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Acute bronchitis

Last updated: January 20, 2021

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Acute bronchitis is a lower respiratory tract infection (LRTI) characterized by inflammation of the bronchi. It often follows an upper respiratory tract infection (URTI) and, in more than 90% of cases, the cause is viral. Acute bronchitis may manifest with cough, runny nose, headache, and malaise. The cough may persist for 2–3 weeks and is usually self-limiting; it is often productive and associated with chest pain. The diagnosis is made on the basis of clinical symptoms and auscultation findings; further diagnostic testing is not routinely necessary. Important differential diagnoses to consider include asthma, acute exacerbation of COPD, and pneumonia. Management of acute bronchitis consists of adequate hydration and symptomatic relief. Treatment with antibiotics is not generally indicated. While chronic bronchitis also involves inflammation of the bronchi, its clinical picture and management are very different (see “COPD”).

The etiology of acute bronchitis is viral in > 90% of cases!

References:[1][2][3]

Approach

  • Acute bronchitis is a clinical diagnosis based on typical clinical features and auscultation findings
  • Diagnostic studies are usually only required to: [6]
    • Rule out alternative diagnoses: e.g., CBC, CXR, nasopharyngeal swab
    • Evaluate for complications (e.g., pneumonia, AECOPD) in patients with:
      • Atypical clinical findings
      • Increased risk of bacterial infection: e.g., smokers, patients > 75 years old, patients with lung disease

Routine laboratory and imaging studies [4]

Further diagnostic testing [4]

Consider targeted testing for alternate diagnoses or complications in patients with the following:

In otherwise healthy patients with typical clinical findings and normal vital signs, acute bronchitis does not require diagnostic testing. [6]

The differential diagnoses listed here are not exhaustive.

Acute bronchitis is generally self-limiting. Treatment is focused on the relief of symptoms. [4][6]

Treatment is focused on symptomatic management. Antibiotics, cough and cold medications, bronchodilators, and steroids have no proven efficacy in uncomplicated acute bronchitis.

  • Generally self-limiting
  • Groups at increased risk for complications: elderly, immunocompromised patients, patients with pre-existing lung conditions

References:[3]

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  3. File TM. Acute Bronchitis in Adults. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/acute-bronchitis-in-adults.Last updated: March 25, 2016. Accessed: March 16, 2017.
  4. Kinkade S, Long NA. Acute Bronchitis.. Am Fam Physician. 2016; 94 (7): p.560-565.
  5. Koehler U, Hildebrandt O, Fischer P, et al. Time course of nocturnal cough and wheezing in children with acute bronchitis monitored by lung sound analysis. Eur J Pediatr. 2019; 178 (9): p.1385-1394. doi: 10.1007/s00431-019-03426-4 . | Open in Read by QxMD
  6. Smith MP, Lown M, Singh S, et al. Acute Cough Due to Acute Bronchitis in Immunocompetent Adult Outpatients: CHEST Expert Panel Report.. Chest. 2020; 157 (5): p.1256-1265. doi: 10.1016/j.chest.2020.01.044 . | Open in Read by QxMD
  7. Harris AM, Hicks LA, Qaseem A. Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2016; 164 (6): p.425-34. doi: 10.7326/m15-1840 . | Open in Read by QxMD
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  16. Llor C, Moragas A, Bayona C, et al. Efficacy of anti-inflammatory or antibiotic treatment in patients with non-complicated acute bronchitis and discoloured sputum: randomised placebo controlled trial.. BMJ. 2013; 347 : p.f5762. doi: 10.1136/bmj.f5762 . | Open in Read by QxMD
  17. Smith SM, Schroeder K, Fahey T. Over-the-counter (OTC) medications for acute cough in children and adults in community settings.. Cochrane Database Syst Rev. 2014 : p.CD001831. doi: 10.1002/14651858.CD001831.pub5 . | Open in Read by QxMD
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