Acute bronchitis

Background

Trachobronchial anatomy.
A - Alveoli AS - Septum alveolare BR - Bronchus respiratorius BT - Bronchus terminalis D - Mucous gland DA - Ductus alveolaris M - Musculus N - Nervus PA - Branch of Arteria pulm. PV - Branch of Vena pulm.
  • Inflammation of large airways of the lung
  • Pneumonia must be excluded by clinical evaluation or by CXR
  • If all 5 are negative pneumonia is safely excluded:
    1. HR >100
    2. RR >24
    3. Temperature >38 (100.4)
    4. Exam findings consistent with focal consolidation, egophony, or fremitus
    5. Age >64yr

Epidemiology

Clinical Features

  • Cough, with or without sputum, without evidence of pneumonia, common cold, or asthma
    • Cough >5d is more suggestive of bronchitis than common cold
    • Cough may persist for 10-20d
    • Cough >3wk suggests asthma, COPD, pertussis, postnasal drip, GERD
  • Often follows URI

Differential Diagnosis

Cough

Acute (< 3 wks)

Chronic (> 8 wks)

Evaluation

Mild peri hilar cuffing as seen in a viral bronchitis. CXR may alternatively be negative and is not required for diagnosis.
  • Clinical diagnosis
  • CXR only indicated in elderly or suspicion for pneumonia

Management

American College of Chest Physicians 2006 Guidelines[1]

  • Routine treatment with antibiotics is NOT necessary
  • Antitussive agents can be useful (codeine, dextromethorphan)
  • In individuals without comorbidities, antibiotics have NO IMPROVEMENT in symptoms or duration [2]
  • Do not treat patients with antibiotics unless:[3]
    • older than 65 years
    • Recent hospitalizations in the past year
    • Diabetes
    • On chronic steroids
    • If treating based upon the above criteria then a 5 day treatment is preferred [4]
    • Bronchodilators only useful if there is wheezing
Despite the recommendations for no antibiotics in the non complicated course of acute bronchitis, patients continue to receive antibiotic prescriptions[5]
  • Oral Steroids do not reduce duration or severity of symptoms in patients with acute bronchitis [6]

Disposition

  • Typically outpatient

See Also

References

  1. ↑ Braman SS. Chronic cough due to chronic bronchitis: ACCP evidence-based clinical practice guidelines. Chest. Jan 2006;129(1 Suppl):104S-115S.
  2. ↑ Aagaard E, Gonzales R. Management of acute bronchitis in healthy adults. Infect Dis Clin North Am. Dec 2004;18(4):919-37
  3. ↑ Tan T, Little P, Stokes T. Antibiotic prescribing for self limiting respiratory tract infections in primary care: summary of NICE guidance. BMJ. Jul 23 2008;337
  4. ↑ El Moussaoui R, Roede BM, Speelman P, Bresser P, Prins JM, Bossuyt PM. Short-course antibiotic treatment in acute exacerbations of chronic bronchitis and COPD: a meta-analysis of double-blind studies. Thorax. May 2008;63(5):415-22
  5. ↑ Barnett, Michael. Jeffrey A. Linder. Antibiotic Prescribing for Adults With Acute Bronchitis in the United States, 1996-2010. May 21, 2014, 311(19)
  6. ↑ Hay, AD et al. Effect of oral prednisolone on symptom duration and severity in nonasthmatic adults with acute lower respiratory tract infection: a randomized clinical trial. 2017 Aug 22;318(8)
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