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Acute Cough Due to Acute Bronchitis in Immunocompetent Adult Outpatients: CHEST Expert Panel Report.Chest May 2020Evidence for the diagnosis and management of cough due to acute bronchitis in immunocompetent adult outpatients was reviewed as an update to the 2006 "Chronic Cough Due...
BACKGROUND
Evidence for the diagnosis and management of cough due to acute bronchitis in immunocompetent adult outpatients was reviewed as an update to the 2006 "Chronic Cough Due to Acute Bronchitis: American College of Chest Physicians (ACCP) Evidence-Based Clinical Practice Guidelines."
METHODS
Acute bronchitis was defined as an acute lower respiratory tract infection manifested predominantly by cough with or without sputum production, lasting no more than 3 weeks with no clinical or any recent radiographic evidence to suggest an alternative explanation. Two clinical population, intervention, comparison, outcome questions were addressed by systematic review in July 2017: (1) the role of investigations beyond the clinical assessment of patients presenting with suspected acute bronchitis, and (2) the efficacy and safety of prescribing medication for cough in acute bronchitis. An updated search was undertaken in May 2018.
RESULTS
No eligible studies relevant to the first question were identified. For the second question, only one relevant study met eligibility criteria. This study found no difference in number of days with cough between patients treated with an antibiotic or an oral nonsteroidal antiinflammatory agent compared with placebo. Clinical suggestions and research recommendations were made based on the consensus opinion of the CHEST Expert Cough Panel.
CONCLUSIONS
The panelists suggested that no routine investigations be ordered and no routine medications be prescribed in immunocompetent adult outpatients first presenting with cough due to suspected acute bronchitis, until such investigations and treatments have been shown to be safe and effective at making cough less severe or resolve sooner. If the cough due to suspected acute bronchitis persists or worsens, a reassessment and consideration of targeted investigations should be considered.
Topics: Acute Disease; Bronchitis; Cough; Humans; Outpatients
PubMed: 32092323
DOI: 10.1016/j.chest.2020.01.044 -
Journal of Pharmacy Practice Dec 2012Acute bronchitis is a disease characterized by inflammation of the large airways within the lung accompanied by a cough lasting from 1 to 3 weeks. The inflammation... (Review)
Review
Acute bronchitis is a disease characterized by inflammation of the large airways within the lung accompanied by a cough lasting from 1 to 3 weeks. The inflammation occurs as a result of an airway infection or environmental trigger, with viral infections accounting for an estimated 89% to 95% of cases. Symptomatic treatment of cough is primarily required for patients, though in most cases the condition is self-limiting. Therapy consists of both nonpharmacological and pharmacological options to include antibiotics and antivirals, antitussive agents, protussive agents, and beta-2-agonists. This article reviews the treatment options for acute bronchitis and recommends criteria for use.
Topics: Acute Disease; Adrenergic beta-2 Receptor Agonists; Anti-Bacterial Agents; Antitussive Agents; Antiviral Agents; Bronchitis; Clinical Trials as Topic; Cough; Evidence-Based Medicine; Humans; Treatment Outcome
PubMed: 23076965
DOI: 10.1177/0897190012460826 -
Journal of General Internal Medicine Sep 1996To determine whether antibiotic and bronchodilator treatment of acute bronchitis in patients without lung disease is efficacious. (Review)
Review
OBJECTIVE
To determine whether antibiotic and bronchodilator treatment of acute bronchitis in patients without lung disease is efficacious.
DESIGN
A MEDLINE search of the literature from 1966 to 1995 was done, using "Bronchitis" as the key word. Papers addressing acute bronchitis in adults were used as well as several citations emphasizing pediatric infections. A manual search of papers addressing the microorganisms causing acute bronchitis was also done. Data were extracted manually from relevant publications.
SETTING
All published reports were reviewed. Papers dealing with exacerbations of chronic bronchitis were excluded in this review.
