eMedicine Specialties > Pediatrics: General Medicine > Pulmonology
Bronchitis, Acute and Chronic: Treatment & Medication
Updated: Mar 19, 2009
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Treatment
Medical Care
Emergency care for acute bronchitis or exacerbation of chronic bronchitis must focus on ensuring that the child is adequately oxygenating. Outpatient care is appropriate unless bronchitis is complicated by severe underlying disease. General measures include rest, use of antipyretics, adequate hydration, and avoidance of smoke. Proper care of the underlying disorder is of paramount importance. Consideration of asthma and adequate therapy are critical to an early response.
Consultations
Referral to a pediatric pulmonologist may be helpful when symptoms persist beyond 2-3 weeks in uncomplicated acute bronchitis or when patients in whom chronic bronchitis is suspected do not respond to initial therapy.
Diet
Increase oral fluid intake when the patient is febrile.
Activity
Instruct the patient to rest until the fever subsides.
Medication
Acute bronchitis
Medical therapy generally targets symptoms and includes use of analgesics and antipyretics. Antitussives and expectorants are often prescribed but have not been demonstrated to be useful. Few data outside of the research laboratory support the efficacy of expectorants. The prototype antitussive, codeine, has been successful in some chronic-cough and induced-cough models, but few clinical data address upper respiratory infections, and the data that are available suggest little benefit. Data show codeine is little or no better than guaifenesin or dextromethorphan.
In otherwise healthy individuals, the use of antibiotics has not demonstrated any consistent benefit in relieving symptoms or improving the natural history of acute bronchitis. Placebo-controlled studies using doxycycline, erythromycin, and trimethoprim-sulfamethoxazole have failed to show significant benefit in patients with acute bronchitis.
While some studies of acute bronchitis have failed to demonstrate the effectiveness of bronchodilators, a trial of inhaled albuterol may provide significant relief of symptoms for some patients.
Chronic bronchitis
Bronchodilator therapy should be considered and instituted; either a beta-adrenergic agonist, such as albuterol or metaproterenol, or theophylline may be effective. Beta-adrenergic agents are less toxic, have a more rapid onset of action than theophylline, and do not require monitoring of levels. Inhaled corticosteroids may be effective.
In the child who continues to cough despite a trial of bronchodilators and in whom the history and physical examination findings suggest a wheezy form of bronchitis, oral corticosteroids should be added. If the response is suboptimal or if fever persists, antibiotic therapy with an agent such as a macrolide or beta–lactamase-resistant antimicrobial may be considered. Too often, antibiotics are the primary therapy. They usually do not result in a cure and may delay the start of more appropriate asthma therapies.
Analgesic and antipyretic agents
These agents are used to control fever, myalgias, and arthralgias.
Acetaminophen (Tylenol, Aspirin-Free Anacin, Feverall)
Treatment of choice for pain in patients who are unable to take aspirin or NSAIDs.
Adult
625-1000 mg PO q4h; not to exceed 4 g/d
Pediatric
<12 years: 10-15 mg/kg PO q4-6h prn; not to exceed 2.6 g/d
>12 years: 325-650 mg PO q4h; not to exceed 5 doses/d
Rifampin can reduce analgesic effects of acetaminophen; coadministration with barbiturates, carbamazepine, hydantoins, and isoniazid may increase hepatotoxicity
Documented hypersensitivity; G-6-PD deficiency
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Hepatotoxicity in patients with chronic alcoholism; severe or recurrent pain or high or continued fever may indicate serious illness
Ibuprofen (Ibuprin, Advil, Motrin)
Usual treatment of choice for mild-to-moderate pain if no contraindications exist. Inhibits inflammatory reactions and pain, probably by decreasing activity of cyclooxygenase, which inhibits prostaglandin synthesis.
