9.2 Acute adult bronchitis, bronchiolitis and bronchiectasis
Learning Outcomes
Be able to:
- Describe the pathophysiology of bronchitis, bronchiolitis and bronchiectasis.
- Provide relevant evidence based education to patients regarding the pathophysiology and treatment of bronchitis and bronchiolitis.
- Describe typical antibiotic and non-drug therapy for Viral and bacterial bronchitis, Bronchiolitis and Bronchiectasis.
This chapter will briefly revise the major structures of the respiratory system, the trachea, bronchi, bronchioles and alveoli. The three conditions that will be discussed are Bronchitis, bronchiolitis and bronchiectasis.
Bronchitis
The presentation and management of bronchitis in adults is very similar to children. Acute bronchitis in adults is typically a self-limiting condition causing inflammation of the bronchi causing a persistent cough for (typically) 3-4 weeks, but as long as 8 weeks, which can be very frustrating. While most cases of Bronchitis are viral in origin and do not justify antibiotic therapy, a viral infection may predispose the patient to an atypical bacterial infection – the main culprits being Mycoplasma pneumonia and Chlamydia pneumonia.
Like in children, the main stay of non-bacterial bronchitis is management of fever and pain from cough using simple analgesics and NSAIDS. In adults, vaccination with the Fluvax and Pneumococcal vaccine is standard practice. This is in addition to smoking cessation and avoidance of irritants. Where there are signs of bacterial infection such as Mycoplasma pneumonia and Chlamydia pneumonia, tetracyclines, macrolide antibiotics and quinolones are used.
- Mycoplasma pneumonia and Chlamydia pneumonia
- Tetracyclines
- Doxycycline
- Macrolide antibiotics
- Azithromycin
- Clarithromycin
- Erythromycin
- Roxthromycin
- Quinolones
- Ciprofloxacin
- Moxifloxacin
- Tetracyclines
Bronchiolitis
Acute Bronchiolitis is better known in children than adults but does occur in adults. it is the inflammation and inflammatory injury to the small airways. The inflammation and irreversible changes typically represent a pathophysiological response to injury commonly by:
- Mycoplasma pneumoniae,
- RSV,
- measles,
- influenza,
- pertussis,
- parainfluenza, and
- adenovirus
Bronchiolitis is usually self limiting in healthy adults but may be treated with antibiotics depending on the morphological sub-type of the bronchiolitis.
📺 Watch the following recorded lecture on the management of bronchitis and bronchiolitis in adults (10:40 min)
Bronchiectasis is the permanent dilatation of the bronchi and bronchioles in response to persistent or recurrent bronchial infection. The resultant chronic inflammation impairs the mucocillary escalator causing an accumulation of secretions and bacterial growth in the bronchi and bronchioles causing permanent airway wall changes, thinning and balloon-like dilatations.
Treatment is specific to bronchiectasis but has some similarity to components of management of cystic fibrosis. Treatment modalities include the mobilisation and decreasing viscosity of sputum using respiratory physiotherapy techniques and mucus thinning agents such as inhaled hypertonic saline and mannitol, the use of bronchodilators such as salbutamol and inhaled corticosteroids to reverse reversible airway limitation, diet and exercise to manage weight, spirometry to monitor lung function, minimise opportunity for cross infection with other patients and preventative immunisations for influenza and pneumococcal disease.
The management of both non-severe and severe infective exacerbations of H. Influenzae and S. Aureus are managed with oral and IV antibiotics respectively typically for a duration of 10 days. Bronchiectasis with non-severe and severe exacerbations with P. aeruginosa are also managed with oral and IV antibiotics respectively, typically over a duration of 14 days.