Acute bronchitis (급성 기관지염) - KMLE 의학 서적: The Root of Ambulatory Care(외래 진료 지침서), 이진우

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 321 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 118-119 323 The Root of ambulatory care