bronchitis%20-%20chronic%20in%20acute%20exacerbation
BRONCHITIS - CHRONIC IN ACUTE EXACERBATION

Chronic bronchitis is an infection of the trachea and bronchi for at least 3 consecutive months for more than 2 consecutive years.
The patient experiences symptoms of increase in dyspnea, sputum volume and sputum purulence over baseline on most days.

Diagnosis is basically based on clinical presentation.

Bronchitis%20-%20chronic%20in%20acute%20exacerbation Diagnosis

Diagnosis

Diagnosis is typically based on clinical presentation.

History

  • History of chronic bronchitis with acute onset of symptoms which include the following:
    • Major criteria: Increase in sputum volume, increase in sputum purulence and increased dyspnea
    • Minor criteria: Wheezing, sore throat, cough and symptoms of a common cold (eg nasal congestion/discharge, fever, 20% increase in respiratory rate or heart rate above baseline)
  • Exacerbation is usually considered if at least 2 major criteria are present or depending on the definition used, the presence of at least 1 major and 1 minor symptom for at least 2 consecutive days

Physical Examination

  • There are no characteristic physical findings in acute exacerbation of chronic bronchitis (AECB) but the following physical findings may be found:
    • Increased respiratory rate
    • Increased wheezing
    • Diffuse crackles without localization, may be present
  • Consider the possibility of pneumonia if there is evidence of consolidation (eg localized crackles, bronchial breath sounds, dullness on percussion)
  • Elevated body temperature usually suggests viral infection or underlying pneumonia as a cause of an AECB

Laboratory Tests

Gram Stain/Culture

  • Sputum Gram stain and culture should be limited to patients with severe chronic obstructive pulmonary disease (COPD), frequent exacerbations or bronchiectasis in whom the presence of more virulent and/or resistant bacteria is more likely
    • Gram stain/culture has a limited role in the investigation of AECB since 30-50% of chronic bronchitis sufferers are colonized with non-encapsulated Haemophilus influenzae, Streptococcus pneumoniae & Moraxella catarrhalis

Pulmonary Function

  • Pre-morbid forced expiratory volume in 1 sec (FEV1) values are a predictor of adverse outcomes during an AECB but it is not necessary to perform FEV1 during the actual exacerbation
  • There is no clear correlation between transient falls in lung function and the severity of exacerbation
    • Objective measurements of pulmonary function should be done after the recovery of patients with AECB

Oxygen Saturation, Arterial Blood Gas

  • Measurement of O2 saturation (+/- blood gases) is recommended in moderate to severe cases to guide therapy

Imaging

Chest X-Ray

  • Chest x-ray is not helpful in making the diagnosis of AECB
    • May consider if needed to exclude other diseases that may complicate the condition eg pneumonia or congestive heart failure (CHF)

Evaluation

Severe Exacerbation

  • Severe exacerbation is considered when all 3 major criteria are present:
    • Increase in sputum volume, increase in sputum purulence and increased dyspnea
  • Patients with severe exacerbations are more likely to benefit from antibiotic treatment

Moderate Exacerbation

  • Moderate exacerbation is considered when 2 of the 3 major criteria are present
  • These patients may benefit from antibiotic treatment

Mild Exacerbation

  • Mild exacerbation is considered when 1 of the major criteria is present along with at least 1 minor criteria
  • Studies have shown that antibiotics are generally no more effective than placebo in these patients
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