Acute bronchitis (급성 기관지염)

The Root of Ambulatory Care
- 저 자 : 이진우
- 출 판 : 군자출판사
- 페이지수: 543면
이진우 선생님, 군자출판사와 제휴를 통해 책 내용 및 그림을 제공합니다.
무단 복제/배포 금지.
KEYWORDS:
Acute infectious bronchitis
Caused by Virus : 90%
(rhinovirus, coronavirus, influenza virus, adenovirus, respiratory syncytial virus,
parainfluenza virus etc)
Caused by Bacteria : 10%
(mycoplasma pneumoniae, chlamydia pneumoniae, bordetella pertussis)
Exacerbation of chronic bronchitis
Exacerbated by Infectious organisms (viruses, haemophilus influenza, Streptococcus
pneumoniae etc)
Exacerbated by Non-infectious factors
(smoking, allergens, occupational irritants)
Acute infectious bronchitis
1. Cough (± sputum)
2. Chest discomfort
Exacerbation of chronic bronchitis
1. Worsening cough
2. Increased dyspnea
3. Sputum purulence
..급성 기관지염의 약 반수에서 기침이 2주간 지속된다.
..Clues to the presence of pneumonia
- HR > 100 beats/min
- RR > 24 breaths/min
Acute
bronchitis
Key symptoms
- Oral temperature > 38℃
- Focal findings on chest examination
1. Chest X ray if needed : dyspnea, rales, rigors, pleurisy, persistent fever/cough
..A sputum gram stain and culture are not usually obtained for patients treated in
the ambulatory setting.
- General considerations
안정과 휴식, 충분한 수분 섭취
- Pharmacologic
1. β2-agonist agents
..Ventolin.. evohaler 0.5mg/puff 1-2puff tid-qid (소아 1 puff tid-qid)
..Bambec.. 10mg 1T qd pohs (1-2주 후 증상에 따라 2T 증량)
(2~12세 : 10mg qd)
..Berotec.. 2.5mg 1T, 1T-2T tid
(5~10세 : 2.5mg qd)
2. Anti-tussive
..Codein.. 1T tid qid
3. Mucolytics
..Mucopect.. 1T tid, qid
Exacerbation of chronic bronchitis
1. Antimicrobial agents
..Amocla.. 250mg/125mg 1C, 2C tid×10days
..Avelox.. 400mg 1T, 1T qd×5days
2. Stop smoking
3. Inhaled bronchodilators
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The Root of ambulatory care
Key tests
Key treatments
Key treatments
Acute
bronchitis
(ipratropium, β2-agonist)
4. Systemic/inhaled corticosteroids
5. Oxygen supply
..Ventolin.. - Salbutamol
..Bambet.. - Bambuterol
..Berotec.. - Fenoterol
..Mucopect.. - Ambroxol
..Amocla.. - Amoxicillin/Clavulanate
..Avelox.. - Moxifloxacin
▶ 5일 이내 증상 호전이 없다면 치료과정에 관한 재평가가 필요하다.
- Incorrect diagnosis (perhaps pneumonia, neoplasm, or CHF)
- An issue of compliance
- Inappropriate antimicrobial selection
- Diminished antimicrobial bioavailability (the co-administration of iron,
antacids, dideoxyinosine, and multivitamins with zinc decreases the absorption
of tetracyclines and fluoroquinolones)
- Excessive bronchospasms and/or bronchial secretions
참고 문헌
Richard A. Gleckman: Bronchitis, in Saunders Manual of Medical Practice, 2nd ed, Robert E. Rakel(ed).
Philadelphia, Saunders, 2000, P 178-181
Nelson M. Gantz, M.D. : Acute Bronchitis, in Conn’s Current Therapy 2004, Robert E. Rakel(ed), Edward
T. Bope(ed_). Philadelphia, Saunders, 2004, P 261-263
오창석(ed) : 급성 기관지염, in Complete Guide To Practical Based Prescription Medicine. 서울, 한우리,
2005, P 118-119
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