You are on page 1of 7

2/12/2019 Acute Bronchitis - StatPearls - NCBI Bookshelf

Acute Bronchitis
Singh A, Zahn E.

Introduction
Acute bronchitis is an inflammation of the lining of the bronchi of lungs. It is a very common presentation in an emergency department,
urgent care center, and primary care office. About 5% of adults have an episode of acute bronchitis each year. An estimated 90% of these
seek medical advice for the same. In the United States, acute bronchitis is among the top ten most common illness among outpatients. Acute
bronchitis typically lasts ten to 20 days (median in a study was 18 days) but can last for more than 4 weeks.[1][2]

Etiology
Acute bronchitis is most commonly due to viruses and is usually self-limiting. Approximately 95% of acute bronchitis in healthy adults are
secondary to viruses. It can sometimes be caused by allergens, irritants, and bacteria. Irritants include smoke inhalation, polluted air
inhalation, dust, among others.[3]

Epidemiology
Like most of the viral diseases of the respiratory tract, acute bronchitis is most commonly seen during the flu season. In the United States,
flu season is most common during autumn and winter. It can follow any viral upper respiratory infection (URI). The common pathogens are
a respiratory syncytial virus, Influenza virus A and B, Parainfluenza, rhinovirus, and similar viruses.

Factor like a history of smoking, living in a polluted place, crowding, and a history of asthma, are all risk factors for acute bronchitis. In
some people, acute bronchitis can be triggered by particular allergens like pollens, perfume, and vapors.

https://www.ncbi.nlm.nih.gov/books/NBK448067/ 1/7
2/12/2019 Acute Bronchitis - StatPearls - NCBI Bookshelf

When the infection is bacterial, the isolated pathogens are usually the same as those responsible for community-acquired pneumonia, for
example, Streptococcus pneumonia and Staphylococcus aureus.[4][5]

Pathophysiology
Sometimes when a person suffers from URI, the inflammation reaches down to bronchi, causing acute inflammation of bronchi, and the
result is bronchitis. Sometimes allergens and pollutants can cause similar inflammation as well. Rarely, in healthy adults, and more often in
immunocompromised adults or an at-risk population, this inflammation may be due to a bacterial pathogen.

History and Physical


An acute bronchitis patient presents with a productive cough, malaise, difficulty breathing, and wheezing. Usually, their cough is clear or
yellowish, although sometimes it can be purulent. The symptoms may have been preceded by URI symptoms of a runny nose, sore throat,
fever, and malaise. A low-grade fever may be present as well. Having high fevers in the setting of acute bronchitis is unusual.

On physical exam, lungs may have wheezing and some rhonchi. Tachycardia can be present reflecting fever as well as dehydration
secondary to the viral illness. Rest of the systems are typically within normal limits.

Evaluation
Usually, acute bronchitis is a clinical diagnosis based on history, past medical history, lung exam, and other physical findings. Oxygen
saturation plays an important role in judging the severity of the disease along with the pulse rate, temperature, and respiratory rate. In more
severe cases a more detailed pulmonary function assessment may be warranted, including forced expiratory volume testing.[6]

A chest x-ray may be needed to differentiate from pneumonia. In cases of acute bronchitis, there is no definitive chest x-ray finding, and it is
typically read as normal. Sometimes it can reflect changes of reactive airway disease. However, infiltrates are not seen.

Complete blood count and chemistry may be ordered as workup for fever. White blood count might be mildly elevated in some cases of
acute bronchitis. Blood chemistry can reflect dehydration changes.
https://www.ncbi.nlm.nih.gov/books/NBK448067/ 2/7
2/12/2019 Acute Bronchitis - StatPearls - NCBI Bookshelf

If there are a persistent cough and hypoxia and the history does not point towards a viral illness or reactive airway disease, then other
pathologies like pulmonary emboli should be considered.

Treatment / Management
Treatment of acute bronchitis is typically symptomatic control and supportive therapy. Analgesic and antipyretic agents may be used to treat
associated malaise, myalgia, and fever. Nebulizer and inhalers can be given to help with reactive airway resulting from inflammation. They
can help relieve bronchospasm and wheezing. Prednisone or other steroids can be given to help with the inflammation as well. Although
there is not enough evidence showing their benefit, it is useful in patients with underlying chronic obstructive pulmonary disease (COPD) or
asthma. Typically steroid is used as short-term burst therapy. Sometimes longer tapering dose of steroid might be warranted, especially in
patients with underlying asthma or COPD. Cough relief can be provided using cough suppressants like benzoate and codeine. A mucolytic
can be used to clear mucus and avoid plugging. If there is an allergic component, then an anti-allergenic can help relieve symptoms.
Humidifier use can also achieve symptomatic relief.[7][8]

Antibiotic is typically not indicated for simple acute bronchitis in otherwise healthy adults. It should be used only in cases where chances of
bacterial bronchitis are high or at special risk populations. Procalcitonin might be useful in deciding on antibiotic use. A Cochrane review of
nine randomized, controlled trials of antibiotic agents showed a minor reduction in the total duration of a cough (0.6 days). The decrease in
the number of days of illness was not significant per this review. Hence antibiotic use should be avoided in simple cases considering the cost
of antibiotic, the growing global problem of antibiotic resistance and the possible side effects of antibiotic usage.

