Acute Bronchitis: Causes, Symptoms, and Treatment

Acute bronchitis exacerbation is a sudden worsening of chronic bronchitis with symptoms such as shortness of breath, chest tightness, wheezing, coughing, and recurrent episodes. Lung function indices such as peak flow or forced expiratory volume in one second (FEV1) are reduced by less than 60% compared to normal levels.

What is acute bronchitis exacerbation?

Acute bronchitis is a chronic respiratory disease caused by increased mucus secretion, swelling, and constriction that obstructs the airway, limiting the flow of air through the respiratory tract.

Acute bronchitis exacerbation is a sudden worsening of chronic bronchitis with symptoms such as shortness of breath, chest tightness, wheezing, coughing, and recurrent episodes. Lung function indices such as peak flow or forced expiratory volume in one second (FEV1) are reduced by less than 60% compared to normal levels.

According to statistics in our country, up to 5% of the population suffers from asthma, with the highest incidence rate being among children aged 12-13.

Symptoms of an acute bronchial asthma attack

People with acute asthma attacks experience difficulty breathing with the following symptoms, especially those with a history of allergies or asthma:

• It starts with sneezing, itchy nose, and coughing.
• Breathlessness, unable to breathe, not enough breath to speak, sweating, and increasing breathlessness.
• Wheezing with breathing.
• Coughing often accompanies breathlessness.
• There is a feeling of heaviness in the chest, making breathlessness worse.
• In some cases, patients may have a fever, cough with phlegm.
• Each acute asthma attack typically subsides within a short period of time, usually 5-15 minutes. Sometimes, it may last longer for several hours. Usually, an acute asthma attack will resolve on its own or after using bronchodilators.

Acute asthma attacks usually occur at night when patients come into contact with allergens (smoke, dust, mold, pollen, etc.), when patients have a cold, or due to weather changes.

Causes and Diagnosis of Acute Bronchial Asthma

There are various causes of acute bronchial asthma such as:

• Allergies: caused by exposure to allergens such as pollen, dust, pet hair, certain foods, drugs, etc.
• Environmental factors: triggered by irritants like cigarette smoke, air pollution, changes in humidity, etc.
• Excessive physical exertion.
• Additionally, acute bronchial asthma may be caused by other factors like respiratory infections, genetic factors, gastroesophageal reflux disease, etc.

Diagnosis of acute bronchial asthma

The diagnosis of acute bronchial asthma is based on clinical symptoms and family history. Additional diagnostic procedures may include measuring peak flow rate if available.

It is important to differentiate acute bronchial asthma from other diseases such as acute exacerbation of chronic obstructive pulmonary disease, pneumothorax, pulmonary edema, cardiac asthma, pulmonary embolism, pneumonia, etc.

Assessing the severity of an asthma attack

Mild to moderate asthma attack

• Able to speak short sentences.
• Prefer sitting to standing and walking.
• Breathing faster than usual.
• Heart rate of 100-120 beats per minute.
• SaO2: 90-95%, PEF > 50%.

Severe asthma attack

• Can only speak single words.
• Leaning forward.
• Breathing more than 30 times per minute.
• Heart rate over 120 beats per minute.
• SaO2 < 90%, PEF≤50%.

Life-threatening asthma attack

• Confused or drowsy.=
• Silent chest.
• Risk factors for life-threatening asthma attack:
• Patient with a history of life-threatening asthma attack requiring intubation and mechanical ventilation.
• Patient with a history of hospitalization for asthma.
• Patient currently using or recently stopped using oral glucocorticoids.
• Patient excessively dependent on quick-acting inhaled beta-2 agonists and requires high doses.
• Patient with a history of psychiatric illness.
• Patient noncompliant with asthma treatment plan.

Acute bronchial asthma treatment

Treatment goals

Reduce respiratory tract obstruction, help air flow more quickly to reduce blood oxygen deprivation.

Have a plan to prevent asthma attacks from recurring.

Drugs for acute bronchial asthma treatment

SABA (Short-acting beta2-agonist) inhalers

The drugs commonly used are: Salbutamol MDI 100μg/dose or 2.5mg/5mg aerosol canister, Terbutaline 5mg aerosol canister.

