Acute bronchitis: how to treat?


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The management of patients with acute bronchitis (AB) still presents significant difficulties. The main problems lie in the field of differential diagnosis, the choice of rational drug therapy. The excess of antibiotic therapy is still associated with the diagnosis of AB, and the variety of medicines for the treatment of cough creates difficulties in the choice of antitussive and mucoactive drugs. An indispensable diagnostic component in patients with suspected AB is the exclusion of more serious causes of cough, such as bronchial asthma, exacerbation of chronic obstructive pulmonary disease, heart failure or pneumonia. Exclusion of community-acquired pneumonia seems to be the most important step., and various tools can be useful for this, including assessment of symptoms and physical findings, radiological imaging, laboratory biomarkers (such as C-reactive protein, procalcitonin). At least 90% of AB cases are caused by a viral infection. This means that the vast majority of patients do not need antibiotics. Cough relief seems to be the most important treatment for patients with OB. The course of OB is often accompanied by a productive cough, so the main task is related to the rational choice of drugs to control cough through a change in the volume and properties of bronchial secretions. In real clinical practice, phytopreparations are the most frequently prescribed drugs for acute respiratory viral infections and are used with the same frequency for all types of cough in adults and children. Bronchipret®, which has anti-inflammatory, secretolytic and broncholytic effects, is one of the actively used phytopreparations with proven efficacy.

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作者简介

Yuliya Belotserkovskaya

Russian Medical Academy of Continuous Professional Education

Email: belo-yuliya@yandex.ru
Cand. Sci. (Med.), Associate Professor at the Department of Pulmonology Moscow, Russia

