Acute Bronchitis Research Paper Samples
Brief description of acute bronchitis (pathophysiology, epidemiology)
The purpose of this paper is describing pathophysiology, epidemiology and clinical representation of acute bronchitis. The paper is also aimed at reviewing the expected physical findings and history in patients. Acute bronchitis is a clinical condition involving reversible inflammation of the large airways of the lungs (bronchial tree). The key characteristic of which is cough without pneumonia (Blush, 2013.)
This disease affects all ages, gender and is seen in a full spectrum of demographics. According to Wenzel & Fowler, acute bronchitis involves about 10% of all adult population annually (2006.) It’s one of the most common reasons people address for medical care. Raymond Blush states that acute abonchitis accounts for over 36 million medical office visits annually (Blush, 2013.) Being in the top-10 of most common diseases in outpatients (Wenzel & Fowler, 2006,) bronchitis also generates significant costs and productivity loss. For each episode of illness, patients get two prescriptions in average and miss from two to three working days (Knutson & Braun, 2002.)
According to the American College of Chest Physicians (ACCP), acute bronchitis is a lower respiratory tree infection. It’s mostly caused by viruses and manifested by productive or non-productive cough (as cited in Blush, 2013.) The viral infection causes inflammation of the bronchial wall, which, in its turn, results in edema of the bronchus and often in increased phlegm (also called mucus) production. The viral triggers of bronchitis in babies under one year of age are mostly parainfluenza virus, respiratory syncytial virus and coronavirus. In children aged between 1 and 10 years old, the prevailing infectious agents are rhinovirus, enterovirus, parainfluenza virus, and respiratory syncytial virus.
In adolescents and adults, the predominating agents of infection are influenza A and B viruses, adenovirus and respiratory syncytial virus (Knutson & Braun, 2002.) Apart from the mentioned above, human metapneumovirus has also been identified as a possible cause of bronchitis. Sometimes, bacteria species (for example, Streptococcus pneumonia, Branhamella catarrhalis and such atypical bacteria as Bordetella pertussis, Mycoplasma pneumonia, Chlamydophila pneumoniae) are isolated from the sputum of patients with acute bronchitis (Wenzel & Fowler, 2006.) Bronchitis caused by rhinovirus, enterovirus and parainfluenza has higher incidence in the fall, while illness caused by coronavirus and influenza most commonly occur in the winter and spring (Knutson & Braun, 2002.)
Acute bronchitis is an inflammatory response to infections of the bronchial epithelium. Infection enters the person’s respiratory tract by droplet inhalation. As a result, widespread inflammation occurs, characterized by increase in goblet cells, squamous metaplasia of columnar epithelium, acute leukotic and lymphocytic infiltration of bronchial walls. The mucous lining of the bronchi becomes irritated and swollen. Cells of this lining may produce mucus as a response to inflammation (NurseLabs, 2012). Mucus formation results in a productive cough. Increased and thickening secretion and narrowing of the airways can cause decrease in ventilation; and the patient demonstrates signs of bronchial obstruction (wheezing or dyspnea on exertion). Also, the ventilation- perfusion imbalance can be observed (Hueston & Maniuos, 1998.)
There is a number of predisposing factors such as comorbid conditions (underlying lung disease), smoking, malnutrition, vaccination status of the patient and population, immune deficiency, presence of a local epidemic. (Blush, 2013.) These factors can increase vulnerability to viral infections.
Key information to obtain in the history
Acute bronchitis should be diagnosed on a basis of the patient’s history and on the findings of physical examination (Alberta Clinical Practice Guideline Working Group, 2008.) At the initial assessment, a complete patient history must be obtained, including information on exposure to toxic substances, smoking; chronic diseases, such as asthma or COPD, previous cardiovascular and pulmonary illnesses; recent acute diseases, hospitalization, surgery, medications; vaccination, recent travel, contacts with ill people. The history of present illness should be analyzed (symptoms, duration of illness, related fever, cough, sputum). The healthcare professional should ask the patient whether she took any medications or other measures (herbs, modalities) to address the symptoms and whether the measures had been successful (Wedro & Davis, 2014.)
