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Acute bronchitis (±Þ¼º ±â°üÁö¿°)

The Root of Ambulatory Care (¿Ü·¡ Áø·á Áöħ¼­) Àüü ¸ñ·Ï º¸±â
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 (¡¾ sputum) 2. Chest discomfort Exacerbation of chronic bronchitis 1. Worsening cough 2. Increased dyspnea 3. Sputum purulence ..±Þ¼º ±â°üÁö¿°ÀÇ ¾à ¹Ý¼ö¿¡¼­ ±âħÀÌ 2ÁÖ°£ Áö¼ÓµÈ´Ù. ..Clues to the presence of pneumonia - HR > 100 beats/min - RR > 24 breaths/min Acute bronchitis Key symptoms - Oral temperature > 38¡É - 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 ¾ÈÁ¤°ú ÈÞ½Ä, ÃæºÐÇÑ ¼öºÐ ¼·Ãë - Pharmacologic 1. ¥â2-agonist agents ..Ventolin.. evohaler 0.5mg/puff 1-2puff tid-qid (¼Ò¾Æ 1 puff tid-qid) ..Bambec.. 10mg 1T qd pohs (1-2ÁÖ ÈÄ Áõ»ó¿¡ µû¶ó 2T Áõ·®) (2~12¼¼ : 10mg qd) ..Berotec.. 2.5mg 1T, 1T-2T tid (5~10¼¼ : 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, ¥â2-agonist) 4. Systemic/inhaled corticosteroids 5. Oxygen supply ..Ventolin.. - Salbutamol ..Bambet.. - Bambuterol ..Berotec.. - Fenoterol ..Mucopect.. - Ambroxol ..Amocla.. - Amoxicillin/Clavulanate ..Avelox.. - Moxifloxacin ¢º 5ÀÏ À̳» Áõ»ó È£ÀüÀÌ ¾ø´Ù¸é Ä¡·á°úÁ¤¿¡ °üÇÑ ÀçÆò°¡°¡ ÇÊ¿äÇÏ´Ù. - 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 Âü°í ¹®Çå 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 ¿Àâ¼®(ed) : ±Þ¼º ±â°üÁö¿°, in Complete Guide To Practical Based Prescription Medicine. ¼­¿ï, Çѿ츮, 2005, P 118-119 323 The Root of ambulatory care