Acute Tracheobronchitis: Insights from My 10 year's Clinical Experience
Acute tracheobronchitis is an acute inflammation of the mucous membranes of the trachea and the bronchial tree. It is often follows infection of the upper respiratory tract. Patients with viral infection have decreased resistance and can readily develop a secondary bacterial infection. Adequate treatment of upper respirator tract infection is one of the major factors in the prevention of acute bronchitis.
In acture tracheobronchitis, the inflammed mucosa of the bronchi produces mucopurulent sputum, often in response to infection by
- Streptococcus pneumonia
- Hemophiliacs influenza
- Mycoplasma pneumoniae
- Aspergillus
- Candida
A sputum culture is essential to identify the specific causative organism. In addition to infection, inhalation of physical and chemical irritants, gases, or other air contaminants can also cause acute bronchial irritation. A subcategory of trachobronchitis is ventilator-associated tracheobronchitis, which is a common illness in chronically ventilated patients. It is my personal observation and suggestion f managed appropriately, ventilator associated pneumonia may be prevented. You can search ventilator associated events on CDC guidelines.
Symptoms :
Initially, the patient has a dry, irritating cough and expectorates a scanty amount of mucoid sputum. The patient may report sternal soreness from coughing and have fever of chills night sweats, headache and general malaise. As the infection progress, the patient may be short of breath, have noisy inspiration and expiration and produce purulent sputum. In severe tracheobronchitis, blood-streaked secretion may be expectorated as a result of the irritation of the mucosa of the airways.
Medical management
Antibiotic treatment may be indicated depending on the symptoms, sputum purulence and results of the sputum culture and sensitivity. Antistamines usually are not prescribed, because they can cause excessive drying and make secretion is more difficult to expectorate.
Fluid intake is increased to thin or viscous and tenacious secretions. Copious purulent secretions that cannot be cleared by coughing place patient at risk for increasing airway obstruction and the development of more severe lower respiratory tract copy may be needed to remove secretions. Rarely, endotracheal intubation may be necessary increase of acute tracheo bronchitis leading to acute respiratory failure, such as in patients who are severely debilitated or who have coexisting disease that also impair the the respiratory system.
In most cases, treatment of tracheobronchitis is largely symptomatic. Increasing the vapor pressure in the air reduces airway irritation. Cool vapor therapy or steam inhalations may help relive laryngeal and tracheal irritation. Most heat to the chest may relive the soreness and pain, and mild analgesics may be prescribed.
Home care or nursing care :
Acute tracheobronchitis is usually treated in the home setting. A primary nursing or home care function is to encourage bronchial hygiene, such as increased fluid intake and directed coughing to remove secretions. Elevate patient's bed 35-45 Degree. We should encourage and assist the patient to sit up frequently to cough effectively and to prevent retention of mucopurulent sputum. If the patient is taking antibiotics for underlying infection , the need to complete the full course of antibiotics prescribed is emphasized(If you want know more about this sentence so refer antibiotic stewardship programme). Fatigue is a consequence of tracheobronchitis, there fore, We should caution the patient against overexertion, which can induce a relapse of exacerbation of the infection. Also we can advice to patient for rest. Follow standard precaution for our safety and prevent infection from patient to us.
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