eMedicine Specialties > Emergency Medicine > Pulmonary
Bronchitis
Updated: Jan 14, 2009
Introduction
Background
Acute bronchitis refers simply to inflammation of the tracheobronchial tree. The cause is usually infectious, but allergens and irritants can produce a similar clinical picture. Bronchitis typically occurs in the setting of an upper respiratory illness; thus, it is observed more frequently in the winter months. Asthma can be mistakenly diagnosed as acute bronchitis if the patient has no prior history of asthma. In one study, one third of patients who had been determined to have recurrent bouts of acute bronchitis were eventually identified as having asthma.
Chronic bronchitis and acute exacerbations of chronic bronchitis are discussed in the eMedicine article Chronic Obstructive Pulmonary Disease and Emphysema.
Pathophysiology
Although bronchitis refers to inflammation of the trachea and bronchi, other segments of the respiratory tract may also be involved because acute bronchitis usually occurs in relation to the common cold or other respiratory illness.
Frequency
United States
According to the National Center for Health Statistics, more than 12 million cases of acute bronchitis occurred in 1994, a number roughly equal to 5% of the US population.1 In comparison, 91 million cases of influenza, 66 million cases of the common cold, and 31 million cases of other acute upper respiratory infections occurred during that same year.
International
Acute bronchitis is common throughout the world and is one of the top 5 reasons for seeking health care in countries that track such data.
Mortality/Morbidity
Bronchitis is nearly always self-limited in the otherwise healthy individual, although it frequently results in absenteeism from work and school. Severe cases occasionally produce deterioration in those with significant underlying cardiopulmonary disease or other comorbid conditions.
Sex
Although bronchitis seems to be diagnosed in women more frequently than in men, little difference is observed.
Age
Although found in all age groups, bronchitis is diagnosed most frequently in children younger than 5 years. In 1994, bronchitis was diagnosed in more than 11 of every 100 children younger than 5 years.1 This compared with only 4 of every 100 individuals in every other age group.
Clinical
History
- A purulent cough is generally the defining presentation for acute bronchitis.
- The following symptoms may also be present:
- Fever
- Malaise
- Rhinorrhea or nasal congestion
- Sore throat
- Wheezing
- Dyspnea
- Chest pain
- Myalgias or arthralgias
- Occupational history may be important in determining whether irritants play a role.
Physical
- No uniform definition describes acute bronchitis. The physical examination findings may include rhonchi or wheezes; in most cases, the examination findings are unremarkable.
- Occasionally, findings may suggest a particular etiology.
- Bullous myringitis suggests Mycoplasma pneumoniae infection, although it is not specific.
- Conjunctivitis and adenopathy suggest adenovirus, although these are also not specific.
Causes
- Influenza, parainfluenza, adenovirus, rhinovirus, and numerous other viruses have been implicated.
- M pneumoniae and Chlamydia pneumoniae have also been implicated, but the role of other bacterial pathogens remains difficult to validate given the difficulties associated with collecting adequate sputum samples and the problem of asymptomatic carriage of putative pathogens such as Streptococcus pneumoniae and Haemophilus influenzae.
- Bordetella pertussis should be considered in children who are incompletely vaccinated; however, studies increasingly report this bacterium as the causative agent in adults as well.2
Differential Diagnoses
| Asthma | Pneumonia, Bacterial |
| Chronic Obstructive Pulmonary Disease and
Emphysema | Pneumonia, Mycoplasma |
| Pediatrics, Bronchiolitis | |
| Pediatrics, Croup or
Laryngotracheobronchitis | |
| Pediatrics, Pertussis |
Other Problems to Be Considered
Acute sinusitis
Aspiration
Bacterial tracheitis
Bronchiectasis
Cystic fibrosis
Influenza
Reactive airway disease
Retained foreign body
Workup
Imaging Studies
- Chest radiography
- Chest radiography may be necessary to exclude pneumonia, particularly when abnormalities in either the vital signs or pulse oximetry readings are observed.
- Lungs appear normal in uncomplicated cases.
Treatment
Emergency Department Care
Care for acute bronchitis is primarily supportive and should ensure that the patient is adequately oxygenating.