Expected physical examination findings in a patient with the topic diagnosis
Acute bronchitis should be differentiated from an acute inflammation of the small airways (asthma or bronchiolitis) and from pneumonia. Also the following diseases and conditions should be excluded: bronchiectasis, pertussis, acute exacerbation of chronic bronchitis, upper respiratory tract infections and sinusitis. Typically, in the case of bronchitis, fever may be present within 1-3 days. In case of prolonged or high-grade fever, according to Knutson & Braun (2002), influenza or pneumonia should be considered. Respiratory exam is usually normal, but wheezes, rhonchi and a prolonged expiratory phase may be present. According to Hueston & Maniuos (1998), “a night cough or wheezing may be the only signs that bronchial obstruction is present.”
Use of Gram staining and analyzing culture of sputum is questionable, because in many cases respiratory flora appears to be normal. If co-morbid obstructive pathology is suspected, the spirometry and pulmonary function testing may be used. Pulmonary function tests demonstrate temporary limitations in airflow in about 40% of acute bronchitis patients (Blush, 2013), but these limitations are reversible.
In a study, conducted by Jonsson and colleagues (1998), 34% of acute bronchitis patients fulfilled criteria for chronic bronchitis or asthma. These patients were assessed with spirometry, methacholine challenge testing and questioned about their about pulmonary symptoms. That’s why, when a healthcare professional sees a patient with an acute bronchitis, possible asthma, chronic bronchitis and bronchial hyperresponsiveness should be considered.
Routine lab tests are often done including Complete Blood Count and a chemistry profile. A blood test results often indicate inflammation process. White blood cell count is increased; C-reactive protein is commonly elevated. In general, cough in the absence of fever, tachypnea, and tachycardia, that lasts no more than three weeks with normal vital signs usually suggests bronchitis. If pneumonia, influenza, asthma and other chronic conditions are excluded, additional diagnostic procedures such as chest radiography, spirometry, bronchoscopy, sputum cytology, are not necessary.
In severe cases or in the presence of co-morbid diseases, physical examination findings may include diffuse diminution of air intake (an indicator of bronchial or tracheal obstruction), “sustained heave along the left sternal border (an indicator of right ventricular hypertrophy secondary to chronic bronchitis), clubbing on the digits and peripheral cyanosis (cystic fibrosis)”, adenopathy, conjunctivitis, and rhinorrhea (in presence of adenoviral infection) (Fayyaz, 2014.)
So, differential diagnosis is very important when symptoms of bronchitis (especially prolonged cough) are present. The main task of a physician is to rule out pneumonia, chronic conditions (for example, asthma), congestive heart failure, reflux, bronchogenic tumors and other severe conditions before considering bronchitis (Alberta Clinical Practice Guideline Working Group, 2008.)
Cultural, ethnic differences in the assessment, if any, in the abnormal findings
Acute bronchitis affect people of any age, ethnicity and gender. There’s a little evidence of any differences in clinical presentation or physical examination findings in patients with different ethnic and cultural background. The study conducted by Jackson & Bannan (1981) was dedicated to analysis of hospital admission statistics with breakdown by race and ethnicity. The findings of this study demonstrated significantly lower admission rates for Black people (3.3 per 1000 admissions), while White and Asians had almost the same admission rates for bronchitis (9.5 and 9.8 respectively, Jackson & Bannan, 1981.) This study has a number of limitations. The authors explain the higher rates for bronchitis in Whites with a combination of “smoking habits and prolonged exposure to atmospheric pollutants”, but the results seem to be questionable.
The following socio-economic and cultural features in various ethnic groups can bias the findings of this study: penetration of insurance programs, income level, symptoms tolerance, application of traditional measures of treatment, refusal of hospital admission. In some cultures tolerance of symptoms and refusal to see a physician are encouraged; and traditional healing practices are widespread. In these cultures (for example, some Asian cultures, Southern American cultures) the patients often come to hospitals in severe conditions and with presence of co-morbid diseases.
