Acute Bronchitis Symptoms & Treatment Essay (Critical Writing)

A Case Study

Mr. John Doe is a 47-year-old Caucasian male who doesn’t smoke and has no underlying lung disease. He presents to the clinic with 8- day history of mild shortness of breath with exertion, as well as a productive cough with purulent sputum. He states that his nose is congested but denies facial pressure or pain; he coughs more in the morning and evening but coughing doesn’t keep him up at night. He denies that he has a recent contact with ill people in his community. He thinks he has a fever because he feels hot at night but he has never taken his temperature. He denies chills, wheezes, or pleuritic chest pain.

He has tried over-the-counter cough syrup and expectorant without improvement. His past medical diagnosis is hyperlipidemia and is taking Lipitor 10 mg one tablet at bedtime. He doesn’t appear to be in acute distress. His blood pressure is 110/75, pulse 78 beats per minute, temperature 37.2 degrees Celsius, and respiratory rate 18 breaths per minute. His oropharynx examination reveals a slightly swollen turbinate without exudates or polyps. Lymph nodes are not palpable. Heart sounds regular rate and rhythm. Lungs sound without wheezes, crackles, or rales. Test results of Influenza A and B are negative. He is diagnosed with acute bronchitis and is prescribed broad-spectrum antibiotics and anti-tussive medications. The clinician states that he prescribes antibiotics because he knows that the patient expected it and this way patients will be satisfied with their office visit. Is an antibiotic needed to treat uncomplicated acute bronchitis? Does antibiotic treatment give patients satisfaction with their visits? This paper will explore two research articles related to both questions.

What is Acute Bronchitis?

Acute bronchitis is an infection in the lower respiratory tract which causes reversible bronchial inflammation. Viral causes account for 95 percent of the cases. This is one of the most common diagnoses made by primary physicians with treatment estimated cost of about $200-$300 million per year. This is so because primary physicians lump various conditions together and diagnose them as bronchitis. This diagnosis is purely clinical as there are no laboratory studies that would prove acute bronchitis. Thus, cough from upper respiratory tract infection, allergic reactions such as mild asthma, and sinusitis may be diagnosed as acute bronchitis (Hueston, et. al. 1998).

Acute bronchitis is characterized to be an infection involving the bronchial tree with bronchial edema and mucus formation causing the formation of productive cough and signs of bronchial obstruction. Unlike asthma, the inflammation is transient and is usually gone after the infection subsides (Hueston, et.al. 1998).

This may have other causes other than infection since inflammation in the bronchial wall can occur in asthma or could be a result of mucosal injury in an acute event such as inhalation of smoke or chemical fume (Hueston, et.al. 1998).

Following a common cold or some viral infections involving the upper respiratory tract, acute bronchitis may occur. Allergies, chronic sinusitis in children, enlargement of tonsils and adenoids may also cause the disease and following acute bronchitis, pneumonia may occur (Respiratory disorders, 2004).

Treatment of acute bronchitis would be determined by some factors as the age of the patient and the obtained medical history, extent of the condition, the patient’s tolerance for the proposed medication, procedure and therapy, expectation for the condition’s course, and the patient’s preference or opinion (Respiratory disorders, 2004).

In most cases of acute bronchitis, antibiotics are not needed as the infection is caused by viruses. Treatment of acute bronchitis usually includes analgesics life ever fever occurs, cough medicines, increased intake of fluids and a cool-mist humidifier in the room may be helpful (Respiratory disorders, 2004).

Literature Review

“The bronchial inflammation is reversible.”

Let look at the research findings to answer these two questions: “Is antibiotic needed to treat uncomplicated acute bronchitis?” and “Does antibiotic treatment give patient satisfaction with their visits?”

In one article entitled “Understanding Bronchitis”, treatments for acute bronchitis would include simple measures such as getting plenty of rest, increased fluid intake, avoiding irritants such as smoke and fumes, inhaled bronchodilator may be needed or cough syrups. It also stated that in healthy people with normal lungs and with no chronic health problems, antibiotics are not needed as the effect of acute bronchitis subsides with proper management (Smith, et. al. 2007).