RESULTS
Although acute bronchitis has multiple causes, the large majority of cases are of viral etiology. Mycoplasma pneumoniae, Chlamydia pneumoniae, and Bordetella pertussis are the only bacteria identified as contributing to the cause of acute bronchitis in otherwise healthy adults. Nine double-blind, placebo-controlled trials were reviewed. Four studies showed no advantage for doxycycline and one study showed no advantage for erythromycin. One study using erythromycin and one study using trimethoprim and sulfamethoxazole showed that these antibiotics were slightly better than placebo. Two other studies showed an impressive superiority for liquid or inhaled albuterol when compared with erythromycin.
CONCLUSIONS
Most studies showed no significant difference between drug and placebo, and the two studies that did showed only small clinical differences. Albuterol had an impressive advantage over erythromycin. Antibiotics should not be used in the treatment of acute bronchitis in healthy persons unless convincing evidence of a bacterial infection is present.
Topics: Acute Disease; Adult; Anti-Bacterial Agents; Bronchitis; Bronchodilator Agents; Humans; Lung Diseases, Obstructive; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 8905509
DOI: 10.1007/BF02599608 -
Canadian Journal of Anaesthesia =... Feb 2022Plastic bronchitis is a rare condition characterized by the formation of airway casts occluding the lower respiratory tract. It is described more commonly in children,...
PURPOSE
Plastic bronchitis is a rare condition characterized by the formation of airway casts occluding the lower respiratory tract. It is described more commonly in children, especially following correction of congenital heart disease. It involves lymphatic abnormalities leading to endobronchial lymph precipitating airway cast formation. When it presents acutely, it can lead to acute airway obstruction, which can be life-threatening. Plastic bronchitis has been rarely described in adults and is potentially underdiagnosed. The purpose of this case report is to emphasize, for the adult anesthesiologist and adult critical care physician, the importance of prompt diagnosis and respiratory support in a case of plastic bronchitis.
CLINICAL FEATURES
A 40-yr-old female with severe aortic stenosis underwent a Ross procedure. The surgery was uneventful, but within two hours of arrival in the intensive care unit, the patient developed severe hypoxemia. Despite attempts to optimize her respiratory status, the patient remained severely hypoxemic, and veno-venous extracorporeal membrane oxygenation (ECMO) was initiated using a percutaneous femoro-femoral cannulation. A bronchoscopy showed bronchial secretions casting the proximal bronchus, suggestive of plastic bronchitis. After numerous bronchoscopies, we were able to clean the airways and wean the ECMO support on postoperative day 3.
CONCLUSION
Plastic bronchitis can present in adult patients and be life-threatening when associated with acute respiratory failure. We report an unusual case of an adult patient treated with veno-venous ECMO for plastic bronchitis following cardiac surgery. Use of ECMO support while providing airway cleaning can be lifesaving in patients with respiratory failure secondary to plastic bronchitis.
Topics: Adult; Bronchitis; Child; Extracorporeal Membrane Oxygenation; Female; Humans; Plastics; Respiratory Distress Syndrome; Respiratory Insufficiency
PubMed: 34859374
DOI: 10.1007/s12630-021-02148-2 -
Family Practice Mar 1989There is much discussion about the aetiology, definition and treatment of acute bronchitis. This paper reviews the main issues in the debate. It concludes that... (Review)
Review
There is much discussion about the aetiology, definition and treatment of acute bronchitis. This paper reviews the main issues in the debate. It concludes that bronchitis should be regarded as a collective name for a wide range of syndromes. Whether further differentiation of the clinical diagnosis is meaningful depends largely on whether such differentiation has therapeutic implications. Further research into medical treatment of the different types of acute bronchitis is necessary.
Topics: Acute Disease; Anti-Bacterial Agents; Bronchitis; Humans; Netherlands
PubMed: 2653940
DOI: 10.1093/fampra/6.1.66 -
Infectious Disease Clinics of North... Dec 2004Acute respiratory infections (ARIs) are the most common infections in humans, accounting for half of all acute conditions each year in the United States. Acute... (Review)
Review
Acute respiratory infections (ARIs) are the most common infections in humans, accounting for half of all acute conditions each year in the United States. Acute bronchitis episodes represent a significant portion of these illnesses. This article focuses on acute bronchitis in otherwise healthy individuals.
