- Clinical science
Acute bronchitis
Summary
Acute bronchitis is a self-limiting lower respiratory tract infection (RTI) characterized by inflammation of the bronchi. In more than 90% of cases, it is caused by a virus. Acute bronchitis usually follows an upper RTI and presents with cough, sometimes in combination with sputum, runny nose, chest pain, headache, and malaise. The diagnosis is made on the basis of clinical symptoms. Important differential diagnoses include bronchiolitis, a very similar disease that often leads to respiratory distress in infants, and pneumonia, which is also a serious complication of acute bronchitis. Chronic bronchitis affects the same anatomical structure but has a very different clinical picture (see COPD). Management of acute bronchitis consists of adequate hydration and possibly NSAIDs for symptomatic relief. Antibiotics are frequently and unnecessarily prescribed as part of treatment; however, they are not indicated unless the patient is at risk for secondary bacterial infection.
Etiology
-
Viruses (> 90% of cases)
- Influenza A and B
- Parainfluenza
- Adenovirus
- RSV
- Rhinovirus
- Coronavirus
- Bacteria
- Environmental etiologies
The etiology of acute bronchitis is viral in > 90% of cases!
References:[1][2][3]
Clinical features
-
Cough
- > 5 days
- Resolves in 2–3 weeks
- Sputum (∼ 50% of cases), especially as infection progresses [4]
- Runny nose and sore throat (likely symptoms of the preceding or simultaneous URI)
- Chest pain and dyspnea
- Headache
- Malaise
- Myalgias
- Fever (uncommon)
References:[2][5][3]
Diagnostics
Differential diagnoses
- See bronchiolitis
- See differential diagnosis of acute cough
- For cough persisting ≥ 8 weeks, see differential diagnosis of chronic cough
The differential diagnoses listed here are not exhaustive.
Treatment
- Rest and adequate hydration
- NSAIDs
-
Antibiotics: generally not recommended!
- Possible indications: patient groups with increased risk of bacterial infection; (e.g., smokers, the elderly, patients with lung disease) and patients with suspected differential diagnosis (see “Differential diagnosis” above)
- Antitussives, expectorants, and bronchodilators are generally not recommended, but may be considered under specific circumstances (e.g., wheezing in older children).
References:[5][3]
Prognosis
- Generally self-limiting
- Groups at increased risk for complications: elderly, immunocompromised patients, patients with pre-existing lung conditions
References:[3]
