Acute Bronchitis

By: Charlene Pelobello & Manilyn Quimba

Acute Bronchitis

- Is an infection of the lower respiratory tract that generally follows an upper respiratory tract infection. As a result of this viral (most common) or bacterial infection, the airways become inflamed and irritated, and mucus production increases.

Assessment:

1. Fever, tachypnea, mild dyspnea, pleuritic chest pain (possible).2. Cough with clear to purulent sputum production.3. Diffuse rhonchi and crackles(contrast with localized crackles usually heard with

pneumonia).

Pathophysiology:

Usually bronchitis occurs after the person was infected with cold or infection. The virus that causes the common cold can also be the virus that can cause bronchitis. Acute bronchitis can also happen by inhaling irritants that can damage and inflame the bronchial tubes. Cigarette smoke and other chemical fumes inhaled can significantly damage your bronchial tubes. The inflammation causes the airway to constrict and therefore, causes you to have difficulty in breathing. If left untreated or if you continue inhaling irritants such as cigarette smoke, the acute bronchitis will eventually develop into its chronic form where it can permanently damage your bronchial tubes and tissues surrounding it.

Diagnostic Evaluation:

1. Chest X-ray may rule out pneumonia. In bronchitis, films show no evidence of lung infiltrates or consolidation.

2. Sputum analysis.

Therapeutic Intervention:

1. Chest physiotherapy to mobilize secretions, if indicated.2. Hydration to liquefy secretions.

Pharmacologic Interventions:

1. Inhaled bronchodilators to reduce bronchospasm and promote sputum expectoration.

2. A course of oral antibiotics such as a macrolide may be instituted, but is controversial.

3. Symptom management for fever and cough.

PROTUSSIVESAND ANTITUSSIVES

Because acute bronchitis is most often caused by a viral infection, usually only symptomatic treatment is required. Treatment can focus on preventing or controlling the cough (antitussive therapy) or on making the cough more effective (protussive therapy).

Protussive therapy is indicated when coughing should be encouraged (e.g., to clear the airways of mucus). In randomized, double-blind, placebo-controlled studies of protussives in patients with cough from various causes, only terbutaline (Brethine), amiloride (Midamor), and hypertonic saline aerosols proved successful. However, the clinical utility of these agents in patients with acute bronchitis is questionable, because the studies examined cough resulting from other illnesses. Guaifenesin, frequently used by physicians as an expectorant, was found to be ineffective, but only a single 100-mg dose was evaluated. Common preparations (e.g., Duratuss) contain guaifenesin in doses of 600 to 1,200 mg.

Antitussive therapy is indicated if cough is creating significant discomfort and if suppressing the body's protective mechanism for airway clearance would not delay healing. Studies have reported success rates ranging from 68 to 98 percent. Antitussive selection is based on the cause of the cough. For example, an antihistamine would be used to treat cough associated with allergic rhinitis, a decongestant or an antihistamine would be selected for cough associated with postnasal drainage, and a bronchodilator would be appropriate for cough associated with asthma exacerbations. Nonspecific antitussives, such as hydrocodone (e.g., in Hycodan), dextromethorphan (e.g., Delsym), codeine (e.g., in Robitussin A-C), carbetapentane (e.g., in Rynatuss), and benzonatate (e.g., Tessalon), simply suppress cough.

Selected Nonspecific Antitussive Agents

Preparation Dosage Side effects

Hydromorphone-guaifenesin (e.g., Hycotuss)

5 mg per 100 mg per 5 mL (one teaspoon)*

Sedation, nausea, vomiting, respiratory depression

Dextromethorphan (e.g., Delsym)

30 mg every 12 hours Rarely, gastrointestinal upset or sedation

Hydrocodone (e.g., in Hycodan syrup or tablets)

5 mg every 4 to 6 hours Gastrointestinal upset, nausea, drowsiness, constipation

Codeine (e.g., in Robitussin A-C)

10 to 20 mg every 4 to 6 hours

Gastrointestinal upset, nausea, drowsiness, constipation

Carbetapentane (e.g., in Rynatuss)

60 to 120 mg every 12 hours

Drowsiness, gastrointestinal upset

Benzonatate (Tessalon) 100 to 200 mg three times daily

Hypersensitivity, gastrointestinal upset, sedation

Management of Acute Bronchitis

Nursing Interventions:

1. Encourage mobilization of secretion through ambulation, coughing, and deep breathing.

2. Ensure adequate fluid intake to liquefy secretions and prevent dehydration caused by fever and tachypnea.

3. Encourage rest, avoidance of bronchial irritant, and a good diet to facilitate recovery.

4. Instruct the patient to complete the full course of prescribed antibiotics and explain the effect of meals on drug absorption.

5. Caution the patient on using over-the-counter cough suppressants, antihistamines, and decongestants, which may cause drying and retention of secretions. However, cough preparations containing the mucolytic guaifenesin may be appropriate.

6. Advise the patient that a dry cough may persist after bronchitis because of irritation of airways. Suggest avoiding dry environments and using a humidifier at bedside. Encourage smoking cessation.

7. Teach the patient to recognize and immediately report early signs and symptoms of acute bronchitis.

GROUP 4

Members:

Mosquera, Rachel Rose

Naluaran, Ghelo Marie

Nicar, Katherine

Pagala, Apple

Parreño, Charlyn Joy

Pelobello, Charlene

Peralta, Vanessa

Pulmones, Joni Rose

Quimba, Manilyn

Samson, Mary may

Tarrazona, Lea Grace

Submitted to:

Mrs. Emily Robite