Medication
Therapy is generally symptomatic and includes use of analgesics, antipyretics, antitussives, and expectorants. Among otherwise healthy individuals, antibiotics have not demonstrated consistent benefit in the symptomatology or natural history of acute bronchitis.3,4 Nonetheless, surveys from Europe, Australia, and the United States show that 80% of patients with acute bronchitis receive antibiotics. Antibiotic overuse contributes to the emergence of drug-resistant organisms. Cognizant of this, the Centers for Disease Control and Prevention (CDC) recently collaborated with numerous medical societies to publish a series of articles on the judicious use of antibiotics for several common conditions, including bronchitis, and have recommended against routine antibiotic use in uncomplicated bronchitis.
Patients are up to 4 times more likely to expect antibiotics for the diagnosis of bronchitis than for a chest cold. Therefore, limiting use of the diagnosis bronchitis may make reduction of antibiotic use more acceptable to patients.
Reviews have also noted that antibiotic use in smokers without chronic obstructive pulmonary disease is no more effective than in nonsmokers.5
Several studies have shown conflicting results on the use of zinc as an adjunct treatment against influenza A.6 Some recent studies have shown favorable results; however, participants complained of a bad taste and significant nausea. Broader use of zinc cannot be recommended at this time.
Antibiotics
Studies have focused on healthy individuals (excluding people with asthma) or patients with chronic obstructive pulmonary disease. Antibiotics may offer a small beneficial effect in patients with chronic obstructive pulmonary disease. Therefore, extending antibiotic therapy to people with asthma and other patients with limited cardiopulmonary reserve may be reasonable. If an antibiotic is to be used, a macrolide is a reasonable first choice because the macrolides are active against mycoplasmal and chlamydial organisms and B pertussis.
Erythromycin (EES, E-Mycin, Ery-Tab)
Used for prophylaxis in patients with penicillin allergy who are undergoing dental, PO, or respiratory tract procedures. Inhibits RNA-dependent protein synthesis, possibly by stimulating dissociation of peptidyl tRNA from ribosomes, resulting in arrest of bacterial replication.
Dosing
Adult
250-500 mg PO qid or 333 mg PO tid
Pediatric
30-50 mg/kg/d PO divided qid
Interactions
Coadministration may increase toxicity of theophylline, digoxin, carbamazepine, and cyclosporine; may potentiate anticoagulant effects of warfarin; coadministration with lovastatin or simvastatin increases risk of rhabdomyolysis
Contraindications
Documented hypersensitivity; hepatic impairment
Precautions
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 formulation may cause cholestatic jaundice; adverse GI effects are common (administer doses pc); discontinue use 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.
Dosing
Adult
250-500 mg PO bid
Pediatric
7.5 mg/kg PO bid
Interactions
Toxicity increases with coadministration of fluconazole or pimozide; effects decrease and GI adverse effects may increase with coadministration of rifabutin or rifampin; may increase toxicity of anticoagulants, cyclosporine, tacrolimus, digoxin, omeprazole, carbamazepine, ergot alkaloids, triazolam, and HMG CoA–reductase inhibitors
Plasma levels of certain benzodiazepines may increase, prolonging CNS depression; arrhythmias and increase in QTc intervals occur with disopyramide; coadministration with omeprazole may increase plasma levels of both agents
Contraindications
Documented hypersensitivity; concurrent pimozide
Precautions
Pregnancy
C - Safety for use during pregnancy has not been established.
Precautions
Coadministration with ranitidine or bismuth citrate not recommended if CrCl <25 mL/min; administer half dose or increase dosing interval if CrCl <30 mL/min; diarrhea may be sign of pseudomembranous colitis; superinfections may occur with prolonged or repeated antibiotic therapies
Azithromycin (Zithromax)
Used to treat mild-to-moderate infections caused by susceptible strains of microorganisms; indicated for chlamydial and gonorrheal infections of genital tract.
Dosing
Adult
Day 1: 500 mg PO
Days 2-5: 250 mg PO
Pediatric
12 mg/kg PO qd; not to exceed 500 mg/dose
Interactions
May increase toxicity of theophylline, warfarin, and digoxin; effects reduced with coadministration of aluminum and/or magnesium antacids; nephrotoxicity and neurotoxicity may occur when coadministered with cyclosporine
Contraindications
Documented hypersensitivity; hepatic impairment; concurrent pimozide
Precautions
Pregnancy
C - Safety for use during pregnancy has not been established.
Precautions
Site reactions can occur with IV route; bacterial or fungal overgrowth may result with prolonged antibiotic use; may increase hepatic enzymes and cholestatic jaundice; caution in patients with impaired hepatic function, prolonged QT intervals, or pneumonia; caution in hospitalized, geriatric, or debilitated patients
Cefditoren pivoxil (Spectracef)
Semisynthetic cephalosporin administered as prodrug. Hydrolyzed by esterases during absorption and distributed in circulating blood as active cefditoren.
