). HFA inhalers should be cleaned with warm water at least once per week;
allow to air
Although antibiotics are commonly prescribed, they are NOT recommended.
ACUTE BRONCHITIS PHARMACOLOGIC MANAGEMENT
Max: 8 inhalations daily
Dry powder inhaler (200
mcg/inhalation): Acute treatment: 1
inhalation (200 mcg) as needed; Max: 4 inhalations (800 mcg)/day; patient should be advised to promptly consult health care provider or seek medical attention if prior dose fails to provide adequate relief or if control of symptoms lasts <3 hr Maintenance (in combination with corticosteroid therapy): 1
inhalation (200 mcg)
q 4-6 hr; Max: 4
inhalations (800 mcg)/day Nebulization solution: 2.5 mg TID-QID as needed; Quick relief: 1.25 to 5 mg q 4-8 hr as needed (NAEPP 2007)
Pediatric: Inhalation: Metered-dose inhaler or dry powder inhaler (90 mcg/actuation) quic k relief: refer to adult dosing for all
dry completely prior to use. A spacer device or valved holding chamber is recommende d for use with metered- dose inhalers.
• Storage
o Metered-
dose inhalers (HFA
aerosols): Store at 15°C to 25°C (59°F to 77°F). Do not store at temperature
>120°F. Do
not puncture. Do not use or store near heat or open flame.
• Ventolin HFA: Discard when counter reads 000 or 12 months after removal from protective pouch, whichever comes first. Store with mouthpiece down.
• Use with caution in
patients with
Although antibiotics are commonly prescribed, they are NOT recommended. [Show Less]