Acute Bronchitis
- self-limiting lower respiratory tract infection, most common cause of cough in the general practice setting.
definition:
- Acute cough (productive or nonproductive) +
- signs of a lower respiratory tract infection
- Sputum production
- Dyspnoea
- Wheeze
- Chest discomfort
- less than 14 days duration
- There should be no other obvious cause, eg. asthma, sinusitis, COPD
- Patients with chronic lung disease:
- pneumonia
- COPD
- bronchiectasis.
Causes
- respiratory viruses – 90% of cases.
- atypical pathogens
- Mycoplasma pneumoniae
- Chlamydophila pneumoniae
Assessment
- nonspecific symptoms of upper or lower respiratory tract infection
- cough
- cough lasts on average 2 to 3 weeks
- 90% of patients, resolves by 4 weeks
- Persistent cough is the main reason patients seek medical treatment for acute bronchitis, reinforced by anxiety about slow recovery time
- If cough is not the predominant clinical feature, consider URTI such as acute rhinosinusitis, acute tonsillitis and pharyngitis
- purulent or coloured sputum (is not predictive of a bacterial infection)
- dyspnoea
- wheeze
- chest discomfort or pain (due to frequent coughing)
- nasal congestion
- headache
- fever.
Due to the nonspecific nature of symptoms need to exclude other causes of cough
DDX
- pneumonia
- tachypnoea at rest
- tachycardia
- persistent fever/rigors
- hypoxaemia
- crepitations (crackles) on auscultation that do not clear with coughing.
- pertussis
- paroxysmal cough or recent exposure to a pertussis case
- asthma
- wheeze could represent a new diagnosis of asthma
- heart failure
- signs of oedema
Investigations
- nasal and throat swabs for polymerase chain reaction (PCR)
- Chest X-ray : not indicated for patients with acute bronchitis
- Chest X-ray should be considered if a patient has any combination of:
- heart rate >100 minute
- respiratory rate >24 minute
- temperature >38°C
- night sweats, or
- focal chest signs
- Sputum culture is of limited value in community settings because of nasopharyngeal contamination, and it is thought that outcomes are unrelated to the identified pathogen.
Management of acute bronchitis
- antibiotics are not indicated
- Reassure the patient that acute bronchitis is a self-limiting condition, caused by a virus in over 90% of cases.
- Advise
- fluids and paracetamol
- rest
- sickness certification as appropriate.
- use of bronchodilators for acute bronchitis although common is not supported by recent research (Are beta2-agonists effective treatment for acute bronchitis or acute cough in patients without underlying pulmonary disease? A systematic review)
- No enough evidence for or against the use of cough suppressants (Over-the-counter (OTC) medications for acute cough in children and adults in ambulatory settings – (Smith SM, Schroeder K, Fahey T. Cochrane Database Syst Rev. 2012)
- If antibiotics are expected or requested by the patient
- delayed prescribing
- patient information leaflets
- Set realistic expectations of the time for symptoms to improve(Occasionally, the cough may persist for up to 8 weeks. Acknowledge that this is frustrating)