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bronchitis
Acute Bronchitis
By Sanjay Sethi, MD, School of Medicine and Biomedical Sciences, University at
Buffalo SUNY
NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
Acute Bronchitis
Acute Bronchitis
Acute inflammation of the tracheobronchial tree in patients with underlying chronic bronchial
disorders (eg, COPD, bronchiectasis, cystic fibrosis) is considered an acute exacerbation of
that disorder rather than acute bronchitis. In these patients, the etiology, treatment, and
outcome differ from those of acute bronchitis (see also Treatment of Acute COPD
Exacerbation).
On resolution, cough is the last symptom to subside and often takes 2 to 3 wk or even longer
to do so.
Diagnosis
Clinical evaluation
Sometimes chest x-ray to exclude other disorders
Sputum Gram stain and culture usually have no role. Nasopharyngeal samples can be tested
for influenza and pertussis if these disorders are clinically suspected (eg, for pertussis,
persistent and paroxysmal cough after 10 to 14 days of illness, only sometimes with the
characteristic whoop and/or retching, exposure to a confirmed casesee also Pertussis :
Diagnosis).
Cough resolves within 2 wk in 75% of patients. Patients with persistent cough should
undergo a chest x-ray. Evaluation for noninfectious causes, including postnasal drip and
gastroesophageal reflux disease, can usually be done clinically. Differentiation of cough-
variant asthma may require pulmonary function testing.
Treatment
Symptom relief (eg, acetaminophen, hydration, possibly antitussives)
Inhaled -agonist or anticholinergic for wheezing
Acute bronchitis in otherwise healthy patients is a major reason that antibiotics are overused.
Nearly all patients require only symptomatic treatment, such as acetaminophen and
hydration. Evidence supporting efficacy of routine use of other symptomatic treatments, such
as antitussives, mucolytics, and bronchodilators, is weak. Antitussives should be considered
only if the cough is interfering with sleep (see Treatment). Patients with wheezing may
benefit from an inhaled 2-agonist (eg, albuterol) or an anticholinergic (eg, ipratropium) for a
few days. Oral antibiotics are typically not used except in patients with pertussis or during
known outbreaks of bacterial infection. A macrolide such as azithromycin 500 mg po once,
then 250 mg po once/day for 4 days or clarithromycin 500 mg po bid for 14 days is given.
Treat most cases of acute bronchitis in healthy patients without using antibiotics.
Key Points
Acute bronchitis is viral in > 95% of cases, often part of a URI.
Diagnose acute bronchitis mainly by clinical evaluation; do chest x-ray and/or other
tests only in patients who have manifestations of more serious illness.
Treat most patients only to relieve symptoms.