Topics: Acute Disease; Adult; Anti-Bacterial Agents; Antiviral Agents; Bacterial Infections; Bronchitis; Bronchodilator Agents; Drug Utilization; Humans; Immunologic Factors; Influenza, Human; Pneumonia
PubMed: 15555832
DOI: 10.1016/j.idc.2004.07.001 -
Journal of General Internal Medicine Mar 2002Community physicians in the United States prescribe antibiotics to 80% to 90% of smokers with acute bronchitis. We performed a systematic review of the literature to... (Review)
Review
OBJECTIVE
Community physicians in the United States prescribe antibiotics to 80% to 90% of smokers with acute bronchitis. We performed a systematic review of the literature to determine the efficacy of antibiotics for smokers with acute bronchitis.
DESIGN
A medline search was done using the keywords bronchitis, cough, and antibiotics to identify English language articles published from January 1966 to September 2001. Randomized, placebo-controlled trials of antibiotics in previously healthy smokers and nonsmokers with acute bronchitis were included.
MEASUREMENTS AND MAIN RESULTS
For each study, we abstracted information on design, size, inclusion criteria, patient characteristics, and outcomes. Of 2,029 articles in the original search, 109 relevant articles were retrieved and reviewed. There have been no studies specifically addressing antibiotic use in smokers with acute bronchitis. Nine randomized, placebo-controlled trials of antibiotics have included 774 patients and over 276 smokers. Lack of subgroup reporting for smokers precluded meta-analysis. In 7 trials, smoking status did not predict or alter patients' response to antibiotics. In one trial, trimethoprim/sulfamethoxazole resulted in less-frequent cough overall, but not among smokers. In another trial, erythromycin reduced symptom scores only among nonsmokers while antibiotic-treated smokers had a trend toward higher symptom scores.
CONCLUSION
Although no trials have specifically addressed antibiotic use in smokers with acute bronchitis, existing data suggest that any benefit of antibiotics is the same or less for smokers than for nonsmokers.
Topics: Acute Disease; Anti-Bacterial Agents; Bronchitis; Humans; Randomized Controlled Trials as Topic; Smoking; Treatment Outcome
PubMed: 11929510
DOI: 10.1046/j.1525-1497.2002.10405.x -
Terapevticheskii Arkhiv Dec 2023Analysis of the clinical effectiveness and safety of erdosteine use in comparison with standard (real practice) mucoactive therapy in patients with acute bronchitis...
AIM
Analysis of the clinical effectiveness and safety of erdosteine use in comparison with standard (real practice) mucoactive therapy in patients with acute bronchitis (АВ) in adults.
MATERIALS AND METHODS
The observational program included 100 adult patients with АВ, 50 of them (group 1) received erdosteine, the group 2 also included 50 patients who received acetylcysteine, bromhexine and other mucolytics (real clinical practice). The following were assessed: cough severity, average time for resolution of night and daytime cough, satisfaction with treatment, NO concentration in exhaled air, levels of C-reactive protein (CRP) and interleukin-6 (IL-6).
