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