Know presentation, DX and Management
Diagnoses List
1. Acute bronchitis-
DESCRIPTION
Acute cough due to inflammation of the bronchioles, bronchi, and trachea; usually follows an upper
respiratory infection or exposure to a chemical irritant.
ETIOLOGY
• Adenovirus
• Rhinovirus
• Influenza A and B
• Parainfluenza
RISK FACTORS
• Upper respiratory infection
• Air pollutants
• Smoking and/or secondary exposure
• Reflux esophagitis
• Allergy
• Chronic obstructive pulmonary disease
• Acute and chronic sinusitis
• Infants
• Older adults
• Immunosuppression
ASSESSMENT FINDINGS
• Cough: dry and nonproductive, then productive; may be purulent
• URI symptoms
• Fatigue
• Fever due to bacterial infection; more common in smokers and patients with COPD
• Fever due to viral cause (unusual after first few days)
• Burning sensation in chest
• Crackles, wheezes
• Chest wall pain
DIFFERENTIAL DIAGNOSIS
• Pneumonia
• Tuberculosis
• Asthma
DIAGNOSTIC STUDIES
• Decision criteria for chest radiographs: tachypnea, hypoxia, fever, abnormal lung exam
• Only consider chest X-ray if high index of suspicion for pneumonia or superimposed heart failure
• Consider PPD: expect negative results
• PREVENTION
• Smoking cessation
• Avoid known respiratory irritants
• Treat underlying conditions that contribute to risk (asthma, gastroesophageal reflux disease, etc.)
• Influenza immunization for high-risk populations
,NONPHARMACOLOGIC MANAGEMENT
• Increase fluid intake
• Use humidifier
• Rest
• Smoking cessation
• Consider honey in children older than 1 year
• Patient education about disease, treatment, expected cause of cough, and emergency actions
PHARMACOLOGIC MANAGEMENT
• Cough suppressants for nighttime relief
• Avoid antihistamines
• Antibiotics if organism is bacterial
• Antivirals if influenza diagnosed
• Decongestants and antihistamines are ineffective unless sinusitis or allergy is underlying
• Bronchodilators if wheezing or prior history of asthma
Although antibiotics are commonly prescribed, they are NOT recommended.
ACUTE BRONCHITIS PHARMACOLOGIC MANAGEMENT
Drug
Dosage
Class Generic name Comments
How Supplied
(Trade name®)
Cough dextromethorphan/guaifenesi Adult: 10 mL q 4 hr • Do not use if taking
Suppressants n Max: 4 doses in 24 an MAO inhibitor or
Suppress cough hours for 2 weeks after
in the Children 6-12 stopping an MAO
medullary years: 5 mL q 4-6 inhibitor
center of the hr; • Contraindicated in
brain Max: 4 doses in 24 Parkinson’s disease
hr • Potential drug
Children <6 interaction with
years: not some SSRIs
recommended • Avoid in patients
who are having
difficulty clearing
Robitussin DM Dextromethorphan secretions
various generics 10 mg/5 mL
Guaifenesin 100
mg/5 mL
,Although antibiotics are commonly prescribed, they are NOT recommended.
ACUTE BRONCHITIS PHARMACOLOGIC MANAGEMENT
dextromethorphan Adult and ≥12 • Do not use if taking
years: 10 mL q 6-8 an MAO inhibitor or
hr prn for cough for 2 weeks after
Max: 4 doses in 24 stopping an MAO
hr inhibitor
Children 6-12 • Contraindicated in
years: 5 mL every 6- Parkinson’s disease
8 hr prn for cough • Potential drug
Max: 4 doses in 24 intervention with
hr some SSRIs
4-6 years: 2.5 mL • Avoid in patients
every 6-8 hr prn for who are having
cough difficulty clearing
Max: 4 doses in 24 secretions
hr • Do not use if on a
sodium restricted
diet
Delsym Dextromethorphan
15 mg/5 mL (alcohol
free/orange or grape
flavor)
Adult: 10 mL q 12
hr
Children 6-12
years: 5 mL q 12 hr
Children 4-6
years: 2.5 mL q 12
hr
codeine/guaifenesin Adults and children • Do not use if taking
≥ 12 years: 10 mL q an MAO inhibitor or
4 hr prn cough for 2 weeks after
Max: 6 doses in 24 stopping an MAO
hr inhibitor
• Contraindicated in
Children 6-12 Parkinson’s disease
years: 5 mL q 4 hr • Potential drug
prn cough interaction with
Max: 6 doses in 24
, Although antibiotics are commonly prescribed, they are NOT recommended.
ACUTE BRONCHITIS PHARMACOLOGIC MANAGEMENT
hr some SSRIs
• Schedule V
medication
Robitussin AC Each 5 mL contains • Avoid in patients
100 mg guaifenesin who are having
and difficulty clearing
10 mg codeine secretions
• Avoid narcotic cough
suppressants in
patient with COPD
or asthma
• May be habit
forming
• May aggravate
constipation
Antitussives benzonatate Adults and children • Do not break or
Topical > 10 years: chew capsule - can
anesthetic effect 100-200 mg TID prn produce local
on the cough anesthesia and may
respiratory Max: 600 mg daily reduce patient’s gag
stretch reflex
receptors • Monitor for
dizziness,
Tessalon Caps: 100 mg, 200 drowsiness and
mg visual changes
• Begins to act in 15-
20 minutes and lasts
for 3-8 hours
• Avoid use in patients
sensitive to or taking
agents with PABA -
possible adverse
CNS effects
Expectorants guaifenesin Adult: 200-400 mg • Caution if
PO q 4 hr prn nephrolithiasis
Max: 2400 mg/day • Caution in patients
Children 2-5
Diagnoses List
1. Acute bronchitis-
DESCRIPTION
Acute cough due to inflammation of the bronchioles, bronchi, and trachea; usually follows an upper
respiratory infection or exposure to a chemical irritant.
