Table 18.1 Nomenclature of bone tumors
Bronchitis and asthma are different diseases and must be differentiated. The following further distinctions are made: acute and chronic bronchitis with two chronic forms-simple chronic bronchitis and chronic obstructive pulmonary disease (COPD). COPD is differentiated from simple chronic bronchitis by obstruction to airflow, which is diagnosed by spirometry.
Acute bronchitis is characterized by an acute inflammation of the airways, usually caused by viruses, e. g., myxovirus (i. e., influenza A, B, C, parainfluenza, HRS virus), adenoviruses, and picorna viruses (e. g., rhinoviruses). Acute bronchitis is differentiated from an acute exacerbation of COPD by the patient’s history.
EPIDEMIOLOGY & DEMOGRAPHICS
• Highest incidence in smokers, older adults, young children, and in winter months
• In the U.S. there are nearly 30 million ambulatory visits annually for cough, leading to more than 12 million diagnoses of “bronchitis.”
PHYSICAL FINDINGS & CLINICAL PRESENTATION
• Cough, usually worse in the morning, often productive. It is mainly caused by transient bronchial hyperresponsiveness.
• Low-grade fever
• Substernal discomfort worsened by coughing
• Postnasal drip, pharyngeal injection
• Rhonchi that may clear after cough, occasional wheezing
Clinical Findings. Acute bronchitis is often a feature of the so-called common cold, which is most commonly accompanied by rhinosinusitis, a sore throat, and cough. Acute bronchitis usually occurs endemically, most frequently during winter. Acute rhinosinusitis needs to be differentiated from allergic rhinosinusitis and inflammation by industrial toxins, as well as from rhinitis asomotorica.
• Viral infections are the leading cause of bronchitis (rhinovirus, influenza virus, adenovirus, respiratory syncytial virus)
• Atypical organisms (Mycoplasma, Chlamydia pneumoniae)
• Bacterial infections (Haemophilus influenzae, Moraxella, Streptococcus pneumoniae)
• Cystic fibrosis
• Cough secondary to medications
• Neoplasm (elderly patients)
• Allergic aspergillosis
• CHF (in elderly patients)
• Bronchogenic neoplasm
Seldom necessary (e.g., to rule out pneumonia, neoplasm)
• Tests are generally not necessary.
• CBC may reveal mild leukocytosis.
• Sputum culture, Gram stain, and blood cultures are generally not indicated.
Chest x-ray examination is usually reserved for patients with suspected pneumonia, influenza, or underlying COPD and no improvement with therapy.
• Avoidance of tobacco and other pulmonary irritants
• Increased fluid intake
• Use of vaporizer to increase room humidity
ACUTE GENERAL Rx
• Inhaled bronchodilators (e.g., albuterol, metaproterenol) prn for 1 to 2 wk in patients with wheezing or troublesome cough. Inhaled albuterol has been proven effective in reducing the duration of cough in adults with uncomplicated acute bronchitis.
• Cough suppression with guaifenesin; addition of codeine for cough suppression (e.g., Robitussin-AC) if cough is severe and is significantly interrupting patient’s sleep pattern
• Use of antibiotics (TMP-SMX, amoxicillin, doxycycline, cefuroxime) for acute bronchitis is generally not indicated; should be considered only in patients with concomitant COPD and purulent sputum or in patients unresponsive to prolonged conservative treatment
• Antibiotics are overused in patients with acute bronchitis (70% to 90% of office visits for acute bronchitis result in treatment with antibiotics); this practice pattern is contributing to increases in resistant organisms
Avoidance of tobacco and other pulmonary irritants
• Complete recovery within 7 to 10 days in most patients
• Patients should be informed to expect to have a cough for 10 to 14 days after the visit
Figure 14.10 Common bronchial and pulmonary diseases. Exposure to infectious pathogens and/or polluted air, including tobacco smoke, causes the diseases and disorders shown here.