Bactericidal activity results from inhibition of cell wall synthesis via affinity for penicillin-binding proteins.
No dose adjustment necessary for mild renal impairment (CrCl 50-80 mgL/min/1.73 m2) or mild-to-moderate hepatic impairment.
Indicated for the treatment of acute exacerbation of chronic bronchitis caused by susceptible strains of Streptococcus pyogenes.
Dosing
Adult
400 mg PO with meals bid for 10 d
Moderate renal impairment (CrCl 30-49 mL/min/1.73 m2): Not to exceed 200 mg PO bid
Severe renal impairment (CrCl <30 mL/min/1.73 m2): 200 mg PO qd
Pediatric
<12 years: Not established
>12 years: Administer as in adults
Interactions
Absorption reduced with H2 receptor antagonists and antacids of magnesium and aluminum hydroxides; probenecid may increase plasma concentrations of cefditoren
Contraindications
Documented hypersensitivity to drug, penicillin, related compounds, or milk protein sodium caseinate; carnitine deficiency or inborn errors of metabolism that may result in clinically significant carnitine deficiency
Precautions
Pregnancy
B - Usually safe but benefits must outweigh the risks.
Precautions
May cause diarrhea, nausea, and vaginal moniliasis (yeast infection); pseudomembranous colitis may occur; clinical manifestations of carnitine deficiency may occur with prolonged use; prolonged use may result in emergence and overgrowth of resistant organisms; caution in breastfeeding
Tetracycline (Sumycin)
For susceptible bacterial infections of both gram-positive and gram-negative organisms as well as infections caused by mycoplasmal, chlamydial, or rickettsial organisms. Inhibits bacterial protein synthesis by binding with 30S and, possibly, 50S ribosomal subunit(s). Provides coverage for mycoplasmal, chlamydial, and B pertussis organisms, but less effective than erythromycin.
Dosing
Adult
50-500 mg PO qid
Pediatric
<8 years: Not recommended
>8 years: 10-20 mg/lb (25-50 mg/kg) PO divided qid
Interactions
Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; can decrease effects of PO contraceptives, causing breakthrough bleeding and increased risk of pregnancy; can increase hypoprothrombinemic effects of anticoagulants
Contraindications
Documented hypersensitivity; severe hepatic dysfunction
Precautions
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; use during tooth development (ie, last half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines
Doxycycline (Bio-Tab, Doryx, Vibramycin)
Provides coverage for mycoplasmal and chlamydial organisms but not active against B pertussis; inhibits protein synthesis and bacterial growth by binding with 30S and, possibly, 50S ribosomal subunits of susceptible bacteria.
Dosing
Adult
100 mg PO bid
Pediatric
<8 years: Not recommended
>8 years: 2-5 mg/kg/d PO qd or divided q12h; not to exceed 200 mg/d
Interactions
Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; can increase hypoprothrombinemic effects of anticoagulants; can decrease effects of PO contraceptives, causing breakthrough bleeding and increased risk of pregnancy
Contraindications
Documented hypersensitivity; severe hepatic dysfunction
Precautions
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; use during tooth development (ie, last half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines
Trimethoprim-sulfamethoxazole (Bactrim)
Inhibits bacterial synthesis of dihydrofolic acid by competing with para-aminobenzoic acid, inhibiting bacterial growth. Antibacterial activity of TMP-SMZ includes common urinary tract pathogens except Pseudomonas aeruginosa. Like tetracycline, has in vitro activity against B pertussis; not useful in mycoplasmal infections.
