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American Family Physician Oct 2016Cough is the most common illness-related reason for ambulatory care visits in the United States. Acute bronchitis is a clinical diagnosis characterized by cough due to... (Review)
Review
Cough is the most common illness-related reason for ambulatory care visits in the United States. Acute bronchitis is a clinical diagnosis characterized by cough due to acute inflammation of the trachea and large airways without evidence of pneumonia. Pneumonia should be suspected in patients with tachypnea, tachycardia, dyspnea, or lung findings suggestive of pneumonia, and radiography is warranted. Pertussis should be suspected in patients with cough persisting for more than two weeks that is accompanied by symptoms such as paroxysmal cough, whooping cough, and post-tussive emesis, or recent pertussis exposure. The cough associated with acute bronchitis typically lasts about two to three weeks, and this should be emphasized with patients. Acute bronchitis is usually caused by viruses, and antibiotics are not indicated in patients without chronic lung disease. Antibiotics have been shown to provide only minimal benefit, reducing the cough or illness by about half a day, and have adverse effects, including allergic reactions, nausea and vomiting, and Clostridium difficile infection. Evaluation and treatment of bronchitis include ruling out secondary causes for cough, such as pneumonia; educating patients about the natural course of the disease; and recommending symptomatic treatment and avoidance of unnecessary antibiotic use. Strategies to reduce inappropriate antibiotic use include delayed prescriptions, patient education, and calling the infection a chest cold.
Topics: Acute Disease; Bronchitis; Cough; Diagnosis, Differential; Humans
PubMed: 27929206
DOI: No ID Found -
American Family Physician Dec 2010Cough is the most common symptom bringing patients to the primary care physician's office, and acute bronchitis is usually the diagnosis in these patients. Acute... (Review)
Review
Cough is the most common symptom bringing patients to the primary care physician's office, and acute bronchitis is usually the diagnosis in these patients. Acute bronchitis should be differentiated from other common diagnoses, such as pneumonia and asthma, because these conditions may need specific therapies not indicated for bronchitis. Symptoms of bronchitis typically last about three weeks. The presence or absence of colored (e.g., green) sputum does not reliably differentiate between bacterial and viral lower respiratory tract infections. Viruses are responsible for more than 90 percent of acute bronchitis infections. Antibiotics are generally not indicated for bronchitis, and should be used only if pertussis is suspected to reduce transmission or if the patient is at increased risk of developing pneumonia (e.g., patients 65 years or older). The typical therapies for managing acute bronchitis symptoms have been shown to be ineffective, and the U.S. Food and Drug Administration recommends against using cough and cold preparations in children younger than six years. The supplement pelargonium may help reduce symptom severity in adults. As patient expectations for antibiotics and therapies for symptom management differ from evidence-based recommendations, effective communication strategies are necessary to provide the safest therapies available while maintaining patient satisfaction.
Topics: Acute Disease; Anti-Bacterial Agents; Bronchitis; Complementary Therapies; Diagnostic Techniques, Respiratory System; Humans
PubMed: 21121518
DOI: No ID Found -
European Respiratory Review : An... Dec 2022Lower respiratory infections include acute bronchitis, influenza, community-acquired pneumonia, acute exacerbation of COPD and acute exacerbation of bronchiectasis. They... (Review)
Review
Lower respiratory infections include acute bronchitis, influenza, community-acquired pneumonia, acute exacerbation of COPD and acute exacerbation of bronchiectasis. They are a major cause of death worldwide and often affect the most vulnerable: children, elderly and the impoverished. In this paper, we review the clinical presentation, diagnosis, severity assessment and treatment of adult outpatients with lower respiratory infections. The paper is divided into sections on specific lower respiratory infections, but we also dedicate a section to COVID-19 given the importance of the ongoing pandemic. Lower respiratory infections are heterogeneous entities, carry different risks for adverse events, and require different management strategies. For instance, while patients with acute bronchitis are rarely admitted to hospital and generally do not require antimicrobials, approximately 40% of patients seen for community-acquired pneumonia require admission. Clinicians caring for patients with lower respiratory infections face several challenges, including an increasing population of patients with immunosuppression, potential need for diagnostic tests that may not be readily available, antibiotic resistance and social aspects that place these patients at higher risk. Management principles for patients with lower respiratory infections include knowledge of local surveillance data, strategic use of diagnostic tests according to surveillance data, and judicious use of antimicrobials.
