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

• 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

• 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

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

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)
    
    

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