Dosing
Adult
160 mg TMP/800 mg SMZ PO q12h for 10-14 d
Pediatric
<2 months: Contraindicated
>2 months: 15-20 mg/kg/d (TMP) PO divided tid/qid for 14 d
Interactions
May increase PT when used with warfarin (perform coagulation tests and adjust dose accordingly); coadministration with dapsone may increase blood levels of both drugs; coadministration of diuretics increases incidence of thrombocytopenic purpura in elderly people; may increase phenytoin levels; may potentiate effects of methotrexate in bone marrow depression; may increase hypoglycemic response to sulfonylureas; may increase levels of zidovudine
Contraindications
Documented hypersensitivity; megaloblastic anemia due to folate deficiency; age <2 mo
Precautions
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
Discontinue at first appearance of rash or sign of adverse reaction; obtain CBC counts frequently; discontinue therapy if significant hematologic changes occur; goiter, diuresis, and hypoglycemia may occur with sulfonamides; prolonged IV infusions or high doses may cause bone marrow depression (if signs occur, administer 5-15 mg/d leucovorin); caution in folate deficiency (eg, chronic alcoholism, elderly persons, those receiving anticonvulsant therapy, those with malabsorption syndrome); hemolysis may occur in G-6-PD deficiency; patients with AIDS may not tolerate or respond to TMP-SMZ; caution in renal or hepatic impairment (perform urinalyses and renal function tests during therapy); administer fluids to prevent crystalluria and stone formation
Analgesics/antipyretics
These agents are used to control fever as well as myalgias and arthralgias.
Ibuprofen (Ibuprin, Advil, Motrin)
Usually DOC for treatment of mild to moderate pain if no contraindications are recognized. Inhibits inflammatory reactions and pain, probably by decreasing activity of enzyme cyclooxygenase, which results in inhibition of prostaglandin synthesis.
Dosing
Adult
400-800 mg PO q4-6h
Pediatric
10 mg/kg PO q6-8h
Interactions
Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity; may decrease effects of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase risk of methotrexate toxicity; may increase phenytoin levels
Contraindications
Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency; high risk of bleeding
Precautions
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in CHF, hypertension, and decreased renal or hepatic function; caution in anticoagulation abnormalities or during anticoagulant therapy, monitor PT closely and instruct patients to watch for signs of bleeding
Acetaminophen (Tylenol, Panadol, Aspirin-free Anacin)
DOC for treatment of pain in those with documented hypersensitivity to aspirin or NSAIDs, with upper GI disease, or taking PO anticoagulants
Dosing
Adult
625-1000 mg PO q4h; not to exceed 4 g/d
Pediatric
<12 years: 10-15 mg/kg/dose PO q4-6h prn; not to exceed 2.6 g/d
>12 years: 325-650 mg PO q4h; not to exceed 5 doses in 24 h
Interactions
Rifampin can reduce analgesic effects; coadministration with barbiturates, carbamazepine, hydantoins, or isoniazid may increase hepatotoxicity
Contraindications
Documented hypersensitivity; G-6-PD deficiency
Precautions
Pregnancy
B - Usually safe but benefits must outweigh the risks.
Precautions
Hepatotoxicity possible in chronic alcoholism following various dose levels; severe or recurrent pain or high or continued fever may indicate serious illness; acetaminophen is contained in many OTC products and combined use with these products may result in cumulative acetaminophen doses exceeding recommended maximum dose
Antitussives and expectorants
Little data on the efficacy of expectorants outside the test tube are available. The prototype antitussive, codeine, has been used successfully in some chronic cough and induced cough models;7 however, little clinical data on upper respiratory infections are available. Existing data indicate that codeine is slightly better or equal in efficacy to guaifenesin, dextromethorphan, or even placebo.
Guaifenesin and codeine (Robitussin A-C, Guiatuss AC, Mytussin AC)
Treats minor cough resulting from bronchial and throat irritation.
Dosing
Adult
5-10 mL PO q4-8h; not to exceed 60 mL/d
Pediatric
1-1.5 mg/kg/d codeine PO divided qid
Interactions
Increases toxicity of CNS depressant drugs
Contraindications
Documented hypersensitivity
Precautions
Pregnancy
C - Safety for use during pregnancy has not been established.
Precautions
Do not administer for productive cough or persistent chronic cough from emphysema; caution in renal impairment
Guaifenesin with dextromethorphan (Humibid DM, Mytussin, Robitussin DM)
Treats minor cough resulting from bronchial and throat irritation.
Dosing
Adult
10 mL PO q4h
Pediatric
<2 years: Not recommended
2-6 years: 2.5 mL PO q4h
6-12 years: 5 mL PO q4h
>12 years: Administer as in adults
Interactions
None reported
Contraindications
Documented hypersensitivity
Precautions
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
Do not use to treat productive cough or persistent chronic cough resulting from emphysema
Bronchodilators
Studies have shown that bronchodilators are advantageous and may even be superior to antibiotics for bronchitis symptoms. However, patient numbers in trials are disappointingly few given how commonly acute bronchitis is diagnosed.
Albuterol sulfate (Proventil, Ventolin)
Beta-agonist used in treatment of bronchospasm refractory to epinephrine. Relaxes bronchial smooth muscle by action on beta2-receptors and shows little effect on cardiac muscle contractility.
Dosing
Adult
2 puffs q4-6h or 2-4 mg PO tid/qid
Pediatric
0.1-2 mg/kg PO tid
Interactions
Beta-adrenergic blockers antagonize effects; inhaled ipratropium may increase duration of bronchodilatation by albuterol; cardiovascular effects may increase with MAOIs, inhaled anesthetics, tricyclic antidepressants, or sympathomimetic agents
Contraindications
Documented hypersensitivity
Precautions
Pregnancy
C - Safety for use during pregnancy has not been established.
Precautions
Caution in hyperthyroidism, diabetes mellitus, and cardiovascular disorders
Antiviral agents
Influenza vaccinations offer greater protection for the appropriate populations because they offer coverage for influenza A and B. Amantadine and rimantadine have been demonstrated to be useful during epidemics of influenza A, but are no longer recommended because of resistance. Zanamivir and oseltamivir are the neuraminidase inhibitors that are now preferred for chemoprophylaxis during outbreaks of influenza A and B, although data from institutional outbreaks are limited.
Oseltamivir (Tamiflu)
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 cap and PO susp. Oseltamivir (Tamiflu) resistance has emerged in the US during the 2008-2009 influenza season. The US Centers for Disease Control and Prevention (CDC) has issued revised interim recommendations for antiviral treatment and prophylaxis of influenza. Preliminary data from a limited number of states indicate the prevalence of influenza A (H1N1) virus strains resistant to oseltamivir (Tamiflu) is high. 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 may be used, rather than oseltamivir alone. Local influenza surveillance data and laboratory testing can assist the physician regarding antiviral agent choice.
Dosing
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
>23-40 kg: 60 mg PO bid for 5 d
>40 kg: Administer as in adults
Prophylaxis:
<1 year: Not established
>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
Interactions
None reported
Contraindications
Documented hypersensitivity
Precautions
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 containing 5-mg blisters of drug are inserted into supplied inhalation device.
Dosing
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
Interactions
None reported
Contraindications
Documented hypersensitivity; obstructive airway disease
Precautions
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
Follow-up
Deterrence/Prevention
- Patients with underlying cardiopulmonary disease should receive annual influenza vaccinations.
- In certain locations, such as in nursing homes, amantadine or rimantadine have been administered when an index case is found until the vaccine has had a chance to take effect. However, because of increasing resistance, their routine use has been discouraged by the CDC beginning in 2005 in favor of neuraminidase inhibitors.
- Influenza vaccination of healthy patients may reduce absenteeism.
Complications
- Fewer than 5% of patients with bronchitis develop pneumonia. Incidence of subsequent pneumonia, however, remains unaffected by the use of antibiotics.
Prognosis
- For the vast majority of patients, the prognosis is excellent.
Patient Education
- For excellent patient education resources, visit eMedicine's Lung and Airway Center and Allergy Center. Also, see eMedicine's patient education articles, Bronchitis and Coughs.
References
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Keywords
tracheobronchitis, chronic obstructive lung disease, COLD, obstructive airway disease, OAD, chronic obstructive pulmonary disease, COPD, respiratory tract infection, asthma, viralrespiratory tract infection, bacterial respiratory tract infection, chronic bronchitis, CB, acute 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
airpollution, air pollutants, smoking, second-hand smoke, allergies, chronic aspiration, gastroesophagealreflux, GER, fungal infection
Contributor Information and Disclosures
Author
Samuel Ong, MD, Visiting Assistant Professor, Department of Emergency Medicine, University of California at Los Angeles Medical Center-Olive View
Disclosure: Nothing to disclose.
Medical Editor
David FM Brown, MD, Assistant Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital
David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.
Pharmacy Editor
Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment
Managing Editor
Paul Blackburn, DO, FACOEP, FACEP, Program Director, Department of Emergency Medicine, Maricopa Medical Center; Assistant Professor, Department of Surgery, University of Arizona
Paul Blackburn, DO, FACOEP, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American Medical Association, and Arizona Medical Association
Disclosure: Nothing to disclose.
CME Editor
John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.
Chief Editor
Robert E O'Connor, MD, MPH, Professor and Chair, Department of Emergency Medicine, University of Virginia Health System
Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.
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