Acute Bronchitis

Background

• Acute bronchitis usually refers to a self-limiting, lower respiratory tract infection with cough as the predominant feature.
• Viruses are a far more common cause of acute bronchitis in adults than bacteria.
• Symptoms typically arise due to acute inflammation of the bronchial mucosa.
• Other than acute cough, individuals may experience sputum production, breathlessness, wheeze, and mild chest discomfort; concomitant features of an upper respiratory tract infection such as a sore throat, coryza, nasal congestion and low grade fever may also be present
• Symptoms may commonly persist for 2-3 weeks, although the cough may persist for longer.

Evaluation

• Consider the diagnosis of acute bronchitis in patients with abrupt onset of cough and sputum production with no clinical features of other common conditions such as pneumonia, acute asthma or an exacerbation of chronic obstructive pulmonary disease (COPD).
• There are no clear diagnostic criteria established and considerable overlap with features of an upper respiratory infection exist.
• Do not perform imaging or laboratory testing in most patients with uncomplicated acute bronchitis,
• Sputum color does not appear to predict presence of bacterial infection in patients with acute bronchitis.

Management

• Do not use antibiotics for uncomplicated acute bronchitis in adults, regardless of duration of cough, due to modest benefit and potential harms (Strong recommendation).
• Encourage smoking cessation (Strong recommendation).
• Short term, as required use of a beta2-agonists such as albuterol via pressurized metered dose inhaler might provide symptom relief (especially in the presence of wheeze), but benefit may be limited to adults with asthma or COPD.
• For adults seeking an antitussive (for short term use only), nonprescription agents with some evidence of efficacy are dextromethorphan, guaifenesin, dexbrompheniramine/pseudoephedrine, and bromhexine.
• Codeine is not an effective antitussive and should be avoided.