 Bronchitis is associated with infection of the upper and lower respiratory tracts, and the trachea is usually involved. Bronchiolitis is an entirely different illness Asthma exacerbations are triggered by upper respiratory tract infections. Calling such exacerbations "asthmatic bronchitis," although technically correct, may confuse parents Acute tracheobronchitis is commonly associated with an upper respiratory tract infection such as nasopharyngitis, influenza, Pertussis, measles, typhoid fever, diphtheria. Pneumococci, staphylococci, Haemophilus influenzae, and hemolytic streptococci may be isolated from the sputum, but their presence does not imply a bacterial cause, and antibiotic therapy does not appreciably alter the course of the illness. Allergy, climate, air pollution, and chronic infections of the upper respiratory tract, particularly sinusitis, may be contributing factors. CLINICAL MANIFESTATIONS. Acute bronchitis is usually preceded by a viral upper respiratory infection. Secondary bacterial infection with Streptococcus pneumoniae, Moraxella catarrhalis, or H. influenzae may occur. The child presents a frequent, dry, hacking, unproductive cough of gradual onset, beginning 3-4 days after the appearance of rhinitis. Low substernal discomfort or burning anterior chest pain is often present and may be aggravated by coughing. Parent may hear whistling sounds during respiration (probably rhonchi), Child complains soreness of the chest, and shortness of breath. Coughing paroxysms or gagging on secretions is associated occasionally with vomiting. cough becomes productive, and the sputum changes from clear to purulent. Usually within 5-10 days, the mucus thins, and the cough gradually disappears. The malaise often associated with the illness may continue for 1 wk after acute symptoms have subsided. Physical findings -Initially, the child is usually afebrile or has low-grade fever, and there are signs of nasopharyngitis, conjunctival infection, and rhinitis. Later, auscultation reveals roughening of breath sounds, coarse and fine moist rales, and rhonchi that may be high-pitched, resembling the wheezing of asthma. complications In undernourished children - otitis media, sinusitis, and pneumonia Repeated attacks of acute bronchitis -think of - respiratory tract anomalies, ciliary disorders, foreign bodies, bronchiectasis, immune deficiency, tuberculosis, allergy, sinusitis, tonsillitis, adenoiditis, and cystic fibrosis. TREATMENT. Infants- pulmonary draining is facilitated by chest physiotherapy Older children - steam inhalation Irritating and paroxysmal coughing causes distress and interfere with sleep. Judicious use of cough suppressants - codeine may help in symptomatic relief. Antihistamines, which dry secretions, should not be used, and expectorants are not helpful. Antibiotics do not shorten the duration of the viral illness or decrease the incidence of bacterial complications. Even in adults antibiotic treatment decreases duration of cough and sputum production by only one-half. In recurrent episodes Antibiotics treatment causes improvent, suggesting that some secondary bacterial infection is present. Source:DR.NS.MANI.MD Associate Professor in Pediatrics |
Acute Bronchitis
