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Acute Tracheobronchitis

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References:

  1. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 15th Edition, ISBN 978-197-51-6103-3, by Janice L. Hinkle, Kerry H. Cheever, and Kristen J. Overbaugh (Ch. 19, [ebook] pp. 1538–1539)

Acute tracheobronchitis, an acute inflammation of the mucous membranes of the trachea and the bronchial tree, often follows infection of the upper respiratory tract usually as a result of a viral infection. Patients with viral infections have decreased resistance and can readily develop a secondary bacterial infection. Adequate treatment of upper respiratory tract infection is one of the major factors in the prevention of acute tracheobronchitis.

Pathophysiology

In acute tracheobronchitis, the inflamed mucosa of the bronchi produces mucopurulent sputum, often in response to infection by Streptococcus pneumoniae, Haemophilus influenzae, or Mycoplasma pneumoniae.

  • A fungal infection (e.g., Aspergillus) may also cause tracheobronchitis.
  • A sputum culture is essential to identify the specific causative organism.
  • In addition to infection, inhalation of physical and chemical irritants, gases, or other air contaminants can also cause acute bronchial irritation.

Clinical Manifestations

  1. Initially, the patient has a dry, irritating cough and expectorates a scanty amount of mucoid sputum. The patient may report sternal soreness from coughing and have fever or chills, night sweats, headache, and general malaise.
  2. As the infection progresses, the patient may be short of breath, have noisy inspiration and expiration (stridor, wheezing) and produce purulent sputum.
  3. In severe tracheobronchitis, blood-streaked secretions may be expectorated as a result of the irritation of the mucosa of the airways.

Medical Management

In most cases, treatment of tracheobronchitis is largely symptomatic. Cool vapor therapy or steam inhalations may help relieve laryngeal and tracheal irritation. Increasing the vapor pressure (moisture content; via humidifier) in the air reduces airway irritation. Moist heat to the chest may relieve the soreness and pain, and mild analgesics may be prescribed.

  1. Antibiotic treatment may be indicated depending on the symptoms, sputum purulence, and results of the sputum culture and sensitivity.
  2. Antihistamines usually are not prescribed because they can cause excessive drying and make secretions more difficult to expectorate.
  3. Fluid intake is increased to thin viscous and tenacious secretions.
  4. Suctioning and bronchoscopy may be needed to remove copious, purulent secretions that cannot be cleared by coughing. If secretions remain in place, airway obstruction and development of more severe lower respiratory tract infections, such as pneumonia, may occur.
  5. Endotracheal intubation is necessary in the rare event that acute tracheobronchitis results in acute respiratory failure, such as in patients who are severely debilitated or who have coexisting diseases that impair the respiratory system.

Nursing Management

Acute tracheobronchitis is usually able to be treated in the home setting. A primary nursing function is to encourage bronchial hygiene, such as increased fluid intake and directed coughing to remove secretions.

  1. The nurse encourages and assists the patient to sit up frequently to cough effectively and to prevent retention of mucopurulent sputum.
  2. If the patient is taking antibiotics for an underlying bacterial infection, the need to complete the full course of antibiotics prescribed is emphasized.
  3. Fatigue is a consequence of tracheobronchitis; therefore, the nurse cautions the patient against overexertion, which can induce a relapse or exacerbation of the infection. The patient is advised to rest.

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