ACUTE TRACHEOBRONCHITIS- acute inflammation of the mucous membrane of the trachea and the bronchial tree CAUSES: often

ten follows infection of the upper respiratory track inhalation of physical and chemical irritants like gasses or other polluted air patient with viral infection has a lower resistance and prone to develop secondary bacterial infection

ACUTE TRACHEOBRONCHITIS

DEFINITION: An acute infectious disease of the trachea and bronchi characterized by cough and chest pain. EPIDEMIOLOGY: incidence: ? age of onset: o childhood -> adolescence risk factors: o unknown but factors such as allergy, climate, air pollution, chronic infections of the upper respiratory tract (i.e. sinusitis) may contribute to susceptibility

Signs and Symptoms:

mucopurulent sputum which is secreted by the edematous mucosa of the bronchi dry irritating cough sternal soreness from coughing fever headache general malaise if progresses , profuse and purulent and cough becomes looser

PATHOGENESIS: 1. Pathogens 1. Major RSV - young children in winter and spring influenzae virus - all age groups in winter and spring M. pneumoniae - schoolaged children in fall

FOR CHILDREN- Acute Tracheobronchitis is serious disease and a child is acutely ill have noisy respiration with inter-costal retraction. Strict nursing monitoring of the child and prompt action for any respiratory obstruction: FOR AGED are prone to develop Bronchopneumonia as a complication due to their inability to cough out secretions therefore tend to retain the mucopurulent exudate Nursing Measures:

2. Minor diphtheria, pertussis, salmonella (typhoid fever), streptococcus (scarlet fever) adenovirus, chlamydia trachomatis, coxsackievirus, measles, parainfluenzae virus, rhinovirus

bed rest increase fluid intake to liquefy the thick tenacious secretion and can be easily expectorate hot compress to relieve soreness and pain hot drinks may prove soothing Fruit juices are rich in Vitamin C will increase resistant against infection steam inhalation to loosen secretion and relieve laryngeal and tracheal irritation for aged- frequent turning side to side and put in sitting position

2. Pathogenesis o acute bronchitis may not exist in children as an isolated entity as the trachea is nearly always involved as well thus the term "acute tracheobronchitis" acute infection of the bronchi usually occurs in association with infections of the: upper respiratory tract nasopharyngitis lower respiratory tract

see minor pathogens above an acute primary tracheobronchitis may occur in older children and adolescents

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CLINICAL FEATURES: 1. Prodrome o o o viral URTI -> acute nasopharyngitis -> rhinitis conjunctival infection occurs 3-4 days before onset of cough

bronchiolitis obliterans recurrent tracheobronchitis investigate for respiratory tract anomalies, foreign body, CF, allergies, TB, bronchiectasis, sinusitis, adenoiditis

INVESTIGATIONS: 1. Imaging Studies 1. Chest X-ray normal

2. Virology/Microbiology 2. Respiratory Manifestations 1. Cough MANAGEMENT: initially dry (unproductive) hacking paroxysmal gradual onset after 2-3 days productive (clear -> purulent (thick and yellow)) gagging on secretions -> vomiting paroxysmal after 5-10 days productive (purulent -> clear and thin) disappears 1. Supportive o most patients recover uneventfully without any treatment postural drainage - frequent shifts in position cough suppression honey and lemon juice in warm water humidified air cough suppressants (Benylin DM, Dimetapp DM) no role for antihistamines or expectorants no role for antibiotics unless secondary bacterial infection or tracheobronchitis due to M. pneumoniae (erythromycin) o tracheal aspirate for viral isolation, C&S

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2. Others high-pitched expiratory wheezes dyspnea course and fine moist crackles substernal discomfort -> burning anterior chest pain made worse with coughing low grade temperature malaise

3. Complications o secondary bacterial infections H. flu, pneumococci, staphylococci, streptococci otitis media, pneumonia, sinusitis