bronchitis%20-%20uncomplicated%20acute
BRONCHITIS - UNCOMPLICATED ACUTE
Uncomplicated acute bronchitis is a self-limiting infection of the trachea and bronchi that usually lasts for 1 to 3 weeks. A healthy patient experiences sudden onset of cough, with or without sputum production.
An inflammatory response to infections of the bronchial epithelium of the large airways of the lungs that begins with mucosal injury, epithelial cell damage and release of proinflammatory mediators.
Transient airflow obstruction and bronchial hyperresponsiveness.
Purulence can result from either bacterial or viral infection.

Pharmacotherapy

  • Routine use of antibiotics is highly discouraged & should only be considered in patients with confirmed pneumonia

Symptomatic Therapy

Choice of therapy depends on which symptoms are most bothersome to the patient

Analgesics (Non-Opioid) and Antipyretics

  • Eg Paracetamol, Ibuprofen
  • Beneficial when influenza symptoms eg malaise and fever are prominent
  • Avoid salicylates in children ≤18 years of age because of the risk of Reye Syndrome

Bronchodilators: Beta2-Agonists

  • Eg Albuterol 
  • May be used to reduce the duration and severity of cough in some patients, but routine use for cough palliation is not recommended
  • Use should be individualized to those who are most likely to benefit
    • Justified in patients with clinical evidence of airflow obstruction or bronchial hyperresponsiveness (eg wheezing or bothersome cough)
  • Effects: Studies have shown that more patients report decrease in cough after 7 days of inhaled bronchodilator as compared to placebo or antibiotic

Cough and Cold Preparations

  • Codeine or Dextromethorphan
    • May be justified for a nonproductive irritating cough, given short term for cough relief
    • Patients with cough lasting >2-3 weeks are the most likely to benefit
    • Suppress the cough reflex by a direct action on the cough center in the medulla of the brain
    • Modest effect on severity & duration of cough
    • Typically not very effective in patients with acute or early cough due to colds or other viral upper respiratory tract infection (URTI)
  • Mucolytic agents are not advised

Other Treatments

  • Pelargonium sidoides
    • May be used  as monotherapy or in combination with symptomatic therapy &/or antibiotics
    • Action: Modulates immune response, has bacteriostatic properties preventing proliferation of bacteria that causes secondary bacterial superinfection & has expectorant & mucolytic properties
    • Effects: Reduces duration & severity of respiratory tract infections caused by viruses

Antibiotics for Pertussis

  • Use is supported only for confirmed or suspected B pertussis cases when there is a high probability of exposure or during an outbreak
  • Erythromycin is the drug of choice for treatment & prophylaxis of pertussis in people of all ages
  • Two small comparative studies suggest that Clarithromycin & Azithromycin are at least as effective as Erythromycin for pertussis treatment
  • Co-trimoxazole may be used as an alternative when macrolides cannot be given
  • Antibiotics are primarily used to decrease shedding of the pathogen & therefore decrease the spread of the disease
    • Patient isolation for 5 days from the start of treatment is a necessary precaution
    • Antibiotic therapy does not appear to resolve symptoms if it is initiated 7-10 days after the onset of illness but does prevent spread to others

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Respirology - Malaysia digital copy today!
DOWNLOAD
Editor's Recommendations
Most Read Articles
Audrey Abella, 16 Feb 2017
Use of nonsteroidal anti-inflammatory drugs (NSAIDs) during acute respiratory infection episodes may increase the risk of acute myocardial infarction (MI), a recent study from Taiwan shows.
Pearl Toh, 22 Jun 2017
The next-generation ALK inhibitor brigatinib yielded high and durable responses in both whole-body and intracranial endpoints, with a median progression-free survival (PFS) of over 1 year in patients with ALK-positive non-small cell lung cancer (NSCLC) whose disease had progressed after crizotinib, according to the ALTA* trial.
Pearl Toh, 01 Mar 2016
Asthma development in young children may be associated with paracetamol exposure during maternal pregnancy or infancy, a new study on the MoBa* cohort showed.
Rachel Soon, 01 Jun 2017

Pirfenidone, an oral antifibrotic and anti-inflammatory agent, is now indicated for the treatment of idiopathic pulmonary fibrosis (IPF) in Malaysia.