Acute bronchitis

Prof.dr.Tamsil Syafiuddin,
SpP(K)
Departemen Pulmonologi
dan Ilmu Kedokteran
Respirasi
Fakultas Kedokteran
Universitas Islam Sumatera Utara
2012

CURRICULUM VITAE

: Prof.Dr.TAMSIL SYAFIUDDIN Sp.P (K)

: Jln.KARSA No F 1 KOMPLEKS EKS KOWILHAN I
EI.AGUL MEDAN 20117
N
: Guru Besar FK- UISU / FK- USU
Ketua Perhimpunan Dokter Paru Indonesia Sumut
Penasihat Perhimpunan Dokter Paru Indonesia Pusat
Anggota Kolegium Pulmonologi Indonesia
Anggota Pokja Asma dan PPOK PDPI pusat
Assesor Program Pendidikan Dokter Spesialis Paru Indonesia

RIWAYAT PENDIDIKAN :
okter Umum FK-USU Medan,1979
okter Spesialis I Paru FK-UI Jakarta, 1990
okter Spesialis II Paru Konsultan Asma/PPOK, 1995
Pendidikan tambahan:

- Pelatihan Kanker Paru, TSUKAGUCHI Hospital, Kobe- Japan 1989

elatihan PPOK, AMAGASAKI Hospital, Kobe- Japan 1990
elatihan Respiratory Physiologi, JAPAN RESPIRATORY PHYSIOLOGIST
CLUB, Kyoto- Japan 1990
- Spirometry Training Course, Department of Respiratory Medicine,
National University Hospital Singapore, Singapore 1997

- Workshop on Transbronchial Lung Biopsy and Trasbronchial

Needle
Aspiration PDPI Cabang Jakarta, RS Persahabatan Jakarta
,Jakarta Maret
1997
- Workshop on Respiratory Physiology and Its Clinical Application,
- Workshop on Medical Thoracoscopy, The American College of
RS Pusat
Chest
Angkatan Darat Gatot Subroto Jakarta, Jakarta Juni 1997
Physicians-The Indonesian Association of Pulmonologist, RS
Persahabatan
Jakarta, Jakarta November 1997
- Workshop on Reformation of Higer Education System,HEDSJICA,Jakarta
1998
-Pulmonary Infections Course, Postgraduate Medical Institute,
Singapore General Hospital, Singapore 2001
-Workshop of Bronchoscopy and Autofluorecent Bronchoscopy,
RS Persahabatan
Jakarta, Jakarta
September
2005
- Bronchoscopy
&Thoracoscopy
Workshop,
Postgraduate
Medical
Institute,
-Training
the newHospital,
interventional
technique
SingaporeofGeneral
Singapore
2005 of
bronchosfiberscopy
(Optical Coherence Tommograhy) , Department of Thoracic
Surgery,

Levels of
competence

Standar Kompetensi Dokter , Konsil Kedokteran Indonesia, 2012

Level of
competence 4:

Mampu membuat diagnosis klinik

berdasarkan
pemeriksaan fisik dan pemeriksaan
tambahan
yang diminta oleh dokter (misalnya:
pemeriksaan
laboratorum sederhana atau X-ray).
Dokter dapat memutuskan dan mampu
menangani
problem itu secara mandiri hingga tuntas.
Standar Kompetensi Dokter , Konsil Kedokteran Indonesia, 2012

KURIKULUM BERBASIS KOMPETENSI

(Problem Based Learning)
MASALAH/DATA/KELUHAN
:
PEMECAHAN MASALAH/
RENCANA(Planning):

IDENTIFIKASI MASALAH/ANALISIS:

MASALAH/DATA:

PEMECAHAN MASALAH/
RENCANA(Planning):

DATA LAIN

Batuk
Sesak napas
Batuk darah
Nyeri dada
Daftar keluhan Standar
Kompetensi Dokter Indonesia

RENCANA
BERIKUT:PF,
Ro,PFR

IDENTIFIKASI MASALAH/ANALISIS:

OBSTRUKTIF
INFEKSI
KEGANASAN
PENYAKIT ORGAN LAIN

1. URTI ?
2. Riwayat sebelumnya?

Sesak
napas
Batuk

1 .Pemeriksaan fisik
Tanda obstruktif ?
2. Spirometri/PFR?
3. Radiologi?

