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:
466.0 - Bronchitis, Acute

Overview

Acute bronchitis is inflammation of the mucous membrane that lines the bronchi, the two main air passages that branch off the trachea into the lungs. 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 common cold or other 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 (usually 2 to 3 weeks, and up to 90 days), 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 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 is found in all age groups and is common throughout the world. Each year an episode of acute bronchitis is reported in up to 5% of the general population; it is one of the most common diagnoses seen in regular physician visits accounting for 10 million visits a year (Braman). Acute bronchitis is the leading cause of emergency department visits in children under 15 years old (Niska 2010).

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 common cold or sinus infection; exposure to allergens or irritants; 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 may complain of cough, which is often prominent and may produce purulent yellow or green sputum, wheezing, malaise, mild fever and chills, chest discomfort or tightness, sore throat, loss of appetite, shortness of breath (dyspnea), and difficulty sleeping as a result of coughing.

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 a cough suppressant (antitussive) to relieve dry, disturbing coughing at short-term. An expectorant may be recommended to help thin mucus secretions so that they can be coughed up. Alternatively, especially in severe cases, an inhaled bronchodilator helps open bronchial passages and assists in clearing the airways. An antipyretic may be recommended for fever reduction. 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. Because acute bronchitis is most often caused by a virus, antibiotics should only be prescribed when a bacterial cause is confirmed or strongly suspected.

Reports have shown that 65% to 80% of patients receive broad-spectrum antibiotics despite evidence of ineffectiveness (Braman), but these rates are beginning to decline following a campaign effort by the Centers for Disease Control and Prevention (CDC) to decrease the prescribing of antibiotics for the treatment of upper respiratory infection (Grijalva 2009). 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.

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, most often 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 (Fayyaz).

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.

Risk: Jobs that require exposure to heavy fumes, dusts, and respiratory irritants are best avoided if possible, although a paper mask may be sufficient protection in most cases. More advanced mask systems as per OSHA guidelines should also be followed in certain industries. In an immune compromised individual, working with heavy public contact, with indigent or incarcerated populations, or in health care settings, may place the individual at increased risk of further or recurrent infection. A person with symptom onset within the last 24 to 48 hours be at a more infectious state and should avoid working in settings with immune compromised individuals. Some risk can be mitigated by frequent hand washing, gloves, or masks.

Capacity: During active infection, capacity will be reduced related to the type and severity.

Tolerance: Milder infections may be managed with over the counter analgesics which may permit an earlier return to work in recovering individuals.

Source: Medical Disability Advisor



Maximum Medical Improvement

14 days.

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.

Fayyaz, Jazeela. "Bronchitis." eMedicine. Eds. Zab Mosenifar, et al. 28 Mar. 2014. Medscape. 5 May 2014 <http://emedicine.medscape.com/article/297108-overview>.

Grijalva, C. G. , J. P. Nuorti, and M. R. Griffin. "Antibiotic Prescription Rates for Acute Respiratory Tract Infections in US Ambulatory Settings." The Journal of the American Medical Association 302 (2009): 758-766.

Niska, R. , F. Bhuiya, and J. Xu. "National Hospital Ambulatory Medical Care Survey: 2007 Emergency Department Summary." National Health Statistics Reports (2010): 1-31.

General

Knutson, Doug, and Chad Braun. "Diagnosis and Management of Acute Bronchitis." American Academy of Family Physicians. 15 May. 2002. 27 May 2014 <http://www.aafp.org/afp/20020515/2039.html>.

Source: Medical Disability Advisor






Feedback
Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment. If you are seeking medical advice, please contact your physician. Thank you!
Send this comment to:
Sales Customer Support Content Development
 
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the author, editors, and publisher are not engaged in rendering medical, legal, accounting or other professional service. If medical, legal, or other expert assistance is required, the service of a competent professional should be sought. We are unable to respond to requests for advice. Any Sales inquiries should include an email address or other means of communication.