Use 4-10 puffs per dose, repeated every 20 minutes as needed.

The medication can be used with a spacer or nebulizer to increase its effectiveness.

Systemic corticosteroids

The drugs chosen are: Prednisolone, Hydrocortisone,…

Patients should be advised to use this type of medication to quickly relieve acute asthma symptoms and prevent recurrence.

If the asthma attack is mild, medication may not be necessary.

Administer the medication within 1 hour of the onset of an acute asthma attack.

The preferred route of administration is oral, with clinical efficacy observed after 4 hours. Inject the medication only if the patient is severely short of breath, unable to speak, and unable to swallow.

The recommended adult dose is a single morning dose of 50mg Prednisolone or 200mg Hydrocortisone divided into multiple doses throughout the day. For children, the dose is based on body weight at 1-2mg/kg/day (maximum of 40mg/day). The duration of treatment is 5-7 days for adults and 3-5 days for children.

Inhaled Corticosteroids

Commonly used medications include Beclomethasone dipropionate (40/80mcg/dose), Budesonide inhaler (200mcg/dose), and Fluticasone (44, 110, 220mcg/dose).

Combination medications such as Budesonide/Formoterol and Fluticasone/Salmeterol are also available.

Ipratropium bromide

Used for moderate to severe acute asthma attacks.

Combined with SABA to reduce hospitalization time and improve FEV1/PEF (better than using SABA alone).

Magnesium sulfate

Administered as a single dose of 2g over 20 minutes in patients with FEV1 <25-30% or non-response to initial treatment and prolonged oxygen deprivation.

 Adrenaline

Administered by injection for acute asthma related to anaphylaxis and shock.

Home treatment for acute asthma

If asthma exacerbation worsens, increase the dosage of rescue medication as follows:

SABA inhaler: increase frequency of inhalation, if available, use a metered-dose inhaler or a spacer to enhance effectiveness. ICS (inhaled glucocorticoids)/Formoterol: increase frequency of inhalation (maximum 72µg/day for Formoterol). ICS (inhaled glucocorticoids): increase dose, at least double, maximum 2000mcg. Add systemic corticosteroids, take in the morning to reduce unwanted effects. If medication is used for less than 2 weeks, it is not necessary to taper the dosage. After an asthma exacerbation, patients should seek medical evaluation to assess symptom control, risk factors, and develop a better treatment plan.

Treatment for asthma at medical facilities

Firstly, confirm if the patient has asthma and evaluate the severity and risk of death.

Mild to moderate severity

• Use SABA 4-10 puffs with a spacer, repeat every 20 minutes.
• Prednisolone: 1mg/kg/day up to a maximum of 50mg in adults, 1-2mg/kg/day up to a maximum of 40mg in children.
• Oxygen should be administered to achieve a saturation level of 93-95% (adults) or 94-98% (children).
• If the patient’s condition worsens after 1 hour of treatment, alternative measures should be taken.
• If the patient’s symptoms improve, the doctor may consider discharging them and providing home treatment if health indicators meet requirements.

Severity level – Emergency department

Provide oxygen therapy via nasal cannula at 4-8 liters/minute for the patient.

Administer bronchodilators such as salbutamol or terbutaline in aerosol form and reevaluate after 3 doses. If dyspnea does not improve, combination therapy with aerosol and intravenous administration is needed. If these medications are not available or ineffective, other bronchodilators can be used.

Depending on the symptoms of each patient, other medications can be used to quickly relieve symptoms.

Ensure adequate hydration by encouraging the patient to drink water. If the patient is unable to drink, intravenous fluids should be given to prevent cardiac failure and hypertension.

If signs of infection are present, antibiotics should be administered.

If acute asthma exacerbation does not improve within 30-60 minutes, the patient should be transferred to a higher-level facility.

Prevention of acute bronchial asthma

To prevent acute asthma attacks in patients with bronchial asthma, patients should pay attention to:

• Using medication through the correct inhalation or spray method.
• Not smoking or being near smokers, avoiding the use of coal stoves, and not keeping pets such as dogs or cats.
• Regular cleaning to keep the house clean and dust-free.
• Avoiding foods that are known to cause allergies such as shellfish and seafood.