Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Bronchitis, Acute


Related Terms

  • Bronchitis
  • Bronchitis with Bronchospasm or Obstruction
  • Exudative Bronchitis
  • Membranous Bronchitis
  • Purulent Bronchitis
  • Septic Bronchitis

Differential Diagnosis

Specialists

  • Family Physician
  • Internal Medicine Physician
  • Pulmonologist

Comorbid Conditions

  • Asthma
  • Chronic lung disease
  • Chronic obstructive pulmonary disease (COPD)
  • Immunodeficiency

Factors Influencing Duration

The length of time it takes for an individual to return to work is influenced by the severity of the symptoms, the individual's age and general health, any pre-existing chronic medical illness (especially lung disease), whether the individual smokes, and the presence of complications.

Medical Codes

ICD-9-CM:
466 - Acute Bronchitis and Bronchiolitis
466.0 - Bronchitis, Acute
506.0 - Bronchitis and Pneumonitis due to Fumes or Vapors

Overview

Acute bronchitis is inflammation of the mucous membrane that lines the air passages of the upper airways. The trachea, large airways (bronchi), and small airways (bronchioles) can be involved. There may be swelling and tenderness of the membranes, cough (with or without sputum production), and reduced airflow. Acute bronchitis may occur with a cold or respiratory infection in the nasal passageways, sinuses, or throat. Respiratory viruses such as influenza, respiratory syncytial virus (RSV), and rhinovirus are the most common causes of acute bronchitis; fewer than 10% of cases are caused by bacteria (Braman). Bordetella pertussis, the agent of whooping cough, is an important bacterial cause of acute bronchitis. The role of mycoplasma and chlamydia (both bacteria-like organisms) in acute bronchitis is less clear. Environmental factors such as gases, fumes, chemicals, dust, and smoke may also contribute to the development of acute bronchitis. Allergens and irritants may cause or prolong an episode of acute bronchitis.

Acute bronchitis is limited in duration (not more than 2 to 3 weeks) and differs from chronic bronchitis, which may develop in individuals who smoke cigarettes or have other lung conditions. Please refer to the Medical Disability Advisor Topic “Bronchitis, Chronic” for additional information.

Chronic cough may develop as a result of acute bronchitis. The American Association of Chest Physicians (AACP) recommends that a diagnosis of acute bronchitis should be made only when the common cold, acute asthma, pneumonia, or an exacerbation of chronic obstructive lung disease (COPD) have been excluded as possible causes of persistent cough (Braman).

Incidence and Prevalence: Acute bronchitis accounts for an estimated 10 million visits to physicians (Qarah) and consistently ranks as one of the top five diagnoses for which individuals seek medical care (Ong). Acute bronchitis is found in all age groups, occurs equally among men and women, and is common throughout the world.

Source: Medical Disability Advisor



Causation and Known Risk Factors

The most common risk factor for developing acute bronchitis is infection with viruses that attack the upper airways such as influenza, parainfluenza, rhinovirus, respiratory syncytial virus, and adenovirus. Individuals who smoke, have chronic lung conditions, are elderly, or have decreased immunity, are at greater risk of developing acute bronchitis when exposed to respiratory irritants at work without wearing respiratory protection.

Source: Medical Disability Advisor



Diagnosis

History: A thorough history is important and may include: recent history of a cold or sinus infection; exposure to allergens or irritants;, past history of asthma, lung disease and other underlying medical conditions;, tobacco use by the individual or family members; family history of lung disease; occupational and recreational exposure to gases, fumes, chemicals, dust, and smoke; and immunization status. The individual also may complain of mild fever, sore throat, loss of appetite, tightness in the chest, difficulty breathing, shortness of breath, wheezing, malaise, chest pain, and difficulty sleeping as a result of coughing. Cough is often a prominent complaint and may produce purulent yellow or green sputum.

Physical exam: Physical examination may reveal changes in vital signs consistent with infection: fever, rapid breathing (tachypnea), and rapid heart rate (tachycardia). There may be signs of an upper respiratory infection with nasal congestion, sinus tenderness, redness in the throat, and noisy breathing (stridor). Examination of the chest with a stethoscope usually reveals coarse breath sounds. Wheezing may be heard in the upper airways, and there may be prolonged expiration.

Tests: A complete blood count (CBC) may be done to investigate overall health, immune system status, and presence of other diseases or conditions. A chest x-ray may be done to rule out pneumonia. If shortness of breath or wheezing is prominent, pulse oximetry is a non-invasive test that may be performed to determine oxygen levels in the blood. The AACP advises that viral cultures, serologic assays, and sputum analyses should not be performed routinely to diagnose acute bronchitis because the causative organism is rarely identified (Braman). Several weeks after the individual recovers from acute bronchitis, spirometry may be performed to determine lung function and assess airway obstruction. This information can be helpful in making a diagnosis of asthma, chronic obstructive pulmonary disease (COPD), and other lung or bronchial problems.