Adult
400-800 mg PO q4-6h; not to exceed 3.2 g/d
Pediatric
10 mg/kg PO q6-8h; not to exceed 2.4 g/d
Coadministration with aspirin increases risk of serious NSAID-related side effects; simultaneous administration with low-dose aspirin may decrease aspirin's cardioprotective and stroke-preventive effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, beta-blockers, and diuretic effect of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; may increase phenytoin or lithium serum levels
Documented hypersensitivity; peptic ulcer disease; recent GI tract bleeding or perforation; renal insufficiency; high risk of bleeding
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Monitor PT closely in patients on anticoagulants; caution in patients with congestive heart failure, hypertension, and decreased renal or hepatic function
Corticosteroids, systemic
These agents are used for short courses (3-10 d) to gain prompt control of inadequately controlled acute asthmatic episodes. Systemic corticosteroids also are used for long-term prevention of symptoms in severe persistent asthma, as well as for suppression, control, and reversal of inflammation. Frequent and repetitive use of beta2-agonists has been associated with beta2-receptor subsensitivity and down-regulation; these processes are reversed with corticosteroids.
Higher-dose corticosteroids have no advantage in severe exacerbations of asthma, and intravenous administration has no advantage over oral therapy, provided that GI tract transit time or absorption is not impaired. The usual regimen is to continue frequent multiple daily dosing until the forced expiratory volume in 1 second (FEV 1 ) or peak expiratory flow (PEF) is 50% of the predicted or personal best values; then, the dose is changed to twice daily. This usually occurs within 48 hours.
Prednisolone (Pediapred, Orapred)
Prednisone (Deltasone, Meticorten, Orasone, Sterapred, Liquid Pred) -- May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Stabilizes lysosomal membranes and suppresses lymphocytes and antibody production.
Adult
5-60 mg/d PO
Pediatric
1-2 mg/kg PO qd or divided bid; not to exceed 80 mg/d
Tapering not necessary with short courses
Coadministration with estrogens may decrease prednisone clearance; concurrent use with digoxin, may cause digitalis toxicity secondary to hypokalemia; phenobarbital, phenytoin, and rifampin may increase metabolism of glucocorticoids (consider increasing maintenance dose); monitor for hypokalemia with coadministration of diuretics
Documented hypersensitivity; viral infection; peptic ulcer disease; hepatic dysfunction; connective tissue infections; fungal or tubercular skin infections; GI tract ulceration or bleeding
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections may occur
Bronchodilators
Studies have found that bronchodilators relieve symptoms of bronchitis, and they have been found superior to antibiotics in this setting. However, in these trials, patient numbers were disappointingly small, given how commonly acute bronchitis is diagnosed.
Albuterol sulfate (Proventil, Ventolin)
Beta-adrenergic agonist useful in treatment of epinephrine-refractory bronchospasm; relaxes bronchial smooth muscle by acting on beta2-adrenergic receptors and has little effect on cardiac muscle contractility. A ready-to-use solution for nebulization is available as 0.083% (2.5 mg/3 mL).
Adult
MDI: 2 actuations (90 mcg/actuation) inhaled PO q4-6h
PO: 2-4 mg PO tid/qid; not to exceed 32 mg/d
Pediatric
PO:
<6 years: 0.3 mg/kg/d PO divided tid; not to exceed 12 mg/d
6-12 years: 6 mg/d PO divided tid; not to exceed 24 mg/d
>12 years: Administer as in adults
MDI:
1-2 actuations (90 mcg/actuation) inhaled PO q4-6h prn
Nebulizer:
<1 year: 0.05-0.15 mg/kg/dose q4-6h
1-5 years: 1.25-2.5 mg/dose q4-6h
5-12 years: 2.5 mg/dose q4-6h
>12 years: 2.5-5 mg/dose q6h
Beta-adrenergic blockers antagonize effects; inhaled ipratropium may increase duration of bronchodilatation by albuterol; cardiovascular effects may increase with MAOIs, inhaled anesthetics, tricyclic antidepressants, and sympathomimetic agents
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Hyperthyroidism, diabetes mellitus, and cardiovascular disorders
Antibiotics
Studies have focused on healthy individuals or patients with chronic obstructive lung disease (COLD). Patients with chronic obstructive pulmonary disease (COPD) or limited cardiopulmonary reserve, such as patients with asthma, may experience a very limited beneficial effect.
Erythromycin (EES, E-Mycin, Ery-Tab)
Inhibits RNA-dependent protein synthesis, possibly by stimulating the dissociation of peptidyl tRNA from ribosomes, inhibiting bacterial growth. Used for prophylaxis in patients who are allergic to penicillin undergoing dental, PO, or respiratory tract procedures.
