INTRODUCTION

Section 2 of 9  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• References

Background

Acute bronchitis refers simply to inflammation of the tracheobronchial tree. The cause is usually infectious, but allergens and irritants can produce a similar clinical picture. Bronchitis typically occurs in the setting of an upper respiratory illness; thus, it is observed more frequently in the winter months. Asthma can be mistakenly diagnosed as acute bronchitis if the patient has no prior history of asthma. In one study, one third of patients who had been determined to have recurrent bouts of acute bronchitis were eventually identified as having asthma.

Chronic bronchitis and acute exacerbations of chronic bronchitis are discussed in the eMedicine article Chronic Obstructive Pulmonary Disease and Emphysema.

Pathophysiology

Although bronchitis refers to inflammation of the trachea and bronchi, other segments of the respiratory tract may also be involved because acute bronchitis usually occurs in relation to the common cold or other respiratory illness.

Frequency

United States

According to the National Center for Health Statistics, more than 12 million cases of acute bronchitis occurred in 1994, a number roughly equal to 5% of the US population.¹ In comparison, 91 million cases of influenza, 66 million cases of the common cold, and 31 million cases of other acute upper respiratory infections occurred during that same year.

International

Acute bronchitis is common throughout the world and is one of the top 5 reasons for seeking health care in countries that track such data.

Mortality/Morbidity

Bronchitis is nearly always self-limited in the otherwise healthy individual, although it frequently results in absenteeism from work and school. Severe cases occasionally produce deterioration in those with significant underlying cardiopulmonary disease or other comorbid conditions.

Sex

Although bronchitis seems to be diagnosed in women more frequently than in men, little difference is observed.

Age

Although found in all age groups, bronchitis is diagnosed most frequently in children younger than 5 years. In 1994, bronchitis was diagnosed in more than 11 of every 100 children younger than 5 years.¹ This compared with only 4 of every 100 individuals in every other age group.

CLINICAL

Section 3 of 9  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• References

History

• A purulent cough is generally the defining presentation for acute bronchitis.
• The following symptoms may also be present:
• • Fever
  • Malaise
  • Rhinorrhea or nasal congestion
  • Sore throat
  • Wheezing
  • Dyspnea
  • Chest pain
  • Myalgias or arthralgias
• Occupational history may be important in determining whether irritants play a role.

Physical

• No uniform definition describes acute bronchitis. The physical examination findings may include rhonchi or wheezes; in most cases, the examination findings are unremarkable.
• Occasionally, findings may suggest a particular etiology.
• • Bullous myringitis suggests Mycoplasma pneumoniae infection, although it is not specific.
  • Conjunctivitis and adenopathy suggest adenovirus, although these are also not specific.

Causes

• Influenza, parainfluenza, adenovirus, rhinovirus, and numerous other viruses have been implicated.
• M pneumoniae and Chlamydia pneumoniae have also been implicated, but the role of other bacterial pathogens remains difficult to validate given the difficulties associated with collecting adequate sputum samples and the problem of asymptomatic carriage of putative pathogens such as Streptococcus pneumoniae and Haemophilus influenzae.
• Bordetella pertussis should be considered in children who are incompletely vaccinated; however, studies increasingly report this bacterium as the causative agent in adults as well.²

DIFFERENTIALS

Section 4 of 9  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• References

Other Problems to be Considered

Acute sinusitis
Aspiration
Bacterial tracheitis
Bronchiectasis
Cystic fibrosis
Influenza
Reactive airway disease
Retained foreign body

WORKUP

Section 5 of 9  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• References

Imaging Studies

• Chest radiography
• • Chest radiography may be necessary to exclude pneumonia, particularly when abnormalities in either the vital signs or pulse oximetry readings are observed.
  • Lungs appear normal in uncomplicated cases.

TREATMENT

Section 6 of 9  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• References

Emergency Department Care

Care for acute bronchitis is primarily supportive and should ensure that the patient is adequately oxygenating.

MEDICATION

Section 7 of 9  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• References

Therapy is generally symptomatic and includes use of analgesics, antipyretics, antitussives, and expectorants. Among otherwise healthy individuals, antibiotics have not demonstrated consistent benefit in the symptomatology or natural history of acute bronchitis.^{3, 4} Nonetheless, surveys from Europe, Australia, and the United States show that 80% of patients with acute bronchitis receive antibiotics. Antibiotic overuse contributes to the emergence of drug-resistant organisms. Cognizant of this, the Centers for Disease Control and Prevention (CDC) recently collaborated with numerous medical societies to publish a series of articles on the judicious use of antibiotics for several common conditions, including bronchitis, and have recommended against routine antibiotic use in uncomplicated bronchitis.

Patients are up to 4 times more likely to expect antibiotics for the diagnosis of bronchitis than for a chest cold. Therefore, limiting use of the diagnosis bronchitis may make reduction of antibiotic use more acceptable to patients.

Reviews have also noted that antibiotic use in smokers without chronic obstructive pulmonary disease is no more effective than in nonsmokers.⁵

Several studies have shown conflicting results on the use of zinc as an adjunct treatment against influenza A.⁶ Some recent studies have shown favorable results; however, participants complained of a bad taste and significant nausea. Broader use of zinc cannot be recommended at this time.

Drug Category: Antibiotics

Studies have focused on healthy individuals (excluding people with asthma) or patients with chronic obstructive pulmonary disease. Antibiotics may offer a small beneficial effect in patients with chronic obstructive pulmonary disease. Therefore, extending antibiotic therapy to people with asthma and other patients with limited cardiopulmonary reserve may be reasonable. If an antibiotic is to be used, a macrolide is a reasonable first choice because the macrolides are active against mycoplasmal and chlamydial organisms and B pertussis.