Source: Medical Disability Advisor



Treatment

The goal of treatment is to relieve symptoms. Medications may include an inhaled bronchodilator to open bronchial passages and/or an oral decongestant to shrink membranes and assist in clearing the airways. An expectorant may be recommended to help thin mucus secretions so that they can be coughed up. Alternatively, a cough suppressant (antitussive) helps relieve coughing short-term. An antipyretic may be recommended for fever reduction. Because acute bronchitis is most often caused by a virus, antibiotics are not appropriate therapy even though their use is widespread. Reports show that 65% to 80% of patients receive broad-spectrum antibiotics despite evidence of ineffectiveness (Braman). The AACP advises that routine treatment with antibiotics is not justified for acute bronchitis (Braman). Inappropriate use of antibiotics is the cause of widespread antibiotic resistance. If symptoms persist beyond three weeks, a secondary bacterial infection may have developed, and antibiotics may be prescribed at that time. If acute bronchitis is environmentally induced, the causative agent must be identified and exposure to the agent must stop. Ideally, the causative agent will be removed from the environment. In situations where this is not possible, an alternative is to provide the individual with appropriate respiratory protection.

Supportive treatment measures include rest, use of a cool mist vaporizer to soothe air passages, and increased fluid intake to maintain hydration and thin secretions. Smokers are advised to quit or at least refrain from smoking until the infection resolves.

Source: Medical Disability Advisor



Prognosis

Acute bronchitis can be treated effectively in otherwise healthy, non-smoking individuals. The prognosis for the individual with uncomplicated acute bronchitis is excellent. The course of the disease is generally 3 to 5 days of acute symptoms, with gradual recovery over the next 7 to 10 days. If bacterial infection is present, recovery time may be longer. It is common for the cough to remain as long as 1 week after other symptoms have subsided and the individual has returned to work. Patients with cough or other symptoms lasting longer than 7 to 10 days should be re-evaluated.

Environmentally-induced acute bronchitis often resolves rapidly when the offending substance is removed from the individual's surroundings.

Source: Medical Disability Advisor



Complications

Bronchitis can progress to pneumonia and respiratory failure in the elderly. Individuals with chronic lung disease (e.g., COPD), congestive heart failure, or immune system dysfunction are considered to be at high risk for complications of acute bronchitis. Fewer than 5% of individuals with acute bronchitis develop pneumonia (Ong).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

It is important to avoid smoke, fumes, dust, and any other inhaled irritants while recovering from acute bronchitis. Proper ventilation and the use of masks or respirators are important for both the recovering individual and for prevention of problems in other workers. The inhalation of extremely hot or extremely cold air can trigger coughing and wheezing. If an individual has had shortness of breath with the bronchitis, a temporary reduction of the job's physical demands may be needed.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Did individual present with a clinical history and symptoms consistent with the diagnosis of acute bronchitis?
  • Did physical exam reveal abnormal breath sounds?
  • Is there a personal or family history of asthma or other lung disease?
  • If diagnosis was uncertain, were additional diagnostic tests performed to rule out other conditions with similar symptoms?

Regarding treatment:

  • Was treatment appropriate for the symptoms manifested?
  • Was individual compliant with treatment recommendations (such as rest, smoking cessation, avoidance of bronchial irritants)? If not, were there barriers that interfered with compliance (such as lack of understanding, lack of motivation)?

Regarding prognosis:

  • Did adequate time elapse for full recovery?
  • Did individual have any comorbid conditions that may have influenced length of disability?
  • Did the individual develop any complications that may have influenced prognosis?

Source: Medical Disability Advisor



References

Cited

Braman, S. S. "Chronic Cough Due to Acute Bronchitis: ACCP Evidence-based Clinical Practice Guidelines." Chest 129 1 (2006): 95S-103S.

Ong, Samuel. "Bronchitis." eMedicine. Eds. David F. M. Brown, et al. 14 Jan. 2009. Medscape. 26 Jan. 2009 <http://emedicine.medscape.com/article/807035-overview>.

Qarah, Samer, et al. "Bronchitis." eMedicine. Eds. Helen M. Hollingsworth, et al. 10 Jun. 2009. Medscape. 26 Jan. 2009 <http://emedicine.medscape.com/article/297108-overview>.

General

Knutson, Doug, and Chad Braun. "Diagnosis and Management of Acute Bronchitis." American Academy of Family Physicians. 26 Jan. 2009 <http://www.aafp.org/afp/20020515/2039.html>.

Source: Medical Disability Advisor






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