![]() Educating patients with acute bronchitis about what symptoms they should follow up on will engage them in their health care and increase adherence to the treatment plan. Conversely, if a patient presents with abnormal vital signs or signs of lung consolidation, a chest radiograph is indicated. Reassuring the patient with an expected time frame for resolution and recommendations for OTC symptom relief are the mainstays of treatment. Indications for a Chest Radiograph in an Adult Patient With Acute Bronchitisįor most patients with acute bronchitis, symptoms are self-limiting and will resolve in 1-4 weeks. 8Therefore, practitioners who suspect pneumonia in a patient, should keep in mind that it is considered the gold standard of care to get a chest radiograph to confirm the presence of an infiltrate (Table). Even the sensitivity of the combination of cough, crackles, fever, and tachycardia was less than 50% when a chest radiograph was used as the standard. 2,7It is important to note that while the symptoms listed above support the diagnosis of CAP, none have proven to accurately predict whether the patient actually has pneumonia. A chest exam can reveal crackles/rales, decreased breath sounds, dullness to percussion, egophony, and tactile fremitus. 7A fever greater than 100.4F and tachycardia are common in most patients. A respiratory rate above 24 breaths per minute is noted in up to 70% of patients and may be the most sensitive sign in older adult patients. Older adults may display mental status changes and are less likely to be febrile upon exam. 7Patients with CAP can present with dyspnea, fever, signs of lung consolidation, tachycardia, or tachypnea. pneumoniabeing the most commonly identified cause of CAP. 7There are more than 100 microbes (bacteria, fungi, parasites, and viruses) that can cause pneumonia, with S. This transparency can prevent inappropriate expectations of antibiotic use and possibly divert additional visits at a higher level of care.Ĭommunity acquired pneumonia (CAP) is defined as an acute infection of the pulmonary parenchyma in a patient who acquired the infection within the community versus within a hospital. 6It is essential to educate the patient about a realistic expected length of illness. The mean duration of cough in evidence-based literature is 18 days. Survey respondents reported a median duration of 5 to 7 days and a mean duration of 7 to 9 days. 6Ebell and colleagues (2013) conducted a population-based survey to determine patients’ expectations regarding the duration of a cough-related illness. Many patients and providers underestimate the time required to fully recover from acute bronchitis. The cough associated with acute bronchitis can be very bothersome, stripping the patient of days at work or school, as well as sleep. Production of sputum, whether it is purulent or not, is common and does not correlate with a bacterial infection. Prolonged coughing can also create substernal musculoskeletal pain. ![]() Mild dyspnea may be present, especially with physical activity. However, the rhonchi typically clear with a forceful cough. Rhonchi and wheezing may be auscultated upon exam. 1,2With involvement of the lower respiratory tract, the cough becomes the dominant symptom. The first few days of illness can produce elevated temperature, headache, mild fever of less than 100.9F, nasal/sinus congestion, and pharyngitis. 2Īcute bronchitis is often preceded by an ARS or URI. Therefore, an accurate history of present illness and physical exam are critical. The treatment plans for these differential diagnoses can vary widely. The diagnoses that have the most overlap with acute bronchitis are upper respiratory infection (URI), acute rhinosinusitis (ARS) and pneumonia. 1Because of the high likelihood of viral etiology, antibiotics are not recommended for treatment of acute bronchitis. 3,4It is typically a self-limited disease, resolving within 1 to 4 weeks 1,2,4, with a median duration of 18 days. ![]() In more than 90% of cases, acute bronchitis has a viral etiology with rhinovirus, enterovirus, influenza A and B, parainfluenza, coronavirus, and respiratory syncytial virus being the most commonly identified pathogens. The cough may be associated with either non-purulent or purulent sputum production. 1It is characterized by an acute cough for more than 5 days in the absence of chronic obstructive pulmonary disease or pneumonia. Acute bronchitis is one of the most common clinical conditions encountered in ambulatory care, accounting for about 10% of visits in the United States or 100 million visits per year.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |