ACUTE BRONCHITIS

 Acute bronchitis is inflammation of the upper airways, commonly following a URI. The
cause is usually a viral infection, though it is sometimes a bacterial infection; the
pathogen is rarely identified. The most common symptom is cough, with or without fever,
and possibly sputum production. In patients with COPD, hemoptysis, burning chest pain,
and hypoxemia may also occur. Diagnosis is based on clinical findings. Treatment is
supportive; antibiotics are necessary only for selected patients with chronic lung disease.
Prognosis is excellent in patients without lung disease, but in patients with COPD, acute
respiratory failure may result.
 Acute bronchitis is frequently a component of a URI caused by rhinovirus, parainfluenza,
influenza A or B, respiratory syncytial virus, coronavirus, or human metapneumovirus.
Less common causes may be Mycoplasma pneumoniae,Bordetella pertussis,
and Chlamydia pneumoniae. Patients at risk include those who smoke and those with
COPD or other diseases that impair bronchial clearance mechanisms, such as cystic
fibrosis or conditions leading to bronchiectasis.

Symptoms and Signs

Symptoms are a nonproductive or minimally productive cough accompanied or preceded by URI
symptoms. Subjective dyspnea results from chest pain or tightness with breathing, not from
hypoxia, except in patients with underlying lung disease. Signs are often absent but may include
scattered rhonchi and wheezing. Sputum may be clear, purulent, or, occasionally, bloody.
Sputum characteristics do not correspond with a particular etiology (ie, viral vs bacterial). Mild
fever may be present, but high or prolonged fever is unusual and suggests influenza or
pneumonia.

On resolution, cough is the last symptom to subside and often takes several weeks or even
longer to do so.

Diagnosis
 Clinical evaluation
 Sometimes, chest x-ray
Diagnosis is based on clinical presentation. Chest x-ray is necessary only if findings suggest
pneumonia (eg, abnormal vital signs, crackles, signs of consolidation, hypoxemia). Elderly
patients are the occasional exception. They may require chest x-ray for productive cough and
fever in the absence of auscultatory findings (particularly if there is a history of COPD or another
lung disorder).

Sputum Gram stain and culture usually have no role.

Cough resolves within 2 wk in 75% of patients. Patients with persistent cough should undergo a
chest x-ray. Evaluation for pertussis, with a culture from nasopharyngeal secretions, and
noninfectious etiologies, such as postnasal drip, allergic rhinitis, and cough-variant asthma, may
be needed.

Treatment
 Symptomatic relief ( acetaminophen , hydration, possibly antitussives)
 Inhaled β-agonist or anticholinergic for wheezing
 Sometimes oral antibiotics for patients with COPD
Acute bronchitis in otherwise healthy patients is a major reason that antibiotics are overused.
Nearly all patients require only symptomatic treatment, such asacetaminophen and hydration.
Antitussives should be used only if the cough is interfering with sleep. Patients with wheezing
may benefit from an inhaled β2-agonist (eg, albuterol) or an anticholinergic (eg, ipratropium )
for ≤ 7 days. If cough persists for > 2 wk because of airway irritation, some patients benefit from
a few days of inhaled corticosteroids. Oral antibiotics are typically not used except in patients
with pertussis or in patients with COPD who have at least 2 of the following:

 Increased cough
 Increased dyspnea
 Increase in sputum purulence
Drugs include amoxicillin 
500 mg po tid for 7 days, doxycycline 
100 mg po bid for 7 days, azithromycin 
500 mg po once/day for 4 days, or trimethoprim-sulfamethoxazole
160/800 mg po bid for 7 days.