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.

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 & increased dyspnea
    • Minor criteria: wheezing, sore throat, cough & 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 & 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 & culture should be limited to patients w/ end-stage COPD, frequent exacerbations or bronchiectasis in whom the presence of more virulent &/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 w/ 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 & the severity of exacerbation
    • Objective measurements of pulmonary function should be done after the recovery of patients w/ AECB

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 chronic 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 & increased dyspnea
  • Patients w/ 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 w/ at least 1 minor criteria
  • Studies have shown that antibiotics are generally no more effective than placebo in these patients
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Respirology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Elvira Manzano, 02 Oct 2018
Triple therapy with budesonide, glycopyrrolate, and formoterol in one metered dose inhaler (BGF MDI) appears effective and is well-tolerated in patients with symptomatic moderate-to-severe chronic obstructive pulmonary disease (COPD) irrespective of exacerbation history, the multicentre, phase III KRONOS* trial has shown.
Dr. Fanny Wai-San Ko, Dr. Wing-Ho Yip, 15 Aug 2018
Although a majority of patients can achieve good asthma control with the use of inhaled corticosteroid (ICS) and bronchodilators, some patients’ asthma remain uncontrolled despite the use of these medications.
Stephen Padilla, 14 Jan 2019
Overall, the risk of lung cancer is higher in former and current smokers with higher concentrations of high sensitivity C-reactive protein (hsCRP), according to a study. Additionally, circulating hsCRP is not associated with the risk of lung adenocarcinoma and may reflect a prediagnostic disease state rather than a causal risk for lung cancer.
20 Feb 2018
Dr Michael Lim, consultant of the Division of Paediatric Pulmonary and Sleep in National University Hospital, Singapore, shares his insights with Pearl Toh on diagnosing and managing paediatric asthma in the primary care setting.