In another article entitled “Patient information: Acute bronchitis in adults”, antibiotics are not helpful to treat acute bronchitis since it is mostly caused by a virus and antibiotics treat bacterial infection and not a viral infection. Most of the people who request antibiotics do so in the hope of getting rid of the cough and that they believed that the antibiotics were effective in the previous cases. Taking antibiotics would only predispose the person to the side effects of the said medicine such as diarrhea, stomach upset, and yeast infection. It would also just add up to unnecessary costs and the possible development of bacteria that are resistant to standard antibiotics. Thus antibiotics should be avoided in the treatment of acute bronchitis (Barlett, 2007).

In a meta-analysis done by Fahey, Stock, and Thomas (1998) entitled Quantitative systematic review of randomized controlled trials comparing antibiotic with placebo for acute cough in adults, wherein they used a quantitative systemic review of randomized placebo-controlled trials, they found out that antibiotic therapy did not improve cough or clinical status and that the patients had more side effects than those who did not take antibiotics.

The researchers used the following methodology. First are the inclusion and exclusion criteria, to be able to select targets or possible subjects of the study. They chose studies that involved subjects who are 12 years old and above who are attending family practice clinics. The researchers included the patients who complained of chronic cough with or without purulent sputum who did not have an antibiotic treatment in the preceding week. With these, they were able to include studies which were prospective trials by which antibiotic was allocated by formal randomization or quasi-randomization and they only included the placebo group in their study and concentrated on the three most commonly reported outcomes which are “the proportion of subjects reporting productive cough, the proportion of subjects who had not improved clinically at re-examination, and the proportion of subjects who reported side effects from taking antibiotic or placebo.”

The researchers found 9 clinical trials that met their inclusion and exclusion criteria. Another method employed was the systematic search wherein the researchers searched Medline and EMBASE databases from the year 1966 to the year 1982 using the recommended Cochrane Collaboration search strategy and the medical subject heading or the MeSH terms respectively. The terms included cough, bronchitis, sputum, and respiratory tract infections, and their search was not limited to the English language. The researchers even contacted the authors and drug companies in the United Kingdom of the published trials to request information about their knowledge about some unpublished studies. And the last method they employed was the assessment of the quality and extraction of data wherein each trial was independently read and assessed of the quality of the study according to the given four criteria by Cochrane Collaboration Handbook.

However, their study had limitations first is that the outcomes chosen and assessed in the trials were varied and different thus creating a difference in the procedures in different trials. Another is that more generic scores for measuring the quality of life were not used in the trials thus limiting the propensity to combine the results. This then did not include the important information of the patient such as the effect of antibiotics on the quality of life and return to work was not included in the report. And the last limitation is the timing of assessment which differed between trials thus making it difficult to measure the clinical course of acute cough.