Drug Category: Analgesics/antipyretics

These agents are used to control fever as well as myalgias and arthralgias.

Drug Category: Antitussives and expectorants

Little data on the efficacy of expectorants outside the test tube are available. The prototype antitussive, codeine, has been used successfully in some chronic cough and induced cough models;⁷ however, little clinical data on upper respiratory infections are available. Existing data indicate that codeine is slightly better or equal in efficacy to guaifenesin, dextromethorphan, or even placebo.

Drug Category: Bronchodilators

Studies have shown that bronchodilators are advantageous and may even be superior to antibiotics for bronchitis symptoms. However, patient numbers in trials are disappointingly few given how commonly acute bronchitis is diagnosed.

Drug Category: Antiviral agents

Influenza vaccinations offer greater protection for the appropriate populations because they offer coverage for influenza A and B. Amantadine and rimantadine have been demonstrated to be useful during epidemics of influenza A. Zanamivir and oseltamivir are the neuraminidase inhibitors that are now preferred for chemoprophylaxis during outbreaks of influenza A and B, although data from institutional outbreaks are limited.

FOLLOW-UP

Section 8 of 9  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• References

Deterrence/Prevention

• Patients with underlying cardiopulmonary disease should receive annual influenza vaccinations.
• In certain locations, such as in nursing homes, amantadine or rimantadine have been administered when an index case is found until the vaccine has had a chance to take effect. However, because of increasing resistance, their routine use has been discouraged by the CDC beginning in 2005 in favor of neuraminidase inhibitors.
• Influenza vaccination of healthy patients may reduce absenteeism.

Complications

• Fewer than 5% of patients with bronchitis develop pneumonia. Incidence of subsequent pneumonia, however, remains unaffected by the use of antibiotics.

Prognosis

• For the vast majority of patients, the prognosis is excellent.

Patient Education

• For excellent patient education resources, visit eMedicine's Lung and Airway Center and Allergy Center. Also, see eMedicine's patient education articles, Bronchitis and Coughs.

REFERENCES

Section 9 of 9

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• References

1. National Center for Health Statistics. Current estimates from the national health interview survey: United States, 1994. Vital health statistics. 1995;10. [Medline].
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3. Braman SS. Chronic cough due to acute bronchitis: ACCP evidence-based clinical practice guidelines. Chest. Jan 2006;129(1 Suppl):95S-103S. [Medline].
4. Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA. Sep 17 1997;278(11):901-4. [Medline].
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9. Croughan-Minihane MS, Petitti DB, Rodnick JE. Clinical trial examining effectiveness of three cough syrups. J Am Board Fam Pract. Mar-Apr 1993;6(2):109-15. [Medline].
10. Dunlay J, Reinhardt R, Roi LD. A placebo-controlled, double-blind trial of erythromycin in adults with acute bronchitis. J Fam Pract. Aug 1987;25(2):137-41. [Medline].
11. Gonzales R, Bartlett JG, Besser RE. Principles of appropriate antibiotic use for treatment of uncomplicated acute bronchitis: background. Ann Emerg Med. Jun 2001;37(6):720-7. [Medline].
12. Gonzales R, Wilson A, Crane LA, Barrett PH. What's in a name? Public knowledge, attitudes, and experiences with antibiotic use for acute bronchitis. Am J Med. Jan 2000;108(1):83-5. [Medline].
13. Huchon GJ, Gialdroni-Grassi G, Leophonte P, et al. Initial antibiotic therapy for lower respiratory tract infection in the community: a European survey. Eur Respir J. Aug 1996;9(8):1590-5. [Medline].
14. Hueston WJ. A comparison of albuterol and erythromycin for the treatment of acute bronchitis. J Fam Pract. Nov 1991;33(5):476-80. [Medline].
15. Hueston WJ. Albuterol delivered by metered-dose inhaler to treat acute bronchitis. J Fam Pract. Nov 1994;39(5):437-40. [Medline].
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17. Meza RA, Bridges-Webb C, Sayer GP, et al. The management of acute bronchitis in general practice: results from the Australian Morbidity and Treatment Survey, 1990-1991. Aust Fam Physician. Aug 1994;23(8):1550-3. [Medline].
18. Molfino NA. Genetics of COPD. Chest. May 2004;125(5):1929-40. [Medline].
19. Palmer DA, Bauchner H. Parents' and physicians' views on antibiotics. Pediatrics. Jun 1997;99(6):E6. [Medline].
20. Siegel D, Sande MA. Patterns of antibiotic use in a busy metropolitan emergency room: analysis of efficacy and cost-appropriateness. West J Med. May 1983;138(5):737-41. [Medline].
21. Smith NM, Bresee JS, Shay DK. Prevention and Control of Influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. Jul 28 2006;55(RR-10):1-42. [Medline].
22. Smucny J, Fahey T, Becker L, Glazier R. Antibiotics for acute bronchitis. Cochrane Database Syst Rev. 2004;CD000245. [Medline].
23. Snyder LD, Eisner MD. Obstructive lung disease among the urban homeless. Chest. May 2004;125(5):1719-25. [Medline].
24. Stott NC, West RR. Randomised controlled trial of antibiotics in patients with cough and purulent sputum. Br Med J. Sep 4 1976;2(6035):556-9. [Medline].
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Article Last Updated: May 12, 2008