Acute bronchitis

Introduction

Acute Bronchitis is an inflammation of the bronchial tubes commonly caused by a variety of viruses, same as those that are responsible for common cold.
Primary bacterial aetiology may also occur.
Acute bronchitis can last from a few days to 10 days but the associated cough may last for several weeks after the infection has cleared up.
Bronchitis lasting up to 90days is still usually classified as acute bronchitis.

Symptoms and clinical features of acute bronchitis

  1. Cough
  2. Sputum production
  3. Sputum may be clear, yellow or greenish
  4. Wheezing
  5. Muscle and backache
  6. Low grade fever
  7. Shortness of breath in severe cases
  8. Chest pain especially while coughing

Differential diagnosis

  • Cough-variant asthma
  • Mycoplasma pneumonia
  • Chlamydia pneumonia
  • Bordetella pertussis

Complications of acute bronchitis

  1. Pneumonia
  2. Acute respiratory failure
  3. Repeated bouts of acute bronchitis over time may lead to COPD

Relevant investigations

  • Chest x-ray
  • Sputum tests
  • (Quality sputum for culture and tests for evidence of allergy)
  • Pulmonary function tests

Management

Antibiotics usually is not required in the treatment of acute bronchitis unless
there is clear evidence of primary
bacterial aetiology or secondary bacterial infection

Drug treatment

Empirical antimicrobials
Examples:
Amoxicillin

  • Adult: 500mg PO 8 hourly for 5-7 days
  • Child:
    • <3 months: 30 mg/kg/day PO divided q12hr
    • >3 months and <40 kg: 25 mg/kg/day PO divided q12hr or 20 mg/kg/day PO divided q8h
    • 40 kg: 500 mg PO q12hr or 250 mg PO q8hr

Macrolide e.g. erythromycin Stearate

  • Adult: 500mg 8 hourly 5-7 days
  • Child: 30-50 mg/kg/day PO divided q6-8hr

Co-trimoxazole

  • Adult: 960mg 12hourly 5 – 7 days
  • Child:
    • < 2 months: contraindicated
    • > 2 months: 8 mg TMP/kg/day PO divided q12hr

Adverse events related to drugs

  • Nausea
  • Skin rashes,
  • rarely Stevens Johnson syndrome with co-trimoxazole.