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acute bronchitis


  • acute bronchitis is a common cause of cough, and it is generally a diagnosis of exclusion of more serious conditions such as community acquired pneumonia (CAP) in adults
  • >85% are viral and there is limited evidence that antibiotics are of use in healthy individuals

clinical features

  • starts as annoying dry cough with minimal fever, headache, coryzal symptoms
  • may develop myalgias, fevers, fatigue
  • cough generally becomes frequent enough to impair sleep
  • after several days cough becomes productive of white/yellow and possibly blood-stained sputum, and lasts at least 10-14 days
  • the cough lasts for less than 3 weeks in 50% of patients, but for more than 1 month in 25% of patients - especially if it is adenoviral


Mx of probable acute bronchitis in previously well adults

  • exclude serious conditions such as pneumonia, red flags include:
    • presence of complicating underlying disease such as malignancy or immune deficiency
    • SOB
    • tachycardia
    • tachypnoea
    • chest pain
    • haemoptysis
    • hypotension
    • worsening clinical state
  • CXR to exclude pneumonia, etc if either:
    • HR > 100
    • RR > 24
    • oral temp > 38°C
    • chest exam suggests consolidation
  • if no red flags, generally no need for blood tests, sputum cultures (sputum tests have low sensitivity and specificity), viral analysis or serology
    • adenoviral infections may cause a raised CRP thus a raised CRP does not mean it is bacterial
    • the color of the sputum has no predictive value for the diagnosis of bacterial bronchitis or the differentiation between pneumonia and bronchitis
  • expectorants and antitussives are generally of no benefit
  • antibiotics probably will do more harm than the potential good of reducing duration by half a day in a subgroup of patients - consider in the 1st week if high risk of it being pertussis
  • beta 2 adrenergic agonists only if patient has asthma or is wheezy
  • advise to abstain from smoking
  • encourage fluid intake, rest, analgesics, and, nasal decongestants if blocked nose is an issue
  • patients should expect the cough to last at least 10-14 days and maybe several weeks
  • if the cough persists > 8 weeks then detailed investigation may be warranted
acute_bronchitis.txt · Last modified: 2017/03/10 13:26 (external edit)