Topics: Adult; Child; Humans; Aged; COVID-19; Respiratory Tract Infections; Community-Acquired Infections; Bronchitis; Pneumonia; Acute Disease; Anti-Infective Agents; Hospitals; Anti-Bacterial Agents
PubMed: 36261157
DOI: 10.1183/16000617.0092-2022 -
American Family Physician Nov 2020
Review
Topics: Anti-Bacterial Agents; Antimicrobial Stewardship; Bronchitis; Humans
PubMed: 33118784
DOI: No ID Found -
Deutsche Medizinische Wochenschrift... Feb 2019Respiratory tract infections and acute bronchitis are one of the major indications for which antibiotics are prescribed. As most of respiratory tract infections are...
Respiratory tract infections and acute bronchitis are one of the major indications for which antibiotics are prescribed. As most of respiratory tract infections are caused by viruses and antibiotic therapy is rarely indicated. Reasons for the unnecessary prescription of antibiotics in this patient population are false expectations regarding the course and duration of common cold symptoms and especially coughing. After exclusion of severe diseases acute coughing should be treated with a symptom-oriented therapy. There is no reliable data on the use of antibiotic therapy in patient groups with an increased risk for severe complications. Studies on the use of laboratory makers to identify persons with bacterial infections who might benefit from antibiotic therapy and to reduce unnecessary prescriptions have been negative for CRP and inconclusive for procalcitonin. Peer-review and delayed prescribing could be demonstrated to reduce the rate of unneeded antibiotic prescriptions. Most of the symptomatic therapies employed for cough and the common cold are not studied in methodologically sound randomized controlled trials. The most common expectorants used in Germany are Ambroxol and N-Acetylcytein. For both substances there is little data supporting a benefit in patients with an acute bronchitis. Antitussiva reduce the symptom burden, but there is also a strong placebo-effect on the cough reflex.
Topics: Acute Disease; Anti-Bacterial Agents; Bronchitis; Germany; Humans; Respiratory Tract Infections
PubMed: 30703838
DOI: 10.1055/a-0655-8058 -
Missouri Medicine 2021Plastic Bronchitis (PB) is a rare pulmonary condition characterized by the presence of casts in the trachea or bronchial tree. While there are many individual cases... (Review)
Review
PURPOSE OF STUDY
Plastic Bronchitis (PB) is a rare pulmonary condition characterized by the presence of casts in the trachea or bronchial tree. While there are many individual cases reported in pediatric and adult populations, no thorough reviews of pediatric and adult cases of PB exist in the literature. The purpose of this article is to conduct a comprehensive review of PB regarding presentation, diagnosis, pathophysiology, and treatments.
ETIOLOGY
In the pediatric population, PB can be attributed to pediatric cardiothoracic surgeries such as Fontan procedures, infections, inflammatory processes, acute chest syndrome, or iatrogenic processes. In the adult population, PB can be idiopathic or due to infections, anatomic variations in lymphatic vessels, surgeries, medications, or other comorbidities.
PATHOPHYSIOLOGY
The pathophysiology of PB is still widely unknown; however, associations with inflammatory diseases and cardiac surgery have been proposed. There are two types of cast formations found in plastic bronchitis: Type I casts are associated with inflammatory diseases and Type II casts are associated with surgical procedures.
TREATMENT
Historically, PB has been treated by a variety of pharmacological methods including the use of corticosteroids and mucolytics. Recently, the treatment paradigm has shifted towards procedures such as lymphatic embolization, duct ligation, and stent grafting.
CONCLUSIONS
The information available regarding PB is still sparse, hence future research is necessary for further understanding of the disease. Due to its numerous presentations and disease associations, awareness of plastic bronchitis, and its treatment options is essential for primary care providers and respiratory specialists.
Topics: Adrenal Cortex Hormones; Adult; Bronchitis; Child; Fontan Procedure; Humans; Lymphatic Vessels; Plastics
PubMed: 34373673
DOI: No ID Found -
BMJ Clinical Evidence Jul 2015Acute bronchitis affects more than 40 in 1000 adults per year in the UK. The causes are usually considered to be infective, but only around half of people have... (Review)
Review
INTRODUCTION
Acute bronchitis affects more than 40 in 1000 adults per year in the UK. The causes are usually considered to be infective, but only around half of people have identifiable pathogens. The role of smoking or of environmental tobacco smoke inhalation in predisposing to acute bronchitis is unclear. One third of people may have longer-term symptoms or recurrence.
METHODS AND OUTCOMES
We conducted a systematic review, aiming to answer the following clinical question: What are the effects of treatments for acute bronchitis in people without chronic respiratory disease? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2015 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview).
RESULTS
At this update, searching of electronic databases retrieved 420 studies. After deduplication and removal of conference abstracts, 306 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 245 studies and the further review of 61 full publications. Of the 61 full articles evaluated, three updated systematic reviews and three RCTs were added at this update. We performed a GRADE evaluation for 12 PICO combinations.