A. Sinopalnikov

Russian Medical Academy of Continuous Professional Education

Moscow, Russia

参考

  1. Morice A.H. Epidemiology of cough. Pulm Pharmacol Ther2002;15:253-59. doi: 10.1006/pupt.2002.0352.
  2. Barbee R.A. A longitudinal study of respiratory symptoms in a community population sample. Correlations with smoking, allergen skin-test reactivity, and serum IgE. Chest 1991;99:20-6. doi: 10.1378/chest.99.1.20.
  3. McGarvey L.P., Heaney L.G., Lawson J.T., et al. Evaluation and outcome of patients with chronic non-productive cough using a comprehensive diagnostic protocol. Thorax, 1998;53:738-43. doi: 10.1136/thx.53.9.738.
  4. Woodhead M., Blasi E., Ewig S., et al. Guidelines for the management of adult lower respiratory tract infections. Clin Microbiol Infect. 2011;17(6):E1-59. doi: 10.1111/j.1469-0691.2011.03672.x.
  5. Синопальников А.И., Козлов Р.С. Внебольничные инфекции дыхательных путей. Руководство для врачей, М., 2007. 352 с.
  6. Kinkade S., Long N. A. Acute Bronchitis. Am Fam Physician. 2016;94(7):560-65.
  7. Clark T.W, Medina M.J., Batham S., et al. Adults hospitalised with acute respiratory illness rarely have detectable bacteria in the absence of COPD or pneumonia; viral infection predominates in a large prospective UK sample. J infect. 2014;69(5):507-15. doi: 10.1016/j.jinf.2014.07.023.
  8. Gencay M., Roth M., Christ-Crain M., et al. Single and multiple viral infections in lower respiratory tract infection. Respiration. 2010;80(6):560-67. doi: 10.1159/000321355.
  9. Macfarlane J., Holmes W., Gard P., et al. Prospective study of the incidence, aetiology and outcome of adult lower respiratory tract illness in the community. Thorax. 2001;56(2):109-14. doi: 10.1136/thorax.56.2.109.
  10. Wadowsky R.M., Castilla E.A., Laus S., et al. Evaluation of Chlamydia pneumoniae and Mycoplasma pneumoniae as etiologic agents of persistent cough in adolescents and adults. J Clin Microbiol. 2002;40(2):637-40. doi: 10.1128/JCM.40.2.637-640.2002.
  11. van Vugt S.F., Verheij T.J., de Jong PA. et al.; GRACE Project Group. Diagnosing pneumonia in patients with acute cough: clinical judgment compared to chest radiography. Eur Respir J. 2013;42(4):1076-82. doi: 10.1183/09031936.00111012.
  12. Altiner A., Wilm S., Daubener W., et al. Sputum colour for diagnosis of a bacterial infection in patients with acute cough. Scand J Prim Health Care. 2009;27(2):70-3. doi: 10.1080/02813430902759663.
  13. Steurer J, Held U., Spaar A., et al. A decision aid to rule out pneumonia and reduce unnecessary prescriptions of antibiotics in primary care patients with cough and fever. BMC Med. 2011;9:56. doi: 10.1186/1741-7015-9-56.
  14. Ebell M.H., Lundgren J., Youngpairoj S. How long does a cough last? Comparing patients' expectations with data from a systematic review of the literature. Ann Fam Med. 2013;11(1):5-13. doi: 10.1370/afm.1430
  15. Eccles R., Fietze i., Rose U-W. Rationale for Treatment of Common Cold and Flu with Multiingredient Combination Products for Multi-Symptom Relief in Adults. Open J Respir Dis. 2014;24:73-8. doi: 10.4236/ojrd.2014.43011
  16. Aabenhus R., Jensen J.U., Jorgensen K.J., et al. Biomarkers as point-of-care tests to guide prescription of antibiotics in patients with acute respiratory infections in primary care. Cochrane Database Syst Rev. 2014;(11):CD010130. doi: 10.1002/14651858.CD010130.pub2.
  17. van Vugt S.F, Broekhuizen B.D., Lammens C., et al.; GRACE Consortium. Use of serum C reactive protein and procalcitonin concentrations in addition to symptoms and signs to predict pneumonia in patients presenting to primary care with acute cough: diagnostic study. BMJ. 2013;346:f2450. doi: 10.1136/bmj.f2450.
  18. Held U., Steurer-Stey C., Huber F., et al. Diagnostic aid to rule out pneumonia in adults with cough and feeling of fever. A validation study in the primary care setting. BMC infect Dis. 2012;12:355. doi: 10.1186/1471-2334-12-355.
  19. Brink A.J., Wyk J.V., Moodley V.M., et al. The role of appropriate diagnostic testing in acute respiratory tract infections: An antibiotic stewardship strategy to minimise diagnostic uncertainty in primary care. S Afr Med J. 2016;106(6):30-7. doi: 10.7196/SAMJ.2016.v106i6.10857.
  20. Vasileva D., Badawi A. C-reactive protein as a biomarker of severe H1N1 influenza. inflamm Res. 2019;68:39-46. doi: 10.1007/s00011-018-1188-x
  21. Белоцерковская Ю.Г., Лебедев С.С., Закатов Д.В. с соавт. COViD-19: отдельные клинические аспекты через призму практического опыта. Фарматека. 2020;10:38-51. doi: 10.18565/pharmateca.2020.10.38-51.
  22. Luo X., Zhou W., Yan X., et al. Prognostic Value of C-Reactive Protein in Patients With Coronavirus 2019. Clin infect Dis. 2020;71(16): 2174-79. doi: 10.1093/cid/ciaa641.
  23. Liu F., Li L., Xu M., et al. Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COViD-19. J Clin Virol. 2020;127:104370. doi: 10.1016/j.jcv.2020.104370.
  24. Wu C., Chen X., Cai Y., et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA intern Med. 2020;180:934-43. doi: 10.1001/jamainternmed.2020.0994.
