What is the management approach for bronchitis with hypothermia (low body temperature) and symptoms of dry cough?

Management of Bronchitis with Low Body Temperature and Dry Cough

For bronchitis with hypothermia and dry cough, immediate rewarming is the priority, followed by symptomatic treatment with antitussives like dextromethorphan for cough relief, while avoiding antibiotics unless specifically indicated for bacterial infection. 1

Initial Assessment and Management of Hypothermia

• Begin active rewarming immediately by moving the patient to a warm environment, removing wet clothing, and wrapping all exposed body surfaces with blankets, clothing, or newspapers 1
• Place the patient near a heat source and apply containers of warm (not hot) water in contact with the skin for active rewarming 1
• Monitor body temperature until normothermia is achieved 1
• Ensure rewarming does not delay definitive care if the hypothermia is severe 1

Diagnosis of Bronchitis

• Diagnose acute bronchitis when a patient presents with cough (with or without sputum) lasting up to 3 weeks, with no clinical or radiographic evidence of pneumonia, and after ruling out common cold, asthma, or COPD exacerbation 1
• The absence of the following findings reduces the likelihood of pneumonia: heart rate >100 beats/min, respiratory rate >24 breaths/min, oral temperature >38°C, and chest examination findings of focal consolidation 1
• Viral cultures, serologic assays, and sputum analyses are not routinely recommended as the responsible organism is rarely identified in clinical practice 1

Management of Dry Cough in Bronchitis

Non-Pharmacological Approaches

• Adequate hydration to help thin mucus 2
• Use of humidifiers to moisten airways 2
• Avoidance of respiratory irritants (e.g., cigarette smoke, environmental pollutants) 1
• Simple home remedies like honey and lemon mixtures can be effective for benign viral cough 2

Pharmacological Management

• Antitussive agents are recommended for short-term symptomatic relief of coughing 1

  • Dextromethorphan is preferred as a non-opioid central cough suppressant with minimal side effects 2, 3
  • Maximum cough reflex suppression occurs at 60 mg of dextromethorphan 2
  • Codeine or pholcodine have no greater efficacy than dextromethorphan but have more adverse effects and are not recommended 2

• Menthol by inhalation provides acute but short-lived cough suppression 2

• For select adult patients with wheezing accompanying the cough, treatment with β2-agonist bronchodilators may be useful 1

• Mucokinetic agents are not recommended due to lack of consistent favorable effect on cough 1

Antibiotic Therapy

• Routine treatment with antibiotics is not justified for acute bronchitis and should not be offered 1, 4, 5
• Antibiotics have been shown to provide only minimal benefit (reducing cough by about half a day) while exposing patients to adverse effects 6
• The decision not to use antibiotics should be addressed individually with explanations, as many patients expect to receive antibiotics based on previous experiences 1
• Exceptions for antibiotic use include:
  • Suspected pertussis (macrolide antibiotic recommended) 1
  • Patients at increased risk of developing pneumonia (e.g., those 65 years or older) 4

Special Considerations for Hypothermia

• The urgency of treatment depends on the length of exposure and the victim's body temperature 1
• Transport to an advanced medical facility as rapidly as possible if hypothermia is severe 1
• Continue monitoring for signs of respiratory complications or infection as the patient rewarms 1

When to Seek Further Medical Attention

• If the patient coughs up blood 1
• If the patient experiences breathlessness 1
• If there is prolonged fever and feeling unwell 1
• If symptoms persist for more than three weeks 1, 5
• If the patient has underlying medical conditions such as chronic bronchitis (COPD), heart disease, diabetes, or asthma 1

Expected Course

• Symptoms of bronchitis typically last about 2-3 weeks, which should be emphasized with patients 4, 5, 6
• Acute bronchitis is usually self-limiting and caused by viruses in more than 90% of cases 4, 7