CONCLUSIONS
In this systematic review we categorised the efficacy for six intervention-comparison combinations, based on information about the effectiveness and safety of the following interventions: antibiotics, antihistamines, antitussives, beta2 agonists (inhaled), and expectorants/mucolytics.
Topics: Acute Disease; Administration, Inhalation; Adrenergic beta-2 Receptor Agonists; Anti-Bacterial Agents; Antitussive Agents; Bronchitis; Expectorants; Histamine Antagonists; Humans; Treatment Outcome
PubMed: 26186368
DOI: No ID Found -
American Family Physician Oct 2016
Topics: Acute Disease; Bronchitis; Humans
PubMed: 27929221
DOI: No ID Found -
Pediatrics Sep 2020One-third of outpatient antibiotic prescriptions for pediatric acute respiratory tract infections (ARTIs) are inappropriate. We evaluated a distance learning program's... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
One-third of outpatient antibiotic prescriptions for pediatric acute respiratory tract infections (ARTIs) are inappropriate. We evaluated a distance learning program's effectiveness for reducing outpatient antibiotic prescribing for ARTI visits.
METHODS
In this stepped-wedge clinical trial run from November 2015 to June 2018, we randomly assigned 19 pediatric practices belonging to the Pediatric Research in Office Settings Network or the NorthShore University HealthSystem to 4 wedges. Visits for acute otitis media, bronchitis, pharyngitis, sinusitis, and upper respiratory infection for children 6 months to <11 years old without recent antibiotic use were included. Clinicians received the intervention as 3 program modules containing online tutorials and webinars on evidence-based communication strategies and antibioti c prescribing, booster video vignettes, and individualized antibiotic prescribing feedback reports over 11 months. The primary outcome was overall antibiotic prescribing rates for all ARTI visits. Mixed-effects logistic regression compared prescribing rates during each program module and a postintervention period to a baseline control period. Odds ratios were converted to adjusted rate ratios (aRRs) for interpretability.
RESULTS
Among 72 723 ARTI visits by 29 762 patients, intention-to-treat analyses revealed a 7% decrease in the probability of antibiotic prescribing for ARTI overall between the baseline and postintervention periods (aRR 0.93; 95% confidence interval [CI], 0.90-0.96). Second-line antibiotic prescribing decreased for streptococcal pharyngitis (aRR 0.66; 95% CI, 0.50-0.87) and sinusitis (aRR 0.59; 95% CI, 0.44-0.77) but not for acute otitis media (aRR 0.93; 95% CI, 0.83-1.03). Any antibiotic prescribing decreased for viral ARTIs (aRR 0.60; 95% CI, 0.51-0.70).
CONCLUSIONS
This program reduced antibiotic prescribing during outpatient ARTI visits; broader dissemination may be beneficial.
Topics: Acute Disease; Anti-Bacterial Agents; Bronchitis; Chicago; Child; Child, Preschool; Communication; Confidence Intervals; Education, Distance; Female; Humans; Inappropriate Prescribing; Infant; Intention to Treat Analysis; Logistic Models; Male; Odds Ratio; Otitis Media; Outpatients; Pediatric Nursing; Pediatricians; Pharyngitis; Primary Health Care; Program Development; Quality Improvement; Respiratory Tract Infections; Sinusitis; Streptococcal Infections
PubMed: 32747473
DOI: 10.1542/peds.2020-0038 -
BMJ Clinical Evidence Jun 2011Acute bronchitis affects over 40/1000 adults a year in the UK. The causes are usually considered to be infective, but only around half of people have identifiable... (Review)
Review
INTRODUCTION
Acute bronchitis affects over 40/1000 adults a year in the UK. The causes are usually considered to be infective, but only around half of people have identifiable pathogens. The role of smoking or of environmental tobacco smoke inhalation in predisposing to acute bronchitis is unclear. One third of people may have longer-term symptoms or recurrence.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for acute bronchitis in people without chronic respiratory disease? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 21 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: analgesics, antibiotics (macrolides, tetracyclines, cephalosporins, penicillins, or trimethoprim-sulfamethoxazole [co-trimoxazole]), antihistamines, antitussives, beta(2) agonists (inhaled or oral), and expectorants/mucolytics.
Topics: Acute Disease; Administration, Oral; Anti-Bacterial Agents; Antitussive Agents; Bronchitis; Humans; Penicillins; Trimethoprim, Sulfamethoxazole Drug Combination
PubMed: 21711957
DOI: No ID Found