  25. Hamade B., Huang D.T Procalcitonin: Where Are We Now? Crit Care Clin. 2020;36(1):23-40. doi: 10.1016/j.ccc.2019.08.003.
  26. Albrich W.C., Dusemund F., Bucher B., et al. ProREAL Study Team. Effectiveness and safety of procalcitonin-guided antibiotic therapy in lower respiratory tract infections in "real life": an international, multicenter poststudy survey (ProREAL). Arch intern Med. 2012;172(9):715-22. doi: 10.1001/archinternmed.2012.770.
  27. Metlay J.P., Schulz R., Li Y.H., et al. influence of age on symptoms at presentation in patients with community-acquired pneumonia. Arch intern Med. 1997;157(13):1453-59.
  28. Braman S.S. Chronic cough due to acute bronchitis: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1):95S-103S. doi: 10.1378/chest.129.1_suppl.95S.
  29. Gerber J.S. improving Outpatient Antibiotic Prescribing: Another Nudge in the Right Direction. JAMA. 2016;315(6):558-59. doi: 10.1001/jama.2016.0430.
  30. Barnett M.L., Linder J.A. Antibiotic prescribing for adults with acute bronchitis in the United States, 1996-2010. JAMA. 2014;311(19):2020-22. doi: 10.1001/jama.2013.286141.
  31. Butler C.C., Kelly M.J., Hood K., et al. Antibiotic prescribing for discoloured sputum in acute cough/lower respiratory tract infection. Eur Respir J. 2011;38(1):119-25. doi: 10.1183/09031936.00133910.
  32. Oeffinger K.C., Snell L.M., Foster B.M. et al. Treatment of acute bronchitis in adults. J Fam Pract. 1998;46(6):469-75.
  33. Smith S.M., Fahey T., Smucny J., Becker L.A. Antibiotics for acute bronchitis. Cochrane Database Syst Rev. 2017;6:CD000245. doi: 10.1002/14651858.CD000245.pub4.
  34. Козлов Р.С., Зырянов С.К., Синопальников А.И. и др. Эмпирическая антибактериальная терапия инфекций дыхательных путей с учетом факторов риска резистентной флоры. Резолюция совета экспертов. Справочник поликлинического врача. 2018;1:28-32.
  35. Зайцев А.А., Белоцерковская Ю.Г. Мукоактивная и противокашлевая терапия при острых респираторных заболеваниях в реальной клинической практике. Практическая пульмонология. 2021;2:79-84. doi: 10.24412/2409-6636-202112694.
  36. Клячкина И.Л., Белоцерковская Ю.Г., Романовских А.Г. Мукорегуляторы в программе лечения острой респираторной вирусной инфекции. Русский медицинский журнал. 2018;3(1):14-8.
  37. Soilemezi D., üeydoe G.M., Yan R., et al. Herbal medicine for acute bronchitis: A qualitative interview study of patients' and health professionals' views.Complement Ther Med. 2020;SS:102613. doi: 10.1016/j.ctim.2020.102613.
  38. Brendler T, van Wyk B.E. A historical, scientific and commercial perspective on the medicinal use of Pelargonium sidoides (Geraniaceae). J Ethnopharmacol. 2008;119:420-33. doi: 10.1016/j.jep.2008.07.037.
  39. Singh A.K., Raghubanshi A.S., Singh J.S. Medical ethnobotany of the tribals of Sonaghati of Sonbhadra district, Uttar Pradesh, India. J Ethnopharmacol2002;81:31-41. doi: 10.1016/s0378-8741(02)00028-4.
  40. Kardos P., Berck H., Fuchs K.H. Guidelines of German Respiratory Society for diagnosis and treatment of adults suffering from acute or chronic cough. Pneumologie. 2010;64:336-73. doi: 10.1055/s-0030-1255526.
  41. Kemmerich B. Evaluation of efficacy and tolerability of a fixed combination of dry extracts of thyme herb and primrose root in adults suffering from acute bronchitis with productive cough. A prospective, double-blind, placebo-controlled multicentre clinical trial. Arzneimittelforschung 2007;57:607-15. doi: 10.1055/s-0031-1296656.
  42. Kemmerich B., Eberhardt R., Stammer H. Efficacy and tolerability of a fluid extract combination of thyme herb and ivy leaves and matched placebo in adults suffering from acute bronchitis with productive cough. A prospective, double-blind, placebo-controlled clinical trial. Arzneimittelforschung. 2006;56:652-60. doi: 10.1055/s-0031-1296767.
  43. Cwientzek U., Ottillinger B., Arenberger P. Acute bronchitis therapy with ivy leaves extracts in a two-arm study. A double-blind, randomised study vs. an other ivy leaves extract. Phytomedicine. 2011;18:1105-109. doi: 10.1016/j.phymed.2011.06.014.
  44. Kurth W. Gesicherte therapeutische Wirksamkeit des traditionellen Antitussivums Mintetten im Doppelblindversuch. Med Welt. 1978;29:1906-909.
  45. Wagner L., Cramer H., Klose P., et al. Herbal Medicine for Cough: A Systematic Review and Meta-Analysis. Forsch Komplementmed. 2015;22(6):359-68. doi: 10.1159/000442111.
  46. Кладова О.В., Анджель А.Е., Компаниец Ю.В. Роль растительного лекарственного препарата с противовоспалительным и секретолитическим действием в лечении кашля при ОРВИ. Медицинский совет. 2020;(1):92-9. doi: 10.21518/2079-701X-2020-1-92-99.
  47. Ismail C., Willer G., Steindl H. Бронхипрет и синтетические муколитики при остром бронхите: сравнительное когортное исследование. Фарматека. 2005;19:86-90.
  48. Martin D., Konrad M., Adarkwah C.C., et al. Reduced antibiotic use after initial treatment of acute respiratory infections with phytopharmaceuticals - a retrospective cohort study. Postgrad Med. 2020;132(5):412-18. doi: 10.1080/00325481.2020.1751497.

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