Adult
250-500 mg PO qid or 333 mg PO tid
Pediatric
30-50 mg/kg/d PO divided qid; not to exceed 2 g/d
Coadministration may increase toxicity of theophylline, digoxin, carbamazepine, and cyclosporine; may potentiate anticoagulant effects of warfarin; coadministration with lovastatin and simvastatin increases risk of rhabdomyolysis
Documented hypersensitivity; hepatic impairment
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Caution in liver disease; estolate preparation may cause cholestatic jaundice; administer pc to avoid adverse GI tract effects; discontinue if nausea, vomiting, malaise, abdominal colic, or fever occur
Clarithromycin (Biaxin)
Reversibly binds to P site of 50S ribosomal subunit of susceptible organisms and may inhibit RNA-dependent protein synthesis by stimulating dissociation of peptidyl tRNA from ribosomes, inhibiting bacterial growth.
Adult
250-500 mg PO bid
Pediatric
7.5 mg/kg PO bid
May result in toxic clarithromycin levels and death if administered with pimozide; may cause adverse cardiovascular effects, including death, cardiac arrest, ventricular fibrillation, torsade de pointes, and other ventricular effects if taken with astemizole or cisapride; may increase serum digoxin concentrations as a result of effects of gut flora that metabolize digoxin in >10% of patients; may increase plasma levels of disopyramide, causing arrhythmias and increasing QTc intervals; may cause acute ergot toxicity characterized by severe peripheral vasospasm and dysesthesia, necessitating monitoring in patients taking ergot alkaloids
May increase risk of severe myopathy or rhabdomyolysis associated with HMG-CoA reductase inhibitors; may increase levels of tacrolimus, increasing risk of adverse effects such as nephrotoxicity; levels may be increased significantly by fluconazole; levels of both clarithromycin and omeprazole may be increased if taken together; antimicrobial effects may be decreased or frequency of adverse GI tract effects may be increased by rifabutin or rifampin; may increase levels of certain benzodiazepines, prolonging CNS-depressant effects; may increase carbamazepine concentrations
Documented hypersensitivity; patients taking pimozide, astemizole, cisapride, or terfenadine
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Consider pseudomembranous colitis in patients who present with diarrhea; increased risk of secondary infections if therapy is prolonged; monitor coagulation functions if patient is taking anticoagulant
Azithromycin (Zithromax)
Treats mild-to-moderately severe infections caused by susceptible strains of microorganisms; indicated for chlamydial and gonorrheal infections of genital tract.
Adult
500 mg PO on day 1, then 250 mg PO on days 2-5
Pediatric
10 mg/kg/d PO on day 1, followed by 5 mg/kg on days 2-5; not to exceed adult dose
May increase theophylline and digoxin levels and toxicity; may potentiate anticoagulant effects of warfarin; may increase cyclosporine levels, increasing risk of nephrotoxicity, neurotoxicity, and other toxic effects; peak serum levels, but not absorption, is reduced by antacids containing aluminum or magnesium
Documented hypersensitivity; hypersensitivity to erythromycin; patients taking pimozide; hepatic impairment; prolonged QTc interval; pneumonia; elderly or debilitated patients
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Use caution in patients with prolonged QTc intervals; may result in bacterial or fungal overgrowth of nonsusceptible organisms, which may lead to secondary infection, especially if therapy is prolonged or repeated; may increase hepatic enzyme levels or cause cholestatic jaundice; use caution in patients with impaired hepatic function
Tetracycline (Sumycin)
Inhibits bacterial protein synthesis by binding with 30S and, possibly, 50S ribosomal subunits of susceptible bacteria. Treats susceptible bacterial infections of both gram-positive and gram-negative organisms, as well as mycoplasmal, chlamydial, and rickettsial infections; less effective than erythromycin in mycoplasmal, chlamydial, and Bordetella pertussis infections.
