ACUTE BRONCHITIS

Acute inflammatory disease of the bronchi.

Causes

  • Mostly viral
  • In older children, can be caused by Mycoplasma pneumoniae
  • Secondary Bacterial infection: Streptococcus pneumoniae,  Haemophilus influenzae

Predisposing factors

  • Exposure to cold, dust, smoke
  • Cigarette smoking

Clinical features

  • Often starts with rhinopharyngitis, descend progressively to larynx, pharynx, tracheitis
  • Irritating, productive cough sometimes with scanty mucoid, blood streaked sputum
  • Chest tightness, sometimes with wheezing
  • Fever may be present
  • No tachypnoea or dyspnoea
  • Secondary bacterial infection: fever > 38.5°C, dyspnoea, purulent expectorations

Differential diagnosis

  • Bronchial asthma, emphysema
  • Pneumonia, tuberculosis

Investigations

  • Diagnosis based on clinical features
  • Chest X-ray

Management

  • Most cases are viral and mild
  • Paracetamol 1 g every 4-6 hours (max: 4 g daily)
  • Child: 10 mg/kg (max: 500 mg) per dose
  • Plenty of oral fluids
  • Children: nasal irrigation with normal saline to clear the airway
  • Local remedies for cough (honey, ginger, lemon)

If there is suspicion of bacterial infection, especially if patient is in general poor conditions
(malnutrition, measles, rickets, severe anaemia, elderly, cardiac disease)

  • Give Amoxicillin 500 mg every 8 hours
    Child: 40 mg/kg dispersible tablets every 12 hours
  • Or Doxycycline 100 mg every 12 hours
    Child >8 years: 2 mg/kg per dose

Prevention

  • Avoid predisposing factors above