Acute Bronchitis – Causes, Symptoms, Diagnosis, Treatment and Ongoing care
- Inflammation of trachea, bronchi, and bronchioles resulting from a respiratory tract infection or chemical irritant (1,2)
- Cough is the predominant symptom (3).
- Generally self-limited, with complete healing and full return of function
- Most infections are viral if no underlying cardiopulmonary disease is present.
- Synonym(s): Tracheobronchitis, chest cold
Can be serious, particularly if part of influenza, with underlying chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF) (3)
- Usually occurs in association with other conditions of upper and lower respiratory tract (trachea usually involved) (4)
- If repeated attacks occur, child should be evaluated for anomalies of the respiratory tract, including immune deficiencies or for chronic asthma.
- When acute bronchitis is caused by respiratory syncytial virus (RSV), it may be fatal.
- Predominant age: All ages
- Predominant gender: Male = Female.
- ∼5% of adults per year (3)
- A common cause of infection in children (4)
Results in 10–12 million office visits per year (3)
- Air pollutants
- Secondhand smoke
- Environmental changes
- Chronic bronchopulmonary diseases
- Chronic sinusitis
- Bronchopulmonary allergy
- Hypertrophied tonsils and adenoids in children
- Immunoglobulin deficiency
- HIV infection
- Gastroesophageal reflux disease (GERD)
No known genetic pattern
- Avoid smoking.
- Control underlying risk factors (i.e., asthma, sinusitis, and reflux).
- Avoid exposure, especially day care.
- Pneumovax, influenza immunization
Acute bronchitis causes an injury to the epithelial surfaces, resulting in an increase in mucous production (2) and thickening of the bronchiole wall (1).
- Viral infections, such as adenovirus, influenza A and B, parainfluenza virus, coxsackievirus, RSV, rhinovirus, coronavirus (types 1–3), herpes simplex virus
- Bacterial infections, such as Chlamydia pneumoniae [Taiwan acute respiratory (TWAR) agent], Mycoplasma, Bordetella pertussis, Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, and Mycobacterium tuberculosis
- Secondary bacterial infection as part of an acute upper respiratory infection
- Possibly fungal infections
- Chemical irritants
Commonly Associated Conditions
- Allergic rhinitis
- Epiglottitis (rare but can be rapidly fatal)
- Sudden onset of cough and no evidence of pneumonia, asthma, exacerbation of COPD, or the common cold (3)
- Cough is initially dry and unproductive, then productive; later, mucopurulent sputum, which may indicate secondary infection
- Dyspnea, wheeze, fever, and fatigue may occur.
- Possible contact with others who have respiratory infections (1)
- Pharynx injected
- Rales, rhonchi, wheezing
- No evidence of pulmonary consolidation
Diagnostic Tests & Interpretation
Initial lab tests
- Sputum culture/sensitivity if purulent
- Influenza titers (if appropriate for time of year)
- White blood cell (WBC)
Follow-Up & Special Considerations
- Arterial blood gases: Hypoxemia (rarely)
- Pulmonary function tests (seldom needed during acute stages): Increased residual volume, decreased maximal expiratory rate (2)
- Lungs normal if uncomplicated
- Helps to rule out other diseases (pneumonia) or complications
- Common cold
- Acute sinusitis
- Bacterial tracheitis
- Reactive airways dysfunction syndrome (RADS)
- Eosinophilic pneumonitis
- Retained foreign body
- Inhalation injury
- Cystic fibrosis
- Bronchogenic carcinoma
- Heart failure
Antibiotics are usually not recommended (1,3,5)[A] unless a treatable pathogen has been identified or significant comorbidities are present.
- Amantadine or rimantadine therapy if influenza A is suspected; most effective if started within 24–48 h of development of symptoms [also consider oseltamivir (Tamiflu) or zanamivir (Relenza)]
- Decongestants if accompanied by sinus condition (1)
- Antipyretic analgesic, such as aspirin, acetaminophen, or ibuprofen
- Antibiotics if a treatable cause (i.e., pertussis) is identified (5)[A]:
- Amoxicillin 500 mg q8h or trimethoprim-sulfamethoxazole DS q12h for routine infection
- Penicillins and trimethoprim-based regimens seem to be equivalent in terms of effectiveness and toxicity for acute bacterial exacerbations of chronic bronchitis (ABECB) (6)[B].
