Know presentation, DX and Management
Diagnoses List
1. Acute bronchitisDESCRIPTION
Acute cough due to inflammation of the bronchioles, bronchi, and trachea; usually follows an upper
respiratory infection or exposure to a chemical irritant.
ETIOLOGY
Adenovirus
Rhinovirus
Influenz...
Know presentation, DX and Management
Diagnoses List
1. Acute bronchitis-
DESCRIPTION
Acute cough due to inflammation of the bronchioles, bronchi, and 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
Drug
Dosage
Class Generic name Comments
How Supplied
(Trade name®)
Cough dextromethorphan/guaifenesi Adult: 10 mL q 4 hr Do not use if taking
Suppressants n Max: 4 doses in 24 an MAO inhibitor or
Suppress cough hours for 2 weeks after
in the Children 6-12 stopping an MAO
medullary years: 5 mL q 4-6 inhibitor
center of the hr; Contraindicated in
brain Max: 4 doses in 24 Parkinson’s disease
hr Potential drug
Children <6 interaction with
years: not some SSRIs
recommended Avoid in patients
who are having
difficulty clearing
Robitussin DM Dextromethorphan secretions
various generics 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 Do not use if taking
years: 10 mL q 6-8 an MAO inhibitor or
hr prn for cough for 2 weeks after
Max: 4 doses in 24 stopping an MAO
hr inhibitor
Children 6-12 Contraindicated in
years: 5 mL every 6- Parkinson’s disease
8 hr prn for cough Potential drug
Max: 4 doses in 24 intervention with
hr some SSRIs
4-6 years: 2.5 mL Avoid in patients
every 6-8 hr prn for who are having
cough difficulty clearing
Max: 4 doses in 24 secretions
hr 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 Do not use if taking
≥ 12 years: 10 mL q an MAO inhibitor or
4 hr prn cough for 2 weeks after
Max: 6 doses in 24 stopping an MAO
hr inhibitor
Contraindicated in
Children 6-12 Parkinson’s disease
years: 5 mL q 4 hr Potential drug
prn cough interaction with
Max: 6 doses in 24
, Although antibiotics are commonly prescribed, they are NOT recommended.
ACUTE BRONCHITIS PHARMACOLOGIC MANAGEMENT
hr some SSRIs
Schedule V
medication
Robitussin AC Each 5 mL contains Avoid in patients
100 mg guaifenesin who are having
and difficulty clearing
10 mg codeine secretions
Avoid narcotic cough
suppressants in
patient with COPD
or asthma
May be habit
forming
May aggravate
constipation
Antitussives benzonatate Adults and children Do not break or
Topical > 10 years: chew capsule - can
anesthetic effect 100-200 mg TID prn produce local
on the cough anesthesia and may
respiratory Max: 600 mg daily reduce patient’s gag
stretch reflex
receptors Monitor for
dizziness,
Tessalon Caps: 100 mg, 200 drowsiness and
mg 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
Expectorants guaifenesin Adult: 200-400 mg Caution if
PO q 4 hr prn nephrolithiasis
Max: 2400 mg/day Caution in patients
Children 2-5
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