Bronchitis laboratory tests: Difference between revisions

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Classification Acute bronchitis Chronic bronchitis
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Revision as of 15:28, 16 September 2016

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

Diagnostic tests are rarely needed to confirm the diagnosis of acute bronchitis. In very specific condition serologic tests, viral cultures or sputum analyses may be applied. Generally the inflammatory markers such as CRP raises during the course of acute bronchitis.
Chronic bronchitis is a diagnosis by definition although there are some laboratory findings as the disease advances and causes consequences.

Laboratory Findings

Acute Bronchitis

Viral cultures, serologic assays, and sputum analyses may be perform when a potentially treatable infection is thought to be circulating or because of epidemiologic purposes^[1].

Serologic assays

Nasopharyngeal swab and aspirates to test for PCR are available but not widely used^[1].

Procalcitonin

Procalcitonin level is helpful to distinguish bacterial from other causes of inflammation. During bacterial infections the level of procalcitonin will raise over 0.25 mcg/L and it encourages the physician to prescribe antibiotics^[2]^[3]^[4].

Chronic Bronchitis

Pulse Oximetry

Though pulse oximetry is not as accurate in predicting the percentage oxygen saturation as arterial blood gas analysis. However, it gives a quick estimate of patient status when combined with the clinical status.

Arterial Blood Gas (ABG)

ABG may show changes of hypoxemia and hypercapnia depending on the severity of disease.

Hematocrit

COPD patients may have hypoxemia due to the chronic underlying disease. This chronic hypoxemia may lead to polycythemia(hematocrit > 55% in men or 50% in women is diagnostic of polycythemia.
A sputum sample showing neutrophil granulocytes (inflammatory white blood cells) and culture showing that has pathogenic microorganisms such as Streptococcus spp.

Alpha 1 Antitrypsin Levels

Serum alpha1 antitrypsin levels below the protective threshold value (ie, 3-7 mmol/L) lead to severe form of emphysema
95% cases are due to the severe variant the Z allele present in these patients.
Specific phenotyping, and genetic counselling is reserved for patients in whom serum levels are 7-11 mmol/L.

References

↑ ^1.0 ^1.1 Wenzel RP, Fowler AA (2006). "Clinical practice. Acute bronchitis". N. Engl. J. Med. 355 (20): 2125–30. doi:10.1056/NEJMcp061493. PMID 17108344.
↑ Schuetz P, Christ-Crain M, Thomann R, Falconnier C, Wolbers M, Widmer I, Neidert S, Fricker T, Blum C, Schild U, Regez K, Schoenenberger R, Henzen C, Bregenzer T, Hoess C, Krause M, Bucher HC, Zimmerli W, Mueller B (2009). "Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial". JAMA. 302 (10): 1059–66. doi:10.1001/jama.2009.1297. PMID 19738090.
↑ Briel M, Schuetz P, Mueller B, Young J, Schild U, Nusbaumer C, Périat P, Bucher HC, Christ-Crain M (2008). "Procalcitonin-guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care". Arch. Intern. Med. 168 (18): 2000–7, discussion 2007–8. doi:10.1001/archinte.168.18.2000. PMID 18852401.
↑ Gilbert DN (2011). "Procalcitonin as a biomarker in respiratory tract infection". Clin. Infect. Dis. 52 Suppl 4: S346–50. doi:10.1093/cid/cir050. PMID 21460294.

Template:WikiDoc Sources

[pmid17108344-1] 1.0 ^1.1 Wenzel RP, Fowler AA (2006). "Clinical practice. Acute bronchitis". N. Engl. J. Med. 355 (20): 2125–30. doi:10.1056/NEJMcp061493. PMID 17108344.

[pmid19738090-2] Schuetz P, Christ-Crain M, Thomann R, Falconnier C, Wolbers M, Widmer I, Neidert S, Fricker T, Blum C, Schild U, Regez K, Schoenenberger R, Henzen C, Bregenzer T, Hoess C, Krause M, Bucher HC, Zimmerli W, Mueller B (2009). "Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial". JAMA. 302 (10): 1059–66. doi:10.1001/jama.2009.1297. PMID 19738090.

[pmid18852401-3] Briel M, Schuetz P, Mueller B, Young J, Schild U, Nusbaumer C, Périat P, Bucher HC, Christ-Crain M (2008). "Procalcitonin-guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care". Arch. Intern. Med. 168 (18): 2000–7, discussion 2007–8. doi:10.1001/archinte.168.18.2000. PMID 18852401.

[pmid21460294-4] Gilbert DN (2011). "Procalcitonin as a biomarker in respiratory tract infection". Clin. Infect. Dis. 52 Suppl 4: S346–50. doi:10.1093/cid/cir050. PMID 21460294.

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 :'''Arterial Blood Gas (ABG)'''
 ::* ABG may show changes of [[hypoxemia]] and [[hypercapnia]] depending on the severity of disease.
-::* Milder exacerbation may present only with hypoxemia without accompanied hypercapnia
-::* Hypercapnia is usually seen when FEV1 falls below 1 L/s or 30% of the predicted value
-::* A pH value below 7.3 usually indicates a severe exacerbation and respiratory compromise.
 :'''Hematocrit'''
-::* COPD patients may have hypoxemia due to the chronic underlying disease. This chronic hypoxemia may lead to [[polycythemia]](hematocrit > 52% in men or 47% in women is diagnostic of polycythemia.
+::* COPD patients may have hypoxemia due to the chronic underlying disease. This chronic hypoxemia may lead to [[polycythemia]](hematocrit > 55% in men or 50% in women is diagnostic of polycythemia.
-::* Correction of hypoxemia should reduce secondary polycythemia in patients who have quit smoking.
-:'''Blood Test'''
-::* A [[blood test]] would indicate inflammation (as indicated by a raised [[white blood cell]] count and elevated [[C-reactive protein]]).
-:::*[[Neutrophil]]s infiltrate the [[lung tissue]], aided by damage to the airways caused by irritation.
-:::*Damage caused by irritation of the airways leads to [[inflammation]] and leads to neutrophils being present
-:::*Mucosal hypersecretion is promoted by a substance released by neutrophils
-:::*Further obstruction to the airways is caused by more [[goblet cell]]s in the small airways. This is typical of chronic bronchitis
-:::*Although [[infection]] is not the reason or cause of [[chronic bronchitis]] it is seen to aid in sustaining the bronchitis.
-:'''Serum Electrolytes'''
-::*COPD patients have irreversible obstruction of airway that causes retention of carbon-dioxide. This in turn causes them to develop chronic respiratory acidosis. To compensate for this the body may develop [[metabolic alkalosis]] that leads to increased bicarbonate production. [[Bicarbonate]] levels act as useful indicator of disease progression.
-:'''Sputum Culture'''
-::* Though sputum culture can be done and yields organisms like [[Streptococcus pneumonia]], and [[Hemophilus influenza]] during acute exacerbation, they are not otherwise useful in management plans.
 ::* A sputum sample showing [[neutrophil granulocyte]]s (inflammatory white blood cells) and [[microbiological culture|culture]] showing that has pathogenic microorganisms such as [[Streptococcus|Streptococcus spp.]]
-:'''Human B-type Natriuretic Peptide'''
-::* Research are ongoing on Human [[B-type natriuretic peptide]] (BNP) and pro-BNP to find if it can help to differentiate between congestive heart failure and COPD. However, no conclusive results are still drawn.
 :'''Alpha 1 Antitrypsin Levels'''
 ::* Serum alpha1 antitrypsin levels below the protective threshold value (ie, 3-7 mmol/L) lead to severe form of [[emphysema]]