1.Air way sistem: Kelainan

obstruktif/Bronkitis akut
2

Problem Based Learning

Definition
Infection of the lower respiratory
tract
Generally follows an upper
respiratory tract infection
From viral or bacterial infection
Airways become inflamed; irritated
Mucus production increases

Adult bronchitis
Acute inflammation of the mucous
membranes of the trachea and
bronchi (duration < 4 weeks)
productive cough
upper respiratory tract symptoms
general symptoms (in 10 - 50%)

20.6.2000

10

Assessment
Fever
Tachypnea
Mild dyspnea
Pleuritic chest pain (possible)
Cough with clear to purulent sputum
production
Diffuse rhonchi and crackles

Aetiology of acute
bronchitis
Common respiratory tract viruses
(80%)
Bacteria (in about 20% of cases):
Pneumococci ( in 2 - 30%)?
Haemophilus ( in 2 - 8%)?
Mycoplasma (in 0.5 - 11%)
Chlamydia (in 0 -18%)
(Pertussis (in 0 - 7%))
20.6.2000

12

Diagnosis of acute
bronchitis
The aim is to
identify, among all patients with cough,
those with other illnesses needing
specific treatment (e.g. pneumonia,
sinusitis, asthma)
identify, among all patients with bronchitis,
those who would benefit from
antibiotics
20.6.2000

13

Diagnostic Evaluation
Chest x-ray -rule out pneumonia
Films show no evidence of lung
infiltrates

When is chest x-ray

needed?
patient is particularly unwell
patient is particularly prone to pneumonia
due to underlying disease, age or
alcoholism
history of pneumonia within the preceding
year
upper respiratory tract symptoms absent
patient requests x-ray (pneumonia can not be
excluded on clinical symptoms and findings only)
20.6.2000

15

(Differential) diagnosis
History (e.g. asthma)
Health status (general condition,
auscultation)

X-ray (to exclude pneumonia)

CRP (high CRP refers to bacterial aetiology or
pneumonia)

Sinus ultrasound (to exclude sinusitis)

Antibody testing (of a few representative
patients if needed to establish an epidemic)

Easy access to a follow-up visit (inform

your assistants!)
20.6.2000

16

Pharmacologic Interventions
1.Bronchodilators
. Reduce brochospasm
. Promote sputum expectoration
2. Oral antibiotics
3. Symptom management for fever
and cough

Treatment of acute
bronchitis
First choice: no antibiotics!
Factors supporting antibiotic
treatment:
CRP > 50 mg/l
patient is particularly unwell or becoming
so
pyrexia of over weeks duration or patient
pyrexial following a period of apyrexia
epidemiological state
patient is immunocompromised
20.6.2000

18

Antimicrobial therapy of acute bronchitis 1

First choice:
in most cases good effect on
pneumococci is sufficient
penicillin resistance in pneumococci in
Finland is low (R < 1%) (A)
penicillin V: 1-1.5 mega units 8 hourly for 5
7 days

for patients with penicillin allergy a first

-generation cephalosporin

20.6.2000

19

Antimicrobial therapy of acute bronchitis 2

Other choices:
probable mycoplasma or chlamydia
infection:
doxycycline 100-150 mg daily for 5 7 days
a macrolide: erythromycin 500mg 3 - 4 times
daily, roxithromycin 150 mg twice daily,
klarithromycin 250mg twice daily or
azithromycin 250 mg daily for 5 7 days

underlying chronic lung disease:

amoxicillin, sulphatrimethoprim

20.6.2000

20

Symptomatic treatment of acute bronchitis

Symptomatic treatment assists the patient
to cope with his/her symptoms and thus
aims at reducing the unnecessary use of
antimicrobial agents
no benefit is gained on cough with codeine, or
dextromethorphan as compared with a placebo,
...but cough improves considerably even during a
placebo-treatment
patient often presents with additional symptoms,
which can be eased with antihistamines,
anticholinergic and/or sympatomimetic agents,
but their benefit remains controversial!
20.6.2000

21

Quality criteria to develop

treatment
as a general rule a young, or middleaged, previously well patient with
bronchitis not to be prescribed
antibiotics, at least not at the first

consultation.
if antibiotics are considered for the
treatment of bronchitis, CRP is to be
determined first
follow-up appointment arrangements to
be patient friendly

20.6.2000

22

Therapeutic Intervention
Chest physiotheraphy to mobilize
secretions
Hydration to liquefy secretions

Nursing Interventions
1.
.
.
.

Encourage mobilization of secretion

Ambulation
Coughing exercises
Deep breathing exercises

2. Adequate fluid intake

. To liquefy secretions
. Prevent dehydration caused by fever
and tachypnea

Nursing Interventions
1.
.
.
.

Encourage mobilization of secretion

Ambulation
Coughing exercises
Deep breathing exercises

2. Adequate fluid intake

. To liquefy secretions
. Prevent dehydration caused by fever
and tachypnea

Nursing Interventions
3. Encourage rest
4. Avoid bronchial irritants
5. Eat nutritious foods to facilitate
recovery
6. Instruct patient to comply taking
medications
7. Caution the patient on using OTCs
medications

Arigatoo
gozaimasu
Syafiuddin San
Imah San

: You are the Inspiring woman

: You are the Wind beneath my