Internal Medicine

0521779407-B02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:52

Bronchitis, Acute 257

Bronchitis, Acute....................................

IVAN W. CHENG, MD

history & physical

History

■Reversible inflammation and edema of the trachea and bronchial

tree

■Most commonly due to infection, but can also result from allergic or

environmental exposures, smoke or chemical fumes

■Most commonly (up to 95%) viral: influenza, adenovirus, respiratory

syncytial virus, rhinovirus, coronavirus, measles, and HSV

■Most viral cases develop between the early fall and spring

■Viral incubation period brief: 1–5 d

■Bacterial etiologies include Mycoplasma and Chlamydia pneumo-

niae andBordetella pertussis

■Bacterial infections generally have longer incubation periods, up to

3–4 wks

Signs & Symptoms

■Cough, sputum production, rhinitis, pharyngitis, laryngitis common

■Hemoptysis, fever less common

■Lungs usually clear to auscultation, but may reveal wheezing,

rhonchi and prolonged expiratory phase

tests

■Gram stain and culture of sputum generally not helpful

■WBC count usually normal

■No definitive tests for diagnosis

■Chest x-ray may be appropriate in some cases (abnormal exam,

elderly, immunocompromised) to rule out pneumonia

■Chest CT generally not indicated

■Pulmonary function tests may demonstrate obstructive physiology,

but this finding probably not useful diagnostically

differential diagnosis

■Sinusitis

■Allergic rhinitis

■Asthma

■Pneumonia

■Allergic aspergillosis

■Occupational exposure