Adult
250-500 mg PO qid
Pediatric
<8 years: Not recommended
>8 years: 25-50 mg/kg/d PO divided qid
Bioavailability may be decreased by antacids containing aluminum, calcium, magnesium, or bismuth subsalicylate; may increase hypoprothrombinemic effects of anticoagulants, necessitating careful monitoring of PT; may decrease pharmacologic effects of PO contraceptives, causing breakthrough bleeding and increased risk of pregnancy
Documented hypersensitivity to minocycline or tetracycline; severe hepatic dysfunction
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Never administer outdated tetracycline, since degradation products are highly nephrotoxic and can cause Fanconilike syndrome; photosensitivity reaction may occur after prolonged exposure to sunlight or tanning equipment; decrease doses in renal impairment (consider serum drug level determinations in prolonged therapy); tooth discoloration if used during tooth development (last one half of pregnancy through age 8 y)
Doxycycline (Vibramycin)
Broad-spectrum bacteriostatic antibiotic that inhibits protein synthesis.
Adult
100 mg PO bid on day 1, then 100 mg PO qd/bid for at least 6 d
Pediatric
<8 years: Not recommended
>8 years:
<45 kg: 5 mg/kg/d PO/IV divided bid on day 1, followed by 2.5-5 mg/kg/d PO/IV qd or divided bid; not to exceed 200 mg/kg/d
>45 kg: 200 mg/d PO/IV divided bid on day 1, followed by 100-200 mg/kg/d PO/IV qd or divided bid
Infuse IV over 1-4 h
May increase PT in patients taking warfarin, necessitating monitoring of PT and dose adjustment if indicated; reduces activity of penicillin; absorption decreased by antacids, bicarbonate, calcium, and iron supplements
Documented hypersensitivity; severe hepatic dysfunction
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in hepatic or renal disease; may increase cranial pressure; may cause GI tract symptoms, photosensitivity, hemolytic anemia, and hypersensitivity reactions; infuse IV over 1-4 h; avoid exposure to direct sunlight; tooth discoloration if used during tooth development (last one half of pregnancy through age 8 y)
Amoxicillin-clavulanic acid (Augmentin)
Semisynthetic bactericidal beta-lactam antibiotic that inhibits cell wall synthesis. It contains amoxicillin combined with clavulanate, a beta-lactamase inhibitor.
Adult
250-500 mg PO q8h
Pediatric
<3 months: 30 mg/kg/d PO divided q12h
>3 months: 40-80 mg/kg/d PO divided q12h
Coadministration with warfarin or heparin increases risk of bleeding
Documented hypersensitivity; PKU (contains phenylalanine); penicillin allergy
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Can produce false-positive result on dipstick test for urine glucose; increases risk of rash in patients with mononucleosis or in patients taking allopurinol; diarrhea may occur; adjust dose with renal impairment
Antivirals
Influenza vaccinations offer coverage for influenza A and B, thereby providing greater protection from bronchitis in the appropriate populations. In past years, amantadine and rimantadine have been useful during epidemics of influenza A. Amantadine and rimantadine are not currently recommended by the Centers for Disease Control and Prevention (CDC) for influenza because of resistance. During the 2005-2006 influenza season, laboratory testing by the CDC on the predominant strain of influenza (H3N2) currently circulating in the United States showed resistance to these drugs. For more information, see CDC information for health care professionals on antiviral agents for influenza.
Oseltamivir (Tamiflu) resistance has emerged in the United States during the 2008-2009 influenza season. The CDC has issued a health advisory with revised interim recommendations for antiviral treatment and prophylaxis of influenza. Preliminary data from a limited number of states indicate a high prevalence of influenza A (H1N1) virus strains resistant to oseltamivir (Tamiflu). Because of this, zanamivir (Relenza) is recommended as the initial choice for antiviral prophylaxis or treatment when influenza A infection or exposure is suspected. A second-line alternative is a combination of oseltamivir plus rimantadine rather than oseltamivir alone. Local influenza surveillance data and laboratory testing can assist the physician regarding antiviral agent choice.