ETIOLOGY
• Adenovirus
• Rhinovirus
• Influenza A and B
• Parainfluenza
RISK FACTORS
• Upper respiratory infection
• Air pollutants
• Smoking and/or secondary exposure
• Reflux esophagitis
• Allergy
• Chronic obstructive pulmonary disease
• Acute and chronic sinusitis
• Infants
• Older adults
• Immunosuppression
ASSESSMENT FINDINGS
• Cough: dry and nonproductive, then productive; may be purulent
• URI symptoms
• Fatigue
• Fever due to bacterial infection; more common in smokers and patients with COPD
• Fever due to viral cause (unusual after first few days)
• Burning sensation in chest
• Crackles, wheezes
• Chest wall pain
DIFFERENTIAL DIAGNOSIS
• Pneumonia
• Tuberculosis
• Asthma
DIAGNOSTIC STUDIES
• Decision criteria for chest radiographs: tachypnea, hypoxia, fever, abnormal lung exam
• Only consider chest X-ray if high index of suspicion for pneumonia or superimposed heart failure
• Consider PPD: expect negative results
• PREVENTION
• Smoking cessation
• Avoid known respiratory irritants
• Treat underlying conditions that contribute to risk (asthma, gastroesophageal reflux disease, etc.)
• Influenza immunization for high-risk populations
,NONPHARMACOLOGIC MANAGEMENT
• Increase fluid intake
• Use humidifier
• Rest
• Smoking cessation
• Consider honey in children older than 1 year
• Patient education about disease, treatment, expected cause of cough, and emergency actions
PHARMACOLOGIC MANAGEMENT
• Cough suppressants for nighttime relief
• Avoid antihistamines
• Antibiotics if organism is bacterial
• Antivirals if influenza diagnosed
• Decongestants and antihistamines are ineffective unless sinusitis or allergy is underlying
• Bronchodilators if wheezing or prior history of asthma
Although antibiotics are commonly prescribed, they are NOT recommended.
ACUTE BRONCHITIS PHARMACOLOGIC MANAGEMENT
Drug
Dosage
Class Generic name Comments
How Supplied
(Trade name®)
Cough dextromethorphan/guaifenesi Adult: 10 mL q 4 hr • Do not use if taking
Suppressants n Max: 4 doses in 24 an MAO inhibitor or
Suppress cough hours for 2 weeks after
in the Children 6-12 stopping an MAO
medullary years: 5 mL q 4-6 inhibitor
center of the hr; • Contraindicated in
brain Max: 4 doses in 24 Parkinson’s disease
hr • Potential drug
Children <6 interaction with
years: not some SSRIs
recommended • Avoid in patients
who are having
difficulty clearing
Robitussin DM Dextromethorphan secretions
various generics 10 mg/5 mL
Guaifenesin 100
mg/5 mL
,Although antibiotics are commonly prescribed, they are NOT recommended.
ACUTE BRONCHITIS PHARMACOLOGIC MANAGEMENT
dextromethorphan Adult and ≥12 • Do not use if taking
years: 10 mL q 6-8 an MAO inhibitor or
hr prn for cough for 2 weeks after
Max: 4 doses in 24 stopping an MAO
hr inhibitor
Children 6-12 • Contraindicated in
years: 5 mL every 6- Parkinson’s disease
8 hr prn for cough • Potential drug
Max: 4 doses in 24 intervention with
hr some SSRIs
4-6 years: 2.5 mL • Avoid in patients
every 6-8 hr prn for who are having
cough difficulty clearing
Max: 4 doses in 24 secretions
hr • Do not use if on a
sodium restricted
diet
Delsym Dextromethorphan
15 mg/5 mL (alcohol
free/orange or grape
flavor)
Adult: 10 mL q 12
hr
Children 6-12
years: 5 mL q 12 hr
Children 4-6
years: 2.5 mL q 12
hr
codeine/guaifenesin Adults and children • Do not use if taking
≥ 12 years: 10 mL q an MAO inhibitor or
4 hr prn cough for 2 weeks after
Max: 6 doses in 24 stopping an MAO
hr inhibitor
• Contraindicated in
Children 6-12 Parkinson’s disease
years: 5 mL q 4 hr • Potential drug
prn cough interaction with
Max: 6 doses in 24
, Although antibiotics are commonly prescribed, they are NOT recommended.
ACUTE BRONCHITIS PHARMACOLOGIC MANAGEMENT
hr some SSRIs
• Schedule V
medication
Robitussin AC Each 5 mL contains • Avoid in patients
100 mg guaifenesin who are having
and difficulty clearing
10 mg codeine secretions
• Avoid narcotic cough
suppressants in
patient with COPD
or asthma
• May be habit
forming
• May aggravate
constipation
Antitussives benzonatate Adults and children • Do not break or
Topical > 10 years: chew capsule - can
anesthetic effect 100-200 mg TID prn produce local
on the cough anesthesia and may
respiratory Max: 600 mg daily reduce patient’s gag
stretch reflex
receptors • Monitor for
dizziness,
Tessalon Caps: 100 mg, 200 drowsiness and
mg visual changes
• Begins to act in 15-
20 minutes and lasts
for 3-8 hours
• Avoid use in patients
sensitive to or taking
agents with PABA -
possible adverse
CNS effects
Expectorants guaifenesin Adult: 200-400 mg • Caution if
PO q 4 hr prn nephrolithiasis
Max: 2400 mg/day • Caution in patients
Children 2-5