Abnormal signs and symptoms compared to normal findings
Bronchitis is often preceded with a viral respiratory tract infection, and cough is a hallmark symptom of this illness. The cough commonly starts within two days of infection in 85% of patients (Knutson & Braun, 2002) and generally lasts for less than two weeks, but can persist for up to eight weeks. The cough of acute bronchitis produces mucoid sputum; as the illness progresses, the purulent sputum can be produced. A productive cough is reported by about a half of all patients (Blush, 2013.)
Clinical presentation of acute bronchitis also includes such signs and symptoms as fever (usually doesn’t last longer than three days), general malaise, fatigue, headache, chest pain, wheezing, muscle aches (myalgia), sore throat and hoarseness, in rare cases - nausea, vomiting, or diarrhea, dyspnea and cyanosis (if co-morbid with other chronic diseases such as chronic obstructive pulmonary disease, Wedro & Davis, 2014.) These constitutional symptoms are not specific for bronchitis, these symptoms are mainly caused by infection. Acute bronchitis has significant negative impact of patient quality of life, including vitality and social functioning, but most of the decrements are temporary and reversible (Wenzel and Fowler, 2006.)
Acute bronchitis, affecting millions of people nationwide every year, impacts patient health significantly. Though, it’s commonly a short-term and reversible condition when full recovery is expected. In diagnostics, acute bronchitis first of all should be distinguished from pneumonia, influenza and chronic diseases manifesting with cough. Understanding etiology, pathophysiology, clinical representation and key diagnostic guidelines enables the healthcare professionals to select the optimal schedule of intervention and care for their patients. As a results, patient health outcomes can be maximized. For example, the acute bronchitis is commonly caused by viral agents. Understanding this fact, physicians will have realistic expectations about the clinical course and consider antibiotics therapy only in particular cases. In general, antibiotics are not beneficial in case of bronchitis and, in addition, can produce serious adverse effects.
Blush, R., R. (2013). Acute bronchitis: Evaluation and management. The Nurse Practitioner: The American Journal of Primary Health Care. October 2013, Volume 38, Number 10, 14-20. Retrieved from http://www.nursingcenter.com/lnc/Static-Pages/Acute-bronchitis-Evaluation-and-management
Wenzel, R. P. & Fowler, A.A. (2006). Acute Bronchitis. The New England Journal of Medicine. 2006;355:2125-30. Retrieved from http://www.nejm.org/doi/pdf/10.1056/NEJMcp061493
Alberta Clinical Practice Guideline Working Group (2008). Guideline for the Management of Acute Bronchitis. Retrieved from http://www.topalbertadoctors.org/download/378/acute_bronchitis_guideline.pdf
Knutson, D.& Braun, Ch. (2002). Diagnosis and Management of Acute Bronchitis. American Family Physician, May 15, 2002 , vol. 65: 2039-44. Retrieved from http://www.sonoma.edu/users/w/wilkosz/n540a-07/Acute%20Bronchitis.pdf
Hueston, W.J. & Maniuos, A.G. (1998). Acute bronchitis. American Family Physician, 1998 Mar 15;57(6):1270-6, 1281-2. Retrieved from http://www.aafp.org/afp/1998/0315/p1270.html
NurseLabs (2012). Bronchitis Pathophysiology & Schematic Diagram. Retrieved from http://nurseslabs.com/bronchitis-pathophysiology/
Wedro, B. & Davis, Ch.P. (2014). Acute Bronchitis. EMedicineHealth. Retrieved from http://www.emedicinehealth.com/acute_bronchitis/page4_em.htm
Jonsson, J. S., Gislason, T., Gislason, D., & Sigurdsson, J. A. (1998). Acute bronchitis and clinical outcome three years later: Prospective cohort study. British Medical Journal, 317(7170), 1433. Retrieved from http://search.proquest.com/docview/204026295?accountid=12779
Fayyaz, J. (2014). Bronchitis. Medscape, 28 Mar, 2014. Retrieved from http://emedicine.medscape.com/article/297108-overview
Jackson, S.H.D. & Bannan, L.T. (1981). Ethnic differences in respiratory disease. Postgraduate Medical Journal, December 1981, 57:777-778. Retrieved from http://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC2426255&blobtype=pdf