Acute bronchitis, assessment Correct Answer - Onset of cough
for > 5 days without evidence of pneumonia, asthma,
exacerbation of COPD
- Cough starts nonproductive and becomes productive.
- Dyspnea, wheezing and fatigue.
- Fever may suggest pneumonia or flu.
Acute bronchitis, General Correct Answer -Cough is
predominant symptom lasting up to 3 weeks.
-Antitussive medication not indicated in patients < 6 years old.
-follow up in 7 days if not improving or if worsening, or sooner
if coexisting disease.
-refer to pulmonologist if not improving after 4 weeks.
Acute bronchitis, pharm Correct Answer - Antibiotics not
recommended
# abx only if bacterial source identified.
- decongestants if accompanied by sinus condition
- honey, cough suppressants, guaifenesin with codeine or
dextromethorphan for pts >6yo
- mucolytics not recommended
- Inhaled beta-agonist in combination with high dose ICS for
cough with bronchospasm in those with airflow obstruction.
Asthma, diagnosis Correct Answer - Episodic symptoms of
airflow obstruction or hyperresponsiveness are present.
- Obstructive airway is at least partially reversible.
, - Alternative dx excluded.
- "Reversible obstructive findings on spirometry is a distinctive
diagnostic abnormality."
Bronchiolitis, General Correct Answer - Inflammation and
obstruction of the small airways and reactive airways generally
affecting infants and young.
- Predominant age: newborn-2 years (peak age < 6 months).
Neonates are not protected despite transfer of maternal antibody.
- Predominant sex male > female.
- Usually viral, typically RSV (70-85%).
- F/u and should improve in 3 to 5 days with complete recovery
and 5 to 10 days, but this depends on underlying disease and
patient age.
Bronchiolitis, patho Correct Answer - Infection results in
necrosis and lysis of epithelial cells and release of inflammatory
mediators.
- Edema and mucus secretion and loss of cilia clearance result
in airflow obstruction.
- Hypoxia.
- Air trapping due to airways narrowing during expiration.
Bronchiolitis, pharmacology Correct Answer - Nebulized
hypertonic saline 5% for moderately ill ambulatory patients or
hospitalized infants- should not be administered to infants in the
ED.
- Bronchodilators should NOT be routinely used.
- Albuterol should NOT be administered to infants and children
with bronchiolitis: risk of harm outweighs benefits.
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