What is the pathophysiology of Acute Bronchitis?
- self limited bronchial inflammation
- associated with viral URI
- Different from chronic bronchitis
What is the etiology of acute bronchitis?
VIRAL!
Which viruses cause Acute Bronchitis?
- Influenza A & B
- Parainfluenza
- Coronavirus
- Rhinovirus
- Respiratory syncytial virus (RSV)
Acute Bronchitis is a “PRRIC”
T/F: Bacteria can cause Acute Bronchitis
TRUE
- mycoplasma pneumoniae
- chlamydophilia pneumoniae
- Bordetella Pertissus
My Bronchitis is not Chronic
What are some differential diagnoses related to Acure Bronchitis?
- Common cold
- sinusitis
- chronic bronchitis
- pneumonia
- postnasal drip
- GERD
- asthma
- heart failure
- bronchogenic tumors
How will a patient with Acute Bronchitis present?
- Cough lasting more than 5 days (usually 1-3 weeks)
- +/- productive
- Usually afebrile unless the viral cause of the bacteria is specifically influenza.
- Febrile if bacterial cause
- Chest wall tenderness
- Wheezing
- mild dyspnea
Physical Exam for Acute Bronchitis
- Wheezing
- Rhonchi that clears w/coughing
- Negative for rales and signs of consolidation
What diagnostics would you use for Acute Bronchitis?
- WBC is normal to mildly elevated
- CXR: normal or nonspecific, may not be needed
What is the management of Acute Bronchitis?
***Symptomatic Treatment***
- Antitussives (codeine, dextromethorphan)?
- B2 agonists If wheezing
- OTC products: expectorants/mucolytics, antihistamines, decongestants
- Corticosteroids
Main take home points of Acute Bronchitis
- It is mainly VIRAL
- Only 1% of patients are given Abx
- Patient education: Be cautious when pts ask about antibiotics: ACUTE BRONCHITIS IS MAINLY CAUSED BY VIRUSES
What is “whooping cough”
Pertussis
What is the etiology of Pertussis?
Bordetella Pertussis
What is the pathology of Bordetella Pertussis?
Releases toxin that damages cilia and causes airways to swell
What age group is most likely to get Pertussis?
< 2 y/o
How is Bordetella Pertussis transmitted?
- Respiratory droplets
- Incubation 7-17 days
- Contagious for 2 weeks after onset of cough
What is the incubation period of B. Pertussis?
7-17 days
Pts with B. Pertussis are contagious for _______ after onset of _______
- 2 weeks
- cough
What is the clinical presentation of Pertussis?
- Catarrhal: 1-2 wks
- malaise, rhinorrhea, mild cough, mild fever
- Lacrimation & conjunctival injection
- Paroxysmal: begins in 2nd week & lasts 2-3 months
- Paroxysmal cough: sudden bursts of rapid, consecutive coughs followed by deep, high-pitched inspiration (whoop)
- +/- post-tussive syncope or emesis
- Convalescent: 1-2 weeks
- Gradual reduction frequency and severity of cough
How long does the Catarrhal stage of Pertussis last and what symptoms are present?
- 1-2 weeks
- Malaise, rhinorrhea, mild cough, mild fever
- lacrimation & conjunctival injection
- 1-2 weeks
- Malaise, rhinorrhea, mild cough, mild fever
- lacrimation & conjunctival injection
What stage of Pertussis is this?
Catarrhal
- Begins in 2nd week & lasts 2-3 months
- Cough: sudden bursts of rapid, consecutive coughs followed by deep, high-pitched inspiration (whoop)
- +/- post-tussive syncope or emesis
Paroxysmal
1-2 weeks
Gradual reduction in frequency and severity of cough
Convalescent
What are diagnostics you want to run for Pertussis?
- CBC: elevated blood count
- Nasopharyngeal culture
- PCR assay
Pertussis Treatment
1st line: Azithromycin
2nd line:
Clarithromycin
Erythromycin Trimethoprim-sulfamethoxazole