1. In another non-experimental research article by Gonzales, Steiner, Maselli, Lum, and Barret (2001) entitled “Prescribing for Acute Bronchitis on Patient Satisfaction”, patients who were not given antibiotic treatment for their acute bronchitis do not report less satisfaction in their visit compared to patients who were treated with an antibiotic.
2. This study employed the following methodology. First is the original intervention wherein it involved the trial of four medical office practices in Denver, Colorado which belongs to a large group model care organization the Kaiser Permanente of Colorado. The second method the researchers employed was the patient enrollment wherein they chose adult patients who were diagnosed at family practice or internal medicine to have acute bronchitis between January 1 and April 30, 1999, were considered eligible for the study. They successfully identified 510 eligible patients but only 416 were contacted as 89 could not be reached by phone. Then the researchers employed the data collection and the statistical analysis to come up with the above-mentioned result.
3. This study also has their limitations which includes its cross-sectional design. It could be possible that there is higher patient satisfaction originally in the control clinic and decreased level at the intervention clinic (Gonzales, et.al. 2001). So the satisfaction of the patients may originally be the results in their survey. This limitation may be a source for a critique of the study. This would make their conclusion weak as patient satisfaction or dissatisfaction may be set by their previous visits to the clinic and not by the current visit when the study was conducted. The researchers did not include if the visit was the first time for the patients or was it a repeated visit because they were satisfied with the service that the clinic gave.
4. Physicians should avoid prescribing antibiotics if ever the patient does not need one. Studies showed that patients who took antibiotics to treat acute bronchitis showed more side effects compared to those who took the placebo (Fahey et.al. 1998). This may just predispose the patient to another disease caused by the side effects of taking antibiotics. Taking antibiotics may shorten the coughing period during an acute bronchitis attack but this may also cause the risk of development of antibiotic-resistant bacteria and may cause the following side effects as nausea, stomach upset, vomiting, diarrhea, rashes on the skin, and increased sensitivity to sun (Wise, 2006). Another reason why one should not take antibiotics in acute bronchitis is that the cost may not be worth the benefits, acute bronchitis would usually clear up on its own within 2-3 weeks and the experts would not recommend it if the patient does not have any other existing health problem (Wise, 2006).
5. As the first study showed that antibiotic treatment is not necessary for the treatment of the antibiotic treatment however the physician of the above-mentioned patient still gave him the antibiotic for the reason of the expectation of the patient and to increase his satisfaction with the clinical visit. However, the second study showed that prescription of antibiotics is not a measure of the patient’s satisfaction for the said clinical visit. The same scenarios were discussed in the study done on Prescribing for Antibiotics on Patient Satisfaction that because patients expect to receive antibiotic treatment for their respiratory illness and that they are requesting for it, physicians would prescribe antibiotics to these patients then (Gonzales, et.al. 2001). As physicians are the expert on this matter they should not make this a habit. They should not encourage the patients to take antibiotics when not needed. They are the ones who could explain better why antibiotics are not necessary for the said disease thus they should educate their patients on the pros and cons of antibiotic treatment. And the same study showed that the physicians’ educational intervention about antibiotic use in uncomplicated acute bronchitis does not affect patient satisfaction. Thus the physician then should advocate the simple measures of treating uncomplicated acute bronchitis.
6. The evidence that the studies presented does not support the treatment done to the patient. It was clearly stated that Mr. Doe doesn’t smoke and has no underlying lung disease thus making him a healthy person with acute bronchitis. The physical assessment as well as the laboratory tests showed that Mr. Doe is having uncomplicated acute bronchitis. However, his doctor still prescribed an antibiotic because of the consideration that the patient is expecting it. The study entitled “Quantitative systematic review of randomized controlled trials comparing antibiotic with placebo for acute cough in adults” showed that antibiotic treatment does not improve the cough experienced by the patients and that there was also no clinical improvement at the re-examination and what is more important is that side effects were more common in the patients treated with antibiotics thus it does not support the action of the doctor (Fahey, et.al., 1998).
7. Another study does not also support the doctor’s reason for prescribing antibiotics to the patient, which is the satisfaction of Mr. Doe. The study entitled “Prescribing for Acute Bronchitis on Patient Satisfaction” has the results as follows. Patient satisfaction with the visit did not differ between the intervention and control clinics, thus prescribing antibiotics or not would affect the patient’s satisfaction with the clinical visit (Gonzales, et.al, 2001). The Dr. of Mr. Doe should have employed health teachings about the use of the antibiotic in connection with acute bronchitis. He should have explained to Mr. Doe the pros and cons of antibiotic therapy in acute bronchitis. In this way, the patient may be more satisfied with the intervention that he gave.
8. The American Journal of Psychiatry has the following guidelines for their writers for an article or study to be published. Before publication the manuscripts should not be published before, the clinical trials should be registered to the public trials registry, the persons designated as authors should qualify for authorship which would have the following bases, one is the substantial contribution to the conception and design or analysis and or interpretation of data, to drafting the article or revising it critically of the intellectual content and the final approval of the version to be published. Another guideline is the disclosure of competing interests and financial support, copyright approval and submission approval, patient anonymity, informed consent, and review process. These are the guidelines of the writers to have their manuscripts published.

References

Gonzales,R., Steiner,J., Maselli, J., Lum, P. and Barret, P. (2001). Impact of Prescribing for Acute Bronchitis on Patient Satisfaction. Web.

Fahey, Tom; Stocks, Nigel; Thomas, Toby. (1999). “Quantitative systematic review of randomised controlled trials comparing antibiotic with placebo for acute cough in adults”. Division of Primary Care, University of Bristol, Canynge Hall, Bristol BS8 2PR. Volume 316(7135), 21 March 1998, pp 906-910.

Hueston, W. and MAINOUS. A. (1998). Acute Bronchitis, Web.

Respiratory Disorders. (2004). Respiratory Disorders: Acute Bronchitis. Web.

Bartlett, J. (2007). Patient information: Acute bronchitis in adults. Web.

Wise, S. (2006). Should I take Antibiotics for Acute Bronchitis? Web.