- Clarithromycin (Biaxin) 500 mg q12h or azithromycin (Zithromax) Z-pack for penicillin allergy or Mycoplasma infection: In patients with acute bronchitis of a suspected bacterial cause, azithromycin tends to be more effective in terms of lower incidence of treatment failure and adverse events than amoxicillin or amoxycillin-clavulanicacid (7)[B].
- Doxycycline 100 mg/d × 10 days if Moraxella, Chlamydia, or Mycoplasma suspected
- Quinolone for more serious infections or other antibiotic failure or in elderly or patients with multiple comorbidities
- Macrolide for pertussis (1)[A]
- Cough suppressant for troublesome cough (not with COPD); guaifenesin with codeine or dextromethorphan (3)[A]
- Inhaled beta agonist (e.g., albuterol) or in combination with steroids for cough with bronchospasm (2,3)[B]
- Consider steroids for bronchospasm
- Contraindication(s): Doxycycline should not be used during pregnancy or in children.
- Watch for theophylline toxicity with macrolides and quinolones.
- Multiple antibiotics have the potential to interfere with the effectiveness of oral contraceptives.
- Other antibiotics if indicated by sputum culture (Moraxella needs a different set of antibiotics)
- Other macrolides or quinolones based on pathogen and sensitivity
- Stop smoking/avoid smoke.
- Steam inhalations
- Adequate hydration
- Antibiotics are usually not recommended (1,3,5)[A].
- Treat associated illnesses (e.g., GERD).
Issues for Referral
- Complications, such as pneumonia or respiratory failure
- Comorbidities, such as COPD
- Cough lasting longer than 3 months
Antipyretic for fever (e.g., acetaminophen, aspirin, or ibuprofen)
Complementary and Alternative Medicine
Throat lozenges for pharyngitis
- Outpatient, unless elderly or complicated by severe underlying disease
- May require supplemental oxygen in selected patients
- Bronchodilators if patient is bronchospastic
- Severe bronchospasm
- Exacerbation of underlying disease
May be helpful if patient is dehydrated
- Ensure patient comfort and monitor for signs of deterioration, especially if underlying lung disease exists.
- May need to follow oxygen saturation in patients with underlying lung disease
Improvement in symptoms and comorbidities
- Usually a self-limited disease not requiring follow-up
- Cough may linger for several weeks.
- In children, if recurrent, need to consider other diagnoses, such as asthma (4)
- Oximetry until no longer hypoxemic
- Recheck for chronicity.
Increased fluids (3–4 L/d) while febrile
- For patient education materials favorably reviewed on this topic, contact the American Lung Association, 1740 Broadway, New York, NY 10019, (212) 315-8700; www.lungusa.org.
- American Academy of Family Physicians: www.familydoctor.org
- Usual: Complete resolution
- Can be serious in the elderly or debilitated
- Cough may persist for several weeks after an initial improvement (1,2).
- Postbronchitic reactive airways disease (rare)
- Bronchiolitis obliterans and organizing pneumonia (rare)
- Superinfection such as bronchopneumonia
- Acute respiratory failure
- Chronic cough
1. Wenzel RP, Fowler AA. Clinical practice. Acute bronchitis. N Engl J Med. 2006;355:2125–30.
2. Knutson D, Braun C. Diagnosis and management of acute bronchitis. Am Fam Physician. 2002;65:2039–44.
3. Braman SS. Chronic cough due to acute bronchitis: ACCP evidence-based clinical practice guidelines. Chest. 2006;129:95S–103S.
4. Fleming DM, Elliot AJ. The management of acute bronchitis in children. Expert Opin Pharmacother. 2007;8:415–26.
5. Fahey T, et al. Antibiotics for acute bronchitis. Cochrane Database Syst Rev. 2004;4:CD000245. DOI:10.1002/14651858.CD000245.pub2.
6. Korbila IP, Manta KG, Siempos II, et al. Penicillins vs trimethoprim-based regimens for acute bacterial exacerbations of chronic bronchitis: Meta-analysis of randomized controlled trials. Can Fam Physician.2009;55:60–7.
7. Panpanich R, Lerttrakarnnon P, Laopaiboon M. Azithromycin for acute lower respiratory tract infections. Cochrane Database Syst Rev. 2008;CD001954.
See Also (Topic, Algorithm, Electronic Media Element)
Asthma; Chronic Obstructive Pulmonary Disease and Emphysema
466.0 Acute bronchitis
10509002 Acute bronchitis (disorder)
- Acute bronchitis is a common and generally self-limited disease.
- Usually does not require treatment with antibiotics
- Cough may linger for several weeks.
- Recurrent or seasonal episodes may suggest another disease process, such as asthma.