Influenza A viruses, including 2 subtypes (H1N1) and (H3N2), and influenza B viruses currently circulate worldwide, but the prevalence of each can vary among communities and within a single community over the course of an influenza season. In the United States, 4 prescription antiviral medications (oseltamivir, zanamivir, amantadine, rimantadine) are approved for treatment and chemoprophylaxis of influenza. Since January 2006, the neuraminidase inhibitors (oseltamivir, zanamivir) have been the only recommended influenza antiviral drugs because of widespread resistance to the adamantanes (amantadine, rimantadine) among influenza A (H3N2) virus strains. The neuraminidase inhibitors have activity against influenza A and B viruses, while the adamantanes have activity against only influenza A viruses.
In 2007-2008, a significant increase in the prevalence of oseltamivir resistance was reported among influenza A (H1N1) viruses worldwide. During the 2007-2008 influenza season, 10.9% of H1N1 viruses tested in the United States were resistant to oseltamivir. For more information, see the CDC health advisory for Interim Recommendations for the Use of Influenza Antiviral Medications in the Setting of Oseltamivir Resistance among Circulating Influenza A (H1N1) Viruses, 2008-09 Influenza Season.
Oseltamivir (Tamiflu)
Resistance has emerged in the United States during the 2008-2009 influenza season for influenza A. Inhibits neuraminidase, which is a glycoprotein on the surface of influenza virus that destroys an infected cell's receptor for viral hemagglutinin. By inhibiting viral neuraminidase, decreases release of viruses from infected cells and thus viral spread. Effective to treat influenza A or B. Start within 40 h of symptom onset. Available as caps and PO susp.
Adult
Acute illness: 75 mg PO bid for 5 d
Prophylaxis: 75 mg PO qd for 10 d
Pediatric
Acute illness:
<1 year: Not indicated
>1 year:
<15 kg: 30 mg PO bid for 5 d
>15-23 kg: 45 mg PO bid for 5 d
24-40 kg: 60 mg PO bid for 5 d
>40 kg: Administer as in adults
Prophylaxis:
<1 year: Not indicated
>1 year:
<15 kg: 30 mg PO qd for 10 d
>15-23 kg: 45 mg PO qd for 10 d
24-40 kg: 60 mg PO qd for 10 d
>40 kg: Administer as in adults
None reported
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in renal impairment, chronic cardiac or respiratory disease, and breastfeeding; do not use in children <1 y (preclinical trials have demonstrated death in young animals, possibly related to immature blood-brain barriers)
Zanamivir (Relenza)
Inhibitor of neuraminidase, which is a glycoprotein on the surface of the influenza virus that destroys the infected cell's receptor for viral hemagglutinin. By inhibiting viral neuraminidase, release of viruses from infected cells and viral spread are decreased. Effective against both influenza A and B. To be inhaled through Diskhaler PO inhalation device. Circular foil discs that contain 5-mg blisters of drug are inserted into supplied inhalation device.
Adult
Treatment: 10 mg (2 inhalations, 5 mg/inhalation) inhaled PO q12h for 5 d; initiate within 2 d of symptom onset
Prophylaxis: 10 mg (2 inhalations, 5 mg/inhalation) inhaled PO qd for 10 d; initiate within 36 h of exposure
Pediatric
Treatment:
<7 years: Not established
>7 years: Administer as in adults
Prophylaxis:
<5 years: Not established
>5 years: Administer as in adults
None reported
Documented hypersensitivity, obstructive airway disease
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Monitor respiratory status; may cause bronchospasm; caution in breastfeeding
Corticosteroids, inhaled
Corticosteroids are the most potent anti-inflammatory agents. Inhaled forms are topically active, poorly absorbed, and least likely to cause adverse effects. No study has shown significant toxicity with inhaled steroid use in children at doses less than the equivalent of 400 mcg/d of beclomethasone. They are used for long-term control of symptoms and for the suppression, control, and reversal of inflammation.
Inhaled forms reduce the need for systemic corticosteroids. They block late asthmatic response to allergens; reduce airway hyperresponsiveness; inhibit cytokine production, adhesion protein activation, and inflammatory cell migration and activation; and reverse beta2-receptor down-regulation and subsensitivity (in acute asthmatic episodes with long-term beta2-agonist use).
Beclomethasone (Qvar)
Inhibits bronchoconstriction mechanisms, causes direct smooth muscle relaxation, and may decrease the number and activity of inflammatory cells, which, in turn, decrease airway hyperresponsiveness. Available as MDI; delivers 40 or 80 mcg/actuation.
