Internal Medicine

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

258 Bronchitis, Acute

■Chronic bronchitis

■Upper respiratory infection, “common cold”

■Congestive heart failure

■Reflux esophagitis

■Bronchogenic tumor

■Aspiration

management

■Treatment generally supportive, based on symptoms: antipyretics,

analgesics, cough suppressants, decongestants, fluids

specific therapy

■Scant evidence that antibiotics have any advantage over placebo

■Placebo-controlled studies using doxycycline, erythromycin, and

trimethoprim-sulfamethoxazole have not shown consistent, signif-

icant benefit

■Liberal use of antibiotics may contribute to development of bacterial

resistance

■Specific antiviral treatment of bronchitis due to influenza may

shorten duration of illness if therapy is begun within first 48 h of

illness

■Reserve antibiotics for those with underlying disease (COPD, IPF)

and those with significant fever and purulent sputum

■Inhaled bronchodilators may speed improvement of symptoms and

return to work

follow-up

Assess for:

■Secondary bacterial infection

■Exacerbation of asthma, COPD

complications and prognosis

■Acute bronchitis may trigger exacerbations of asthma, COPD

■Bronchial hyperresponsiveness may develop and last for weeks; may

cause persistent cough

■Generally no long-term sequelae; link has been postulated between

acute bronchitis caused by Chlamydia and adult-onset asthma