PEDBASE.org - The Pediatric Database - Detailed information of ACUTE TRACHEOBRONCHITIS

ACUTE TRACHEOBRONCHITIS

DEFINITION:

An acute infectious disease of the trachea and bronchi characterized by cough and chest pain.

EPIDEMIOLOGY:

incidence: ?
age of onset:
- childhood -> adolescence
risk factors:
- unknown but factors such as allergy, climate, air pollution, chronic infections of the upper respiratory tract (i.e. sinusitis) may contribute to susceptibility

PATHOGENESIS:

1. Pathogens

1. Major

RSV - young children in winter and spring
influenzae virus - all age groups in winter and spring
M. pneumoniae - school-aged children in fall

2. Minor

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

2. Pathogenesis

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

CLINICAL FEATURES:

1. Prodrome

viral URTI -> acute nasopharyngitis -> rhinitis
conjunctival infection
occurs 3-4 days before onset of cough

2. Respiratory Manifestations

1. Cough

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

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

secondary bacterial infections
- H. flu, pneumococci, staphylococci, streptococci
otitis media, pneumonia, sinusitis
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

tracheal aspirate for viral isolation, C&S

MANAGEMENT:

1. Supportive

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)

Pediatric Database - ACUTE TRACHEOBRONCHITIS

Pediatric Organization - Pedbase [at] Gmail.com