Clinical pathways for the management of acute bronchitis in Family and Community Practice
- Author:
Noel L. Espallardo
- Publication Type:Journal Article
- MeSH:
Community Health Services;
Bronchitis;
Acute Disease;
Critical Pathways
- From:
The Filipino Family Physician
2017;55(4):201-210
- CountryPhilippines
- Language:English
-
Abstract:
Background:Cough is one of the most common symptoms that make patients consult in family practice. Acute bronchitis
is usually the diagnosis given to these patients. Existing guidelines for the treatment of acute bronchitis emphasize
appropriate clinical evaluation, minimal laboratory tests and symptomatic treatment.
Objective:The general objective of this clinical pathway is to improve outcomes of patients with acute bronchitis being
seen in family and community practice. It hopes to achieve this by: 1) promotion of a standardized management of patients
with acute bronchitis, and 2) promoting quality improvement initiatives at the clinic and organizational level.
Method:The PAFP Clinical Pathways Group reviewed the previous Clinical Practice Guideline for the Treatment of Acute
Bronchitis in Family Practice, a local guideline developed by the Family Medicine Research Group and adopted as policy
statement by the Philippine Health Insurance Corporation. A Medline search was done but there is only one guideline
published in Dutch for the Diagnosis and Treatment of Cough. The group also reviewed published medical literature to
identify, summarize, and operationalize the clinical content of diagnostics, interventions and clinical indicators or outcomes
to develop an evidence-based clinical pathway in family medicine practice.
Recommendations:Patient history focusing on the duration of cough, character and sputum production and accompanying
symptoms such as fever, difficulty of breathing or chest pain should be done. Other points to focus on the history should
include past history of asthma, recurrent respiratory disease, exposure to respiratory viral or bacterial infection, smoking
or exposure to toxic inhalants. A complete and thorough physical examination of the upper airways, chest and lungs and
peak expiratory flow rate must be done. There is no recommended laboratory test but chest x-ray may be helpful for those
with probable pneumonia. Symptomatic treatment for acute bronchitis is recommended i.e. bronchodilators, mucolytics,
anti-pyretics and fluids. Herbal and complimentary alternative medication may also be given. Antibiotics are generally
not necessary but may be given to those with severe symptoms and highly probable bacterial infection. Health education
and assurance about the self-limiting condition of acute bronchitis must be given to the patient.
Implementation:To promote rational antibiotic prescription, outreach visits to individual family physician’s clinic have
been identified as an intervention that may improve the practice of health care professionals. This type of ‘face to face’
visit has been referred to educational detailing or academic detailing.
- Full text:PAFP 26.pdf
