Acute Bronchitis

Rp, Wenzel; Aa, Fowler

doi:10.1056/nejmcp061493

Cited by 125 publications

(53 citation statements)

References 1 publication

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“…Twentyeight percent of our participants had a productive cough with purulent sputum. These findings are consistent with other studies, [11,12] in which >50% of parents described the cough as dry, the remainder reporting it to be productive or of a mixed type. As has been reported by others, [13,14] we found that the colour of the sputum had no predictive value for the diagnosis of bacterial bronchitis or for differentiating between pneumonia and bronchitis.…”

Section: Discussionsupporting

confidence: 83%

Cross-sectional evaluation of the Bronchitis Severity Score in Egyptian children: A move to reduce antibiotics

Moawad¹,

Haron²,

Maher³

et al. 2017

S Afr Med J

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Background. Despite evidence of limited benefit of antibiotics in acute bronchitis, most paediatric patients are prescribed them. Objectives. To assess the validity of the Bronchitis Severity Score (BSS) in assessing the clinical response to treatment of acute bronchitis, and determine whether clinical data and basic laboratory measurements can be used to guide antibiotic prescription. Methods. We enrolled 200 patients (age range 6 months 12 years) with clinically diagnosed acute bronchitis. They were divided into three groups according to age. All patients were evaluated three times during the bronchitis episode (days 0, 5 and 7). The primary outcome measurement was the change in the BSS from day 0 to day 7. Results. On the initial visit, the mean (standard deviation (SD)) BSS was 8.36 (2.6), indicating moderate severity of bronchitis. The mean BSS decreased to 4.03 (2.3) on day 5 and to 2.36 (1.45) on day 7. Initial blood tests showed anaemia (80%), leucocytosis (6%), bandaemia (3%) and lymphocytosis (52%). Only four patients were positive for Creactive protein, while the erythrocyte sedimentation rate was elevated in 98% of cases. There were significant correlations between bandaemia, fever grade (p<0.001) and white blood cell count with clinical variables such as the presence of secretions on chest auscultation (p<0.05) and toxic facies on general examination (p<0.05). Conclusions. Acute bronchitis in children is a selflimiting disease that does not require routine administration of antibiotics. The BSS is a simple and practical clinical scoring system that is useful in evaluating disease severity and monitoring disease resolution in acute bronchitis.

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Section: Discussionsupporting

confidence: 83%

Cross-sectional evaluation of the Bronchitis Severity Score in Egyptian children: A move to reduce antibiotics

Moawad¹,

Haron²,

Maher³

et al. 2017

S Afr Med J

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“…44,45 Production of purulent sputum does not distinguish a viral from a bacterial infection. 46 Virally induced asthma exacerbations typically begin 1-2 days after symptoms of infection begin and are characterized by brief episodes of wheezing and decreased pulmonary function. Symptoms are most significant during the first 48 hours of exacerbation and return to baseline within 5 to 10 days.…”

Section: Clinical Characteristicsmentioning

confidence: 99%

Infection-Related Asthma

Darveaux

Lemanske

2014

The Journal of Allergy and Clinical Immunology: In Practice

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The role of infection in asthma is varied in that it may exacerbate established asthma or contribute to the initial development of the clinical onset of asthma. Mounting evidence implicates both roles, with particular viral pathogens, namely human rhinovirus (HRV) and respiratory syncytial virus (RSV), among the most likely culprits in asthma inception. Once asthma is present, infection, particularly viral infections, are a common precipitant of asthma exacerbations. Bacterial infections and colonization also have been associated with exacerbation and recurrent wheeze, an effect that may be independent or a cofactor with viruses. Atypical bacterial infections such as Mycoplasma pneumoniae and Chlamydia pneumoniae and fungi in the case of allergic bronchopulmonary aspergillosis (ABPA), also play a potential role in inducing and exacerbating this disease. Additionally, certain individuals may have a genetic predisposition toward viral induced wheezing and the development of asthma. This paper will discuss host and environmental factors, common pathogens, clinical characteristic, and genetic influences associated with infection related asthma.

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“…A recent acute bronchitis review noted that a procalcitonin < 0.1 ng/ml may be able to safely discriminate between acute bronchitis and CAP, but that more data were needed. (38) This raises the possibility that some of our cohort with a low procalcitonin, although diagnosed clinically and radiographically with CAP by their treating physicians, may not actually have had pneumonia. However, all GenIMS patients met the CAP criteria of Fine et al (5), an expected, low percentage of patients were later deemed not to have CAP, this percentage did not markedly vary by procalcitonin tier (range: 4% -7%), and eliminating these patients from our analyses had minimal effect.…”

Section: Limitationsmentioning

confidence: 99%

Risk Prediction With Procalcitonin and Clinical Rules in Community-Acquired Pneumonia

Huang

Weissfeld

Kellum

et al. 2008

Annals of Emergency Medicine

198

136

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Objective-The Pneumonia Severity Index (PSI) and CURB-65 predict outcomes in community acquired pneumonia (CAP), but have limitations. Procalcitonin, a biomarker of bacterial infection, may provide prognostic information in CAP. Our objective was to describe the pattern of procalcitonin in CAP, and determine if procalcitonin provides prognostic information beyond PSI and CURB-65.Methods-We conducted a multi-center prospective cohort study in 28 community and teaching emergency departments. Patients presenting with a clinical and radiographic diagnosis of CAP were enrolled. We stratified procalcitonin levels a priori into four tiers -I: < 0.1; II: ≥ 0.1 to <0.25; III: ≥ 0.25 to < 0.5; and IV: ≥ 0.5 ng/ml. Primary outcome was 30d mortality.Results-1651 patients formed the study cohort. Procalcitonin levels were broadly spread across tiers: 32.8% (I), 21.6% (II), 10.2% (III), 35.4% (IV). Used alone, procalcitonin had modest test characteristics: specificity (35%), sensitivity (92%), positive likelihood ratio (LR) (1.41), and negative LR (0.22). Adding procalcitonin to PSI in all subjects minimally improved performance. Adding procalcitonin to low risk PSI subjects (Class I-III) provided no additional information. However, subjects in procalcitonin tier I had low 30d mortality regardless of clinical risk, including those in higher risk classes (1.5% vs. 1.6% for those in PSI Class I-III vs. Class IV/V). Among high risk PSI subjects (Class IV/V), one quarter (126/546) were in procalcitonin tier I, and the negative LR of procalcitonin tier I was 0.09. Procalcitonin tier I was also associated with lower burden of other adverse outcomes. Similar results were seen with CURB-65 stratification. Reprints not available from the authors.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusions-Selective use of procalcitonin as an adjunct to existing rules may offer additional prognostic information in high risk patients. NIH Public Access

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Acute Bronchitis

Cited by 125 publications

References 1 publication

Cross-sectional evaluation of the Bronchitis Severity Score in Egyptian children: A move to reduce antibiotics

Cross-sectional evaluation of the Bronchitis Severity Score in Egyptian children: A move to reduce antibiotics

Infection-Related Asthma

Risk Prediction With Procalcitonin and Clinical Rules in Community-Acquired Pneumonia

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