RESULTS
The average duration of relief of severe daytime cough requiring continued therapy was: in group 1 - 3.7±0.46 days, night cough - 1.14±0.94 days. In the second group, daytime cough was relieved in 3.8±0.4 days, night cough - 1.08±0.7 days. The duration of mucoactive therapy in group 1 was 5.32±0.82 days, in group 2 this figure was 8.5±1.4 days (p<0.05). The number of АВ patients with a significant reduction in the severity of productive cough (1 point on cough severity scale) on the 6th day from the beginning of treatment in group 1 (erdosteine) amounted to 32 (64%), in group 2 - 27 (54%). Satisfaction with the treatment was higher in the group receiving erdosteine: according to the indicators "very satisfied" and "extremely satisfied" the patients of the group 1 - 42 - were the leaders in comparison with the group 2, where these positions were marked by 28 patients. The level of CRP in patients with АВ in group 1 was 24.7±21.24 mg/l, in group 2 - 16.37±16.5 mg/l, which indicates the viral etiology of the process and no need in the prescription of antimicrobial drugs. For the first time in Russian practice, the following were determined: the level of IL-6, which in the group 1 was 10.3±6.7 pc/ml; in the group 2 - 10.03±3.94 pc/ml; the level of exhaled NO in group 1 was 16.5±5.1 ppb, in group 2 - 14.9±4.6 ppb (the norm is up to 25 ppb). These indicators, against the background of mucoactive therapy, decreased to normal values by 6th day.
CONCLUSION
The findings expand our understanding of АВ in adults. New results have been obtained on the role of CRP, IL-6 and NO in exhaled air during АВ. The use of erdosteine was accompanied by a significant mucoactive effect in the form of a pronounced regression of cough in patients with АВ compared to the comparison group in shorter term.
Topics: Adult; Humans; Interleukin-6; Bronchitis; Cough
PubMed: 38158950
DOI: 10.26442/00403660.2023.11.202470 -
The American Journal of Medicine Jun 1992Acute bronchitis, an illness frequently encountered by primary-care physicians, is an inflammation of the tracheobronchial tree that results from a respiratory tract... (Review)
Review
Acute bronchitis, an illness frequently encountered by primary-care physicians, is an inflammation of the tracheobronchial tree that results from a respiratory tract infection. It is characterized by persistent cough and sputum production and is occasionally accompanied by fever and/or chest pain. Acute bronchitis may have a viral or bacterial origin and is often treated with antibiotics. Four clinical trials were conducted to compare high and low doses of loracarbef, a new oral beta-lactam antibiotic, with three agents commonly used to treat acute bronchitis: amoxicillin/clavulanate, cefaclor, and amoxicillin. Results of these studies indicated that loracarbef, 400 and 200 mg twice daily, had clinical and bacteriologic efficacy against the common respiratory pathogens Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella (Branhamella) catarrhalis that was comparable with that of the comparative agents. Loracarbef was as well tolerated as cefaclor and amoxicillin; moreover, it produced a significantly lower incidence of diarrhea than did amoxicillin/clavulanate. Loracarbef may be considered a safe and effective alternative agent for the treatment of patients with acute bronchitis.
Topics: Acute Disease; Bronchitis; Cephalosporins; Clinical Trials as Topic; Drug Resistance, Microbial; Europe; Gastrointestinal Diseases; Humans; Respiratory Tract Infections; United States
PubMed: 1621745
DOI: 10.1016/0002-9343(92)90608-e -
Current Opinion in Pulmonary Medicine May 1995Acute bronchitis in previously fit individuals is a common condition that is usually mild and self limiting. Chronic bronchitis remains a common cause of morbidity and... (Review)
Review
Acute bronchitis in previously fit individuals is a common condition that is usually mild and self limiting. Chronic bronchitis remains a common cause of morbidity and mortality, and the cost to the nation due to lost working days and to health services is enormous. Cigarette smoking is the major etiologic factor, although exacerbations may be caused by viruses, environmental pollutants, allergic responses, and bacterial infections. New insights into the underlying basic mechanisms of bronchial inflammation are being made. Antibiotics are commonly used to treat exacerbations, although evidence of efficacy is sometimes lacking. Some patients may be prone to recurrent exacerbations and this influences their chance of recovery. Clinical trials must include an assessment of the severity of the exacerbation, and protocols would be improved by increased definition of the type of patient being enrolled and by inclusion of more detailed measures of benefit. Influenza and pneumococcal vaccination should be encouraged in appropriate patients.
Topics: Anti-Bacterial Agents; Bronchitis; Chronic Disease; Humans; Morbidity; Severity of Illness Index; Smoking
PubMed: 9363050
DOI: No ID Found