Bronchitis

Bronchitis - Acute

 

Definition  

Acute respiratory infection with a normal chest radiograph that is manifested by cough with or without phlegm production that lasts for up to 3 weeks

 

Medical History  

* Environmental Exposure

* Lives in a community

* Finding of immune status

* Adult, Geriatric (>65 years)

* Smoking

* Heart failure

* Patient immunocompromised

* Disorder of lung

 

Findings  

* Cough

* Fever with chills

* Laryngitis

* Malaise

* Myalgia

* Pharyngitis - Acute

* Rhinitis

* Sputum - symptom

* Wheeze - rhonchi

 

Tests  

 

Suspected hypoxia  

* Pulse oximetry: An oxygen saturation of at least 90% is acceptable in most patients .

 

Suspected pneumonia  

* Plain chest X-ray: The presence of alveolar infiltrates on chest x-ray, in combination with suggestive clinical features, establishes the diagnosis of pneumonia .

 

Differential Diagnosis  

* Community acquired pneumonia - Acute

* Influenza

* Pertussis - Acute

* Severe acute respiratory syndrome - Acute

* Asthma - Acute

 

Treatment  

 

Drug Therapy  

 

Acute bronchospasm  

 

ALBUTEROL SULFATE  

Not recommended by guidelines or supported by evidence for patients with cough due to acute bronchitis who do not have asthma but commonly used in clinical practice.

Adults: 2 puffs via metered dose inhaler (MDI) with spacer/holding chamber 3 to 4 times daily as needed OR 1.25 to 5 mg via nebulizer every 4-8 hours as needed

Pediatrics: 2 puffs via MDI with spacer/holding chamber 3 to 4 times daily as needed OR 0.05 mg/kg (minimum 1.25 mg, maximum 2.5 mg) via nebulizer every 4-6 hours as needed

 

 

Acute pain  

 

ACETAMINOPHEN

Adults: 650 to 1,000 mg orally every 4 to 6 hours as needed (maximum 4 g/day)

Pediatrics: 10 to 15 mg/kg orally or rectally every 4 to 6 hours as needed (maximum 5 doses or 4 g/day)

Neonates: 10 to 15 mg/kg orally or rectally every 6 to 8 hours as needed

 

IBUPROFEN

Adults: 200 to 800 mg orally every 6 to 8 hours as needed (maximum 3.2 g/day)

Pediatrics: 5 to 10 mg/kg orally every 6 to 8 hours as needed (maximum, lesser of 40 mg/kg/day or 2.4 g/day)

 

 

Fever  

 

ACETAMINOPHEN

Adults: 650 to 1,000 mg orally every 4 to 6 hours as needed (maximum 4 g/day)

Pediatrics: 10 to 15 mg/kg orally or rectally every 4 to 6 hours as needed (maximum 5 doses or 4 g/day)

Neonates: 10 to 15 mg/kg orally or rectally every 6 to 8 hours as needed

 

IBUPROFEN

Adults: 200 to 800 mg orally every 6 to 8 hours as needed (maximum 3.2 g/day)

Pediatrics: 5 to 10 mg/kg orally every 6 to 8 hours as needed (maximum, lesser of 40 mg/kg/day or 2.4 g/day)

 

 

Treatment of acute bronchospasm in conjunction with beta-2 agonist  

 

IPRATROPIUM BROMIDE  

Adults: 0.5 mg via nebulizer x 1 (used in combination with beta-2 agonist)

Pediatrics: 0.25 mg via nebulizer x 1 (used in combination with beta-2 agonist)

 

 

Cough  

 

DEXTROMETHORPHAN HYDROBROMIDE

Not recommended by guidelines or supported by evidence for pediatric patients with cough but commonly used in clinical practice.

Adults: 10 to 20 mg orally every 4 hours OR 30 mg orally every 6-8 hours OR 60 mg (sustained-release) orally twice daily (maximum 120 mg/day)

Pediatrics (2-6 years): 2.5 to 5 mg orally every 4 hours OR 7.5 mg every 6-8 hours (maximum 30 mg/day) OR 15 mg (sustained-release) orally twice daily

Pediatrics (6-12 years): 5 to 10 mg orally every 4 hours OR 15 mg orally every 6-8 hours (maximum 60 mg/day) OR 30 mg (sustained-release) orally twice daily

 

HYDROCODONE  

Adults: 5 to 10 mg orally 3 or 4 times daily as needed

 

CODEINE  

Not recommended by guidelines or supported by evidence for pediatric patients with cough but commonly used in clinical practice.

Adults: 10 to 20 mg orally every 4-6 hours (maximum 120 mg/day)

Pediatrics (2-6 years): 1 mg/kg/day orally in 4-6 divided doses (maximum 30 mg/day)

Pediatrics (6-12 years): 5 to 10 mg orally every 4-6 hours (maximum 60 mg/day)