Tracheobronchitis: Description, Causes and Risk Factors:
Tracheobronchitis is an acute or chronic inflammation of the trachea and bronchial airways; it may be primary or secondary depending on the etiologic agent. Bronchitis may extend from the bronchioles to the lung parenchyma.
The respiratory tract contains both the windpipe and bronchi. When inflammation occurs in these parts of the body, it is often referred to as tracheobronchitis. This is a relatively common condition that can be the result of a viral or bacterial infection. If a person swallows or inhales an irritant, inflammation can also occur.
Infectious tracheobronchitis occurs most commonly during the winter months and often secondary to upper respiratory infection. The causes of tracheobronchitis include mainly viruses, bacteria
, cold air, dust, and irritating gas, and anaphylaxis-allergens.
In the ICU (intensive care unit) tracheobronchitis is a relatively common problem with an incidence as high as 10.6%. Tracheobronchitis results from two dominating processes; colonization of the oropharynx and its contiguous structures by potentially pathogenic organisms and aspiration of contaminated secretions from these anatomic sites. Mechanically ventilated patients are particularly at risk for tracheobronchitis given the presence of an endotracheal tube. These devices contribute to the pathogenesis of tracheobronchitis in a variety of manners; bypassing natural host defenses, acting as nidus for biofilm formation, allowing pooled secretions and bacteria to leak around the cuff and into the trachea, damaging the ciliated epithelium and reducing bacterial clearance directly or via frequent suctioning to maintain airway patency.
In contrast to nosocomial pneumonia, nosocomial tracheobronchitis does not involve pulmonary parenchyma and thus does not involve pulmonary parenchyma and thus does not cause radiographic pulmonary infiltrates. However, high quality portable chest radiographs may be difficult to obtain in the ICU, where poor patient cooperation, inconsistent technique and other obstacles lead to suboptimal studies. Furthermore, common process such as atelectasis, pulmonary edema, or pleural effusion can cause infiltrates that mimic pneumonia making the clinical distinction between pneumonia and tracheobronchitis difficult.
Bacterial tracheobronchitis is an extremely rare entity, which was long considered to be a pediatric disease. Researchers report the case of a 65-year-old woman who presented with persistent wheezing, worsening productive cough and sore throat. Computed tomography of the chest revealed the presence of tracheomalacia, confirmed at bronchoscopy. The presence of purulent exudate, coating the trachea and main bronchi, was consistent with bacterial tracheobronchitis. Culture of the tracheal aspirates grew methicillin-resistant Staphylococcus aureus (MRSA). As the patient was afebrile and not systemically ill, the clinical picture was consistent with exudative tracheobronchitis. To our knowledge, this is the first case of MRSA exudative tracheobronchitis and tracheomalacia in a non-ventilated adult. Other adult cases of bacterial tracheobronchitis and MRSA tracheobronchitis in mechanically ventilated patients reported in the literature are also reviewed. Physicians should be aware of the diagnosis of tracheomalacia in adults, which can masquerade as persistent asthma and may be associated with the development of serious infections including MRSA tracheobronchitis.
Cough is a prominent respiratory symptom of tracheobronchitis, characterized by dry cough and nonproductive initially, later coughing up phlegm. If the inflammation progresses to a severe bacterial infectious bronchitis, purulent sputum is present and occasionally flecked with blood. Fever
is another symptom about 38 C, and will persist 3 to 5 days. In addition to these symptoms, acute tracheobronchitis is marked by sudden onset and initiated with the symptoms of acute upper respiratory infection.
The diagnosis is made from the history and clinical signs and by elimination of other causes of coughing. Chest radiographs may show an increase in linear and peribronchial markings. Bronchoscopy reveals inflamed epithelium and often mucopurulent mucus in the bronchi. In addition, the procedure allows collection of biopsy and swab samples for in vitro assay. Bronchial washing is an additional diagnostic aid that may demonstrate causative agents or significant cellular responses (eg, eosinophils).
Bronchoalveolar lavage or transtracheal wash for cytology and culture sensitivity may be indicated to identify an etiologic agent and to determine appropriate anti-microbial chemotherapy.
In mild or acute cases, supportive therapy may be effective, but treatment of concurrent disease is also indicated. Rest, warmth, and proper hygiene are important. Broad-spectrum antimicrobial chemotherapy is indicated for treatment of cough. Persistent, nonproductive coughing is best controlled by antitussives that contain codeine. If conservative medical management is unsuccessful, radiographs should be taken of the thorax and cervical trachea, and laboratory tests evaluated to eliminate other differential diagnoses. Pulmonary physiotherapy consisting of sodium chloride nebulization and gentle coupage may loosen secretions and stimulate expectoration. A bathroom environment with steam from a hot shower may be substituted for nebulization.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.