MEDEX Objectives Home: http://faculty.washington.edu/alexbert/MEDEX/

Acute Bronchitis Vs. Pneumonia:

 

Acute Bronchitis (AB)

Pneumonia

 

Definition

“Inflammation of the bronchi” caused by infection. Sputum is a result of destruction and sloughing of the bronchial lining combined with immune cells, water, mucous and fibrin. Sputum will be colored if infected but remember…Colored sputum does not always mean a bacterial infection

Community acquired: infected outside of hospital or w/I 48 hours of admission due to blunted pulmonary defense mechanisms (cough reflex, mucociliary clearance system, immune responses) following aspiration or inhalation of infected aerosols.

Nosocomial: infection developing 48 hours after admission to hospital usually due to colonization of the pharynx and stomach w/ bacteria via exogenous factors (tubes, treatment w/ broad spectrum ABO, dirty hands) and Pt factors (malnutrition, age, altered consciousness, swallowing disorders).

Pathogens

Viruses are most common and include; influenza A and B, parainfluenza, coronavirus, rhinovirus and RSV. Less common are bacterial infections and include; mycoplasma, chlamydia, bordetella pertussis, S. pneumoniae, H influenza, S. Aureus, moraxella, Katarrhalis. Bacterial infect more common in kids and people with tracheostomys or are intubated.

Community acquired: most common pathogen and typical presentation à S. pneumoniae. Atypical presentationà Mycoplasma pneumoniae.

Nosocomial: most common are Psuedomonas aeruginosa, S. Aureus, Klebsiella and E. coli.

Risk factors

Preceding URI, smoking

 Aspiration risk: stroke, NG tube, intubation, seizure, syncope. Bactermia risk: indwelling vascular devices, intrathoracic devices. Debilitation: ETOH, estremes of age, neoplasia, immunosuppresion. Chronic disease: diabetes, renal’liver failure, valvular heart disease, CHF. Pulmonary disorders: COPD, chest wall disorders, muscloskeletal disorders, bronchial obstruction, viral lung infections.

Signs and symptoms

Initial dry cough progressing to mucopurulent sputum, slight fever, fatique, hemoptysis, chest burning, dyspnea (sometimes), rales and wheezing but no evidence of consolidation.

Community: Symàfever, cough w or w/o sputum, dyspnea, rigors, sweats, chills, chest discomfort, pleurisy, fatigue, myalgias, anorexia, HA and abd pain. Signsà fever or hyperthermia, tachypnea, tachycardia and mild SaO2 desaturation.

Nosocomial: Sym similar to above. Signsà fever, leukocytosis, purulent sputum and new or progressive infiltrate on xray.

Diff Dx

And work up

Pneumonia with cough/fever and constitutional s/s. PE + for consolidation. Post nasal drip with cough initiated by drainage running down throat. Asthma with audible wheeze and demonstrated airway obstruction. GERD with cough due to acid reflux. ACE inhibitors cause dry tickly cough. Bronchiectases cough w/ copious amts of mucopurulent sputum. Lung Ca cough with focal wheezing and dim breath sounds. Eosinophilic bronchitis cough due to allergic response.

URI vs. LRIà URI w/ inspiratory stridor, intercostal retraction palpable inspiratory thrills, inflammation of nasal mucosa, afebrile, dry cough. LRI w/ dyspnea, cough wheezing, and fever and chills if infection.

AB vs. Pneumoniaà AB w/ cough w/ or w/o sputum preceded by URI, no xray abnormalities. Pneumonia w/ sudden onset of fever, rigors, dyspnea, tachypnea, tachycardia and decreased breath sounds. Infiltrates seen on xray.

Bacterial vs. atypical pneumoniaà bacterial w/ signs of consolidation, chest pain, fever, dark thick sputum, sudden onset of chills, tachypnea, tachycardia and decreased breath sounds. Atypical w/ lack of sputum production, lack of chest pain and no infiltrates on xray.

Community vs. nosocomial: see above

Tests

Physical exam

Chest xray, sputum and blood cultures, CBC and chem. Panel for renal and electrolytes.

Treatment

Is it infectious or non-infectious?

Typical (S.Pneumoniae)- penicillin G or amoxicillin. Alternatives are macrolides, cephalosporins.

Atypical (mycoplasma)- doxycycline or  erythromycin 500 mg QID x 10-14 dys

Alternatives are clarythromycin 500 mg BID x 10-14 dys,  azithromycin or fluroquinolone.

Indications for hospitalization

 

Inability to take oral meds, multilobular involvement, severe VS abnormalties, acute mental status change, arterial hypoxia, 2ndary suppurative infection, severe acute electrolyte, hematologic or metabolic abnormalty, acute medical conditions.