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Acute Bronchitis

Bronchitis is associated with infection of the upper and lower respiratory tracts, and the
trachea is usually involved. Bronchiolitis is an entirely different illness
Asthma exacerbations are triggered by upper respiratory tract infections. Calling such
exacerbations "asthmatic bronchitis," although technically correct, may confuse parents 

Acute tracheobronchitis is commonly associated with an upper respiratory tract infection
such as nasopharyngitis, influenza, Pertussis, measles, typhoid fever, diphtheria.
Pneumococci, staphylococci, Haemophilus influenzae, and hemolytic streptococci may be
isolated from the sputum, but their presence does not imply a bacterial cause, and
antibiotic therapy does not appreciably alter the course of the illness. Allergy, climate, air
pollution, and chronic infections of the upper respiratory tract, particularly sinusitis, may
be contributing factors.

Acute bronchitis is usually preceded by a viral upper respiratory infection. Secondary
bacterial infection with Streptococcus pneumoniae, Moraxella catarrhalis, or H. influenzae
may occur.
The child presents a frequent, dry, hacking, unproductive cough of gradual onset,
beginning 3-4 days after the appearance of rhinitis.
Low substernal discomfort or burning anterior chest pain is often present and may be
aggravated by coughing. Parent may hear whistling sounds during respiration (probably
Child complains soreness of the chest, and shortness of breath. Coughing paroxysms or
gagging on secretions is associated occasionally with vomiting.
cough becomes productive, and the sputum changes from clear to purulent. Usually within
5-10 days, the mucus thins, and the cough gradually disappears.
The malaise often associated with the illness may continue for 1 wk after acute symptoms
have subsided.

Physical findings -Initially, the child is usually afebrile or has low-grade fever, and there
are signs of nasopharyngitis, conjunctival infection, and rhinitis. Later, auscultation
reveals roughening of breath sounds, coarse and fine moist rales, and rhonchi that may be
high-pitched, resembling the wheezing of asthma.

In undernourished children - otitis media, sinusitis, and pneumonia
Repeated attacks of acute bronchitis -think of - respiratory tract anomalies, ciliary
disorders, foreign bodies, bronchiectasis, immune deficiency, tuberculosis, allergy,
sinusitis, tonsillitis, adenoiditis, and cystic fibrosis.

Infants- pulmonary draining is facilitated by chest physiotherapy
Older children - steam inhalation
Irritating and paroxysmal coughing causes distress and interfere with sleep.  Judicious use
of cough suppressants - codeine may help in symptomatic relief. Antihistamines, which
dry secretions, should not be used, and expectorants are not helpful.
Antibiotics do not shorten the duration of the viral illness or decrease the incidence of
bacterial complications.
Even in adults antibiotic treatment decreases duration of cough and sputum production by
only one-half.
In recurrent episodes Antibiotics treatment causes improvent, suggesting that some
secondary bacterial infection is present. 

Source:DR.NS.MANI.MD Associate Professor in Pediatrics

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