Adult
MDI: 40-80 mcg inhaled PO bid; may increase dose, not to exceed 320 mcg bid
Pediatric
MDI: 40 mcg inhaled PO bid; may increase dose, not to exceed 80 mcg bid
None reported
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Inhaled corticosteroids can cause PO thrush and hoarseness (can prevent by rinsing mouth after dosing and by using with MDI spacer); large doses (>800 mcg/d) have adverse systemic effects including growth retardation and HPA inhibition
Fluticasone (Flovent HFA, Flovent Diskus)
Has extremely potent vasoconstrictive and anti-inflammatory activity. Available as MDI (44-mcg, 110-mcg, or 220-mcg per actuation) and Diskus powder for inhalation (50-mcg, 100-mcg, or 250-mcg per actuation).
Adult
MDI: 88 mcg inhaled PO bid; may increase dose, not to exceed 440 mcg bid
Diskus: 100 mcg inhaled PO bid; may increase dose, not to exceed 500 mcg bid
Pediatric
MDI:
4-11 years: 88 mcg inhaled PO bid
>11 years: Administer as in adults
Diskus:
4-11 years: 50 mcg inhaled PO bid
>11 years: Administer as in adults
Coadministration with barbiturates, phenytoin, and rifampin decreases effects of triamcinolone
Documented hypersensitivity; fungal, viral, and bacterial skin infections
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Inhaled corticosteroids can cause PO thrush and hoarseness (can prevent by rinsing mouth after dosing and by using with MDI spacer); large doses (>800 mcg/d) have adverse systemic effects, including growth retardation and HPA inhibition; high-dose long-term therapy has been associated with HPA inhibition and may retard growth
Budesonide (Pulmicort Flexhaler, Pulmicort Respules)
Alters level of inflammation in airways by inhibiting multiple types of inflammatory cells and decreasing production of cytokines and other mediators involved in the asthmatic response. Available as Flexhaler powder for inhalation (90 mcg/actuation [delivers approximately 80 mcg/actuation]) and Respules suspension for inhalation.
Adult
Flexhaler: 180-360 mcg (2-4 actuations) inhaled PO bid; not to exceed 720 mcg bid
Pediatric
Flexhaler:
<6 years: Not established
6 years or older: 180 mcg inhaled PO bid (2 actuations bid); not to exceed 360 mcg bid (4 actuations bid)
Nebulizer: 0.25 mg/d to 0.5 mg bid; dose and frequency of nebulization depends on whether patient was previously treated with inhaled or PO corticosteroids
None reported
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Inhaled corticosteroids can cause PO thrush and hoarseness (can prevent by rinsing mouth after dosing or using with MDI spacer); large doses have adverse systemic effects, including growth retardation and HPA inhibition; do not mix nebulizer solution with other nebulized medications; administer nebulized solution using tight-fitting mask or mouthpiece; not for treatment of acute attack
More on Bronchitis, Acute and Chronic |
| Overview: Bronchitis, Acute and Chronic |
| Differential Diagnoses & Workup: Bronchitis, Acute and Chronic |
 Treatment & Medication: Bronchitis, Acute and Chronic |
| Follow-up: Bronchitis, Acute and Chronic |
| Multimedia: Bronchitis, Acute and Chronic |
| References |
| « Previous Page | Next Page » |
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Further Reading
Keywords
bronchitis, acute bronchitis, chronic bronchitis, tracheobronchitis, COLD, chronic obstructive lung disease, OAD, obstructive airway disease, COPD, chronic obstructive pulmonary disease, respiratory tract infection, asthma, viral respiratory tract infection, bacterial respiratory tract infection, CB, acute bronchitis, chronic bronchitis, bronchitis, cough, viral infection, adenovirus, influenza, parainfluenza, respiratory syncytial virus, RSV, rhinovirus, coxsackievirus, herpes simplex virus, HSV, Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae, Chlamydia pneumoniae, Mycoplasma species, air pollution, air pollutants, smoking, second-hand smoke, allergies, chronic aspiration, gastroesophageal reflux, GER, fungal infection, treatment, diagnosis
