Understanding and Managing Acute Tracheobronchitis: A Guide for Modern Family Doctors

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Overview

Understanding and Managing Acute Tracheobronchitis: A Guide for Modern Family Doctors

Overview

Acute tracheobronchitis, an inflammation of the tracheobronchial mucosa, is a common respiratory condition that can be caused by various factors. This blog article delves into the causes, diagnosis, treatment, and prevention of acute tracheobronchitis, providing valuable insights for both patients and healthcare professionals.

Causes of Acute Tracheobronchitis

Acute tracheobronchitis can be triggered by a range of factors, including biological, physical-chemical, and allergic agents. Biological factors often involve viruses such as adenovirus, influenza virus, coronavirus, rhinovirus, herpes simplex virus, respiratory syncytial virus, and parainfluenza virus. Bacterial causes include Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, and pathogens like chlamydia and mycoplasma. Physical-chemical factors may include cold air, dust, irritant gases or smoke (e.g., sulfur dioxide, nitrogen dioxide, ammonia, chlorine), while allergic triggers can include pollen, organic dust, fungal spores, animal fur and excrement, bacterial proteins, hookworms, and roundworm larvae.

Diagnosis

The diagnosis of acute tracheobronchitis is primarily based on clinical symptoms, which include a sudden onset of cough, sputum production, occasional hemoptysis, fever (typically around 38°C), and chest tightness or shortness of breath. In infants and young children, systemic symptoms may be more pronounced, leading to difficulty breathing, nasal flaring, decreased appetite, vomiting, dyspepsia, irritability, cyanosis, and even seizures. Physical examination may reveal scattered dry and wet rales in the lungs.

Laboratory tests typically show normal white blood cell counts. However, in cases of bacterial infection, there may be an elevated white blood cell count and neutrophils, an increased erythrocyte sedimentation rate, and positive sputum cultures. Chest X-rays often show hyperemia of the pulmonary vessels. It is important to differentiate acute tracheobronchitis from other conditions such as influenza, acute upper respiratory tract infection, bronchopneumonia, tuberculosis, lung cancer, lung abscess, measles, and pertussis.

Treatment

General Treatment

• Rest and hydration: Adequate rest and fluid intake are crucial.
• Heat and humidity control: Maintaining a comfortable temperature and humidity level in the environment can help alleviate symptoms.

Symptomatic Treatment

• Cough suppressants: For dry cough, medications such as dextromethorphan (10-20 mg) or pentazocine (25 mg) can be used every 3-4 hours.
• Expectorants: For productive cough, medications like ambroxol (30 mg) or bromhexine (8-16 mg) can be taken every 3-4 hours.
• Antispasmodics: For bronchospasm, medications like salbutamol (2-4 mg) or ipratropium bromide (40-80 μg) can be used as needed.

Antibiotic Treatment

In cases of bacterial infection, antibiotics such as macrolides, penicillins, cephalosporins, or quinolones may be prescribed. The U.S. Centers for Disease Control and Prevention recommends azithromycin for 5 days, clarithromycin for 7 days, or erythromycin for 14 days. Most patients can be treated orally, while those with severe symptoms may require intramuscular or intravenous administration.

Traditional Chinese Medicine

Traditional Chinese medicine can be used to treat various types of cough, including those due to wind-cold, wind-heat, and dryness-heat. Common herbal formulas and remedies include Xingsu Decoction, Sangju Tea, and Guaizi Decoction for wind-cold cough; Sanghuangya Decoction and Denglong Cao San for wind-heat cough; and Sangsai Decoction for dryness-heat cough. Lung fire syndrome can be treated with Xiebai Powder.

Acupuncture

Acupuncture can be used to relieve symptoms such as cough and bronchospasm. Common acupoints include Tiantu (BL 13), Fenglong (ST 40), and Dazhui (GV 14).

Prevention

To prevent acute tracheobronchitis, it is important to:

• Strengthen physical fitness and avoid overexertion.
• Maintain a comfortable indoor temperature, ideally not more than 10°C different from outdoor temperatures.
• Improve living and working conditions, reduce air pollution, and prevent exposure to harmful gases.
• Keep the nasal, pharyngeal, and laryngeal mucosa clean and clear of lesions.

Conclusion

Acute tracheobronchitis is a common but manageable condition. Early diagnosis and appropriate treatment can help alleviate symptoms and prevent complications. Healthcare professionals should be familiar with the various causes, diagnostic methods, and treatment options for acute tracheobronchitis to provide the best possible care for their patients.