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Acute bronchitis

German: akute Bronchitis

1 Definition

Acute bronchitis is an acute inflammation of the respiratory tract which is usually caused by infection. Unlike a tracheobronchitis which involves the trachea, bronchitis affects the bronchia.

ICD10-Code: J20

2 Etiology

Most cases of acute bronchitis are caused by viruses. Typical culprits are respiratory viruses that affect the epithelial cells of the bronchial mucosa and proliferate there. Those viruses include:

Respiratory viruses

Bacterial infections are rarely the sole cause of acute bronchitis. They usually develop as a superinfection in the course of a preexisting viral infection. Apoptosis of single epithelial cells caused by the viral infection leaves gaps in the epithelial structure of the mucosa, opening an entry for bacterial pathogens. Typical bacterial pathogens are:

Bacterial pathogens associated with acute bronchitis

An important factor in the development of acute bronchitis is the individual predisposition of the patient, especially the presence of bronchial hyperresponsiveness. This is indicated by the relationship between acute bronchitis and bronchial asthma.

3 Clinical presentation

The first symptom of acute bronchitis is often a nonproductive cough (dry cough), which can be painful at high intensities. In the later course of the disease, the cough becomes productive, resulting in mucous, glazed sputum at first, that later takes on a yellow-green color, especially if a bacterial infection is involved. Auscultation often reveals pathological respiratory sounds (e.g. stridor) which are caused by constriction of the bronchia and increased production of mucus.

Patients often have mild fever. In case of an affected trachea (tracheobronchitis), retrosternal pain can occur additionally.

Symptoms of acute bronchitis
Coughing
Coughing up phlegm
Fever
Stridor

Spirometry shows slight limitations of lung function in about half of the patients, corresponding to mild bronchial asthma.

4 Complications

Descending infections can cause pneumonia. Frequent relapses facilitate the development of chronic bronchitis by damaging the bronchial mucosa.

5 Diagnostics and differential diagnostics

Acute bronchitis is usually diagnosed clinically. Auscultation reveals coarse, bubbly crackles. Differential diagnosis should exclude pneumonia and an exacerbation of chronic bronchitis.

6 Therapy

Acute bronchitis is treated with regard to its symptoms, using

In case of additional blockage of the airways, bronchospasmolytics (e.g. Fenoterol or Salbutamol) can be used complementarily. Severe bacterial infections that pose the risk of bronchopneumonia indicate an antibiotic therapy. This involves the use of antibiotic macrolides (e.g. Clarithromycin, Roxithromycin) or alternatively aminopenicillins + β-Lactamase inhibitors (e.g. Amoxicillin + Clavulanic acid)

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