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PubMed2006

Chronic cough due to acute bronchitis: ACCP evidence-based clinical practice guidelines.

BACKGROUND: The purpose of this review is to present the evidence for the diagnosis and treatment of cough due to acute bronchitis and make recommendations that will be useful for clinical practice. Acute bronchitis is one of the most common diagnoses made by primary care clinicians and emergency department physicians. It is an acute respiratory infection with a normal chest radiograph that is manifested by cough with or without phlegm production that lasts for up to 3 weeks. Respiratory viruses appear to be the most common cause of acute bronchitis; however, the organism responsible is rarely identified in clinical practice because viral cultures and serologic assays are not routinely performed. Fewer than 10% of patients will have a bacterial infection diagnosed as the cause of bronchitis. The diagnosis of acute bronchitis should be made only when there is no clinical or radiographic evidence of pneumonia, and the common cold, acute asthma, or an exacerbation of COPD have been ruled out as the cause of cough. Acute bronchitis is a self-limited respiratory disorder, and when the cough persists for >3 weeks, other diagnoses must be considered. METHODS: Recommendations for this review were obtained from data using a National Library of Medicine (PubMed) search dating back to 1950, which was performed in August 2004. The search was limited to literature published in the English language and human studies, using search terms such as "cough," "acute bronchitis," and "acute viral respiratory infection." RESULTS: Unfortunately, most previous controlled trials guiding the treatment of acute bronchitis have not vigorously differentiated acute bronchitis and the common cold, and also have not distinguished between an acute exacerbation of chronic bronchitis and acute asthma as a cause of acute cough. For patients with the putative diagnosis of acute bronchitis, routine treatment with antibiotics is not justified and should not be offered. Antitussive agents are occasionally useful and can be offered as therapy for short-term symptomatic relief of coughing, but there is no role for inhaled bronchodilator or expectorant therapy. Children and adult patients with confirmed and probable whooping cough should receive a macrolide antibiotic and should be isolated for 5 days from the start of treatment; early treatment within the first few weeks will diminish the coughing paroxysms and prevent spread of the disease; the patient is unlikely to respond to treatment beyond this period. CONCLUSION: Acute bronchitis is an acute respiratory infection that is manifested by cough and, at times, sputum production that lasts for no more than 3 weeks. This syndrome should be distinguished from the common cold, an acute exacerbation of chronic bronchitis, and acute asthma as the cause of acute cough. The widespread use of antibiotics for the treatment of acute bronchitis is not justified, and vigorous efforts to curtail their use should be encouraged.

Acute Disease↗
PubMed1993

A multicentre study comparing the safety and efficacy of dirithromycin with erythromycin in the treatment of bronchitis.

This European multicentre (110 centres), double-blind, randomized clinical trial compared the safety and efficacy of dirithromycin (500 mg orally once daily) and erythromycin (250 mg orally qds) in the treatment of either acute bacterial bronchitis or acute bacterial exacerbations of chronic bronchitis. From January 1989 to September 1990, 1222 patients (529 with acute bronchitis and 693 with acute exacerbations of chronic bronchitis) were included in the trial. Clinical and bacteriological evaluations were performed on 135 evaluable patients with acute bronchitis (72 in the dirithromycin group and 63 in the erythromycin group) and in 202 patients with acute exacerbations of chronic bronchitis (89 treated with dirithromycin and 113 treated with erythromycin). Evaluations were performed during treatment (days 3-5), post-therapy (three to five days after therapy completion), and late post-therapy (10-14 days following the end of therapy). In acute bronchitis, both drugs were effective with clinical success rates of 93.0% and 95.2% at post-therapy, and 96.9% and 100% at late post-therapy for dirithromycin and erythromycin, respectively. Pathogen eradication rates at post-therapy were 83.3% for the dirithromycin group and 85.7% for the erythromycin group. In acute exacerbations of chronic bronchitis, the drugs were also effective with 89.9% and 92.1% cure or improvement at post-therapy and 98.7% and 95.0% at late post-therapy for dirithromycin and erythromycin, respectively. Pathogen eradication rates were 75.3% in both treatment groups. There were no statistically significant differences in clinical and bacteriological results between treatments in patients with acute bronchitis or acute exacerbations of chronic bronchitis. Of the 1222 patients included, no significant differences in the number of patients reporting adverse events were observed. There were nine early discontinuations due to adverse events in the dirithromycin group and 14 in the erythromycin group. Dirithromycin (500 mg once daily for seven days) was as effective and as safe as erythromycin (250 mg qid for seven days) in the treatment of acute bacterial bronchitis and acute bacterial exacerbations of chronic bronchitis.

Adolescent↗
PubMed2005

Immunopathogenic role of IgG antibody and RANTES in house dust mite-induced chronic bronchitis.

Based on immunological and clinical examinations, 21 patients were diagnosed as having house dust mite (HDM)-induced chronic bronchitis and classified into three groups according to the clinical presentation of the disease: stable bronchitis, exacerbated bronchitis and asthma on top of bronchitis. Using ELISA, the levels of serum anti-Dermatophagoides farinae and anti-D. pteronyssinus IgG antibodies and plasma RANTES (regulated upon activation, normal T-cell-expressed and secreted; a chemokine with attractive and activator role for eosinophils) were measured in correlation to serum eosinophil cationic protein (ECP, a marker of eosinophil activation and degranulation measured by chemiluminescent immunometric technique). Using immunoblotting, IgG binding components of D. farinae and D. pteronyssinus were determined providing a clue for diagnosis of HDM-induced chronic bronchitis. Significant higher levels of anti-D. farinae and anti-D. pteronyssinus IgG antibodies and RANTES were found in asthmatic group followed by exacerbated chronic bronchitis in comparison to stable bronchitis and control groups. ECP level correlated significantly with IgG and RANTES levels in exacerbated bronchitis and asthmatic groups. The results provided evidence that over expression of IgG and RANTES plays a crucial role, as mediator in immunopathogenesis of HDM-induced chronic bronchitis and as marker of the immunological changes likely responsible for progression of bronchitis to asthma in HDM-sensitive patients yet, RANTES seemed to be an early indicator. Definition of the immunopathogenic role of IgG and RANTES in HDM-induced bronchitis should enable the manipulation of the critical immune response in the hope of establishing new therapies. D. farinae and D. pteronyssinu antigenic bands at > 205 and 205 KDa, respectively, considered together showed 71.4% sensitivity in diagnosis of HDM induced chronic bronchitis and 100% specificity by immuno-blotting.

Adolescent↗