Lifestyle modification like smoking cessation and the avoidance of allergens and pollutants play an important role in avoidance of
recurrence and complications. Flu vaccine and pneumonia vaccine are especially recommended in special groups including adults older than
65, children younger than two years (older than six months), pregnant women, and residents of nursing homes and long-term care facilities.
People with asthma, COPD, and other immunocompromised adults are also at higher risk of developing complications. Recurrence is seen
in up to a third of the cases of acute bronchitis.

Data for the use of beta-agonist, steroids, and mucolytic agent, especially in patients with no underlying COPD and asthma, is lacking.
Treatment should be guided by the individual response to them and reported benefit, as well as, weighing risk and benefit in each case.

https://www.ncbi.nlm.nih.gov/books/NBK448067/ 3/7
2/12/2019 Acute Bronchitis - StatPearls - NCBI Bookshelf

Differential Diagnosis
Acute/chronic sinusitis
Bronchiolitis
Asthma
COPD
GERD
Viral pharyngitis

Pearls and Other Issues


Sometimes secondary pneumonia can develop. This is usually indicated by worsening symptoms, productive cough and fever. In such cases,
a chest x-ray is indicated. This is especially important in immunocompromised adults, elderly population, infants and newborns, and
smokers. Pulmonary emboli should always be in differentials in a patient with a cough and shortness of breath. Sometimes aggressive
coughing can lead to spontaneous pneumothorax and or spontaneous pneumomediastinum. Hence any acute worsening of symptoms usually
requires a chest x-ray.

Enhancing Healthcare Team Outcomes


A multidisciplinary approach to acute bronchitis

Acute bronchitis is a very common disorder that frequently presents to the emergency department or the primary provider's office. It is a
very common cause of absenteeism from work/school. The condition is best managed by a multidisciplinary team that includes a primary
care provider, nurse, a pharmacist, and a pulmonologist. The key is patient education. Patients should be urged to stop smoking and avoid
exposure to secondhand smoke. These individuals should get the influenza and pneumococcal vaccines to reduce the morbidity. In addition,
the nurse and pharmacist should encourage hand washing to limit the spread of micro-organisms.

https://www.ncbi.nlm.nih.gov/books/NBK448067/ 4/7
2/12/2019 Acute Bronchitis - StatPearls - NCBI Bookshelf

The outcomes of patients with acute bronchitis are good; however, it is a common reason for absenteeism from work. In some patients with
underlying COPD and other lung problems, acute bronchitis can have a high morbidity. Patients whose symptoms persist for more than six
weeks need to be re-evaluated to ensure that the diagnosis is correct.[9][10] (Level V)

Questions
To access free multiple choice questions on this topic, click here.

References
1. Pulia M, Redwood R, May L. Antimicrobial Stewardship in the Emergency Department. Emerg. Med. Clin. North Am. 2018
Nov;36(4):853-872. [PubMed: 30297009]
2. Saust LT, Bjerrum L, Siersma V, Arpi M, Hansen MP. Quality assessment in general practice: diagnosis and antibiotic treatment of acute
respiratory tract infections. Scand J Prim Health Care. 2018 Dec;36(4):372-379. [PubMed: 30296885]
3. Tanner M, Karen Roddis J. Antibiotics for acute bronchitis. Nurs Stand. 2018 Feb 28;32(27):41-43. [PubMed: 29488727]
4. Kronman MP, Zhou C, Mangione-Smith R. Bacterial prevalence and antimicrobial prescribing trends for acute respiratory tract
infections. Pediatrics. 2014 Oct;134(4):e956-65. [PubMed: 25225144]
5. Bai L, Su X, Zhao D, Zhang Y, Cheng Q, Zhang H, Wang S, Xie M, Su H. Exposure to traffic-related air pollution and acute bronchitis
in children: season and age as modifiers. J Epidemiol Community Health. 2018 May;72(5):426-433. [PubMed: 29440305]
6. Irwin RS, French CL, Chang AB, Altman KW., CHEST Expert Cough Panel*. Classification of Cough as a Symptom in Adults and
Management Algorithms: CHEST Guideline and Expert Panel Report. Chest. 2018 Jan;153(1):196-209. [PubMed: 29080708]
7. Smith DRM, Dolk FCK, Pouwels KB, Christie M, Robotham JV, Smieszek T. Defining the appropriateness and inappropriateness of
antibiotic prescribing in primary care. J. Antimicrob. Chemother. 2018 Feb 01;73(suppl_2):ii11-ii18. [PMC free article: PMC5890733]
[PubMed: 29490061]
8. Llor C, Bjerrum L. Antibiotic prescribing for acute bronchitis. Expert Rev Anti Infect Ther. 2016 Jul;14(7):633-42. [PubMed:
27219826]

https://www.ncbi.nlm.nih.gov/books/NBK448067/ 5/7
2/12/2019 Acute Bronchitis - StatPearls - NCBI Bookshelf

9. Bettoncelli G, Blasi F, Brusasco V, Centanni S, Corrado A, De Benedetto F, De Michele F, Di Maria GU, Donner CF, Falcone F, Mereu
C, Nardini S, Pasqua F, Polverino M, Rossi A, Sanguinetti CM. The clinical and integrated management of COPD. Sarcoidosis Vasc
Diffuse Lung Dis. 2014 May 12;31 Suppl 1:3-21. [PubMed: 24820963]
10. Palmer R, Anon JB, Gallagher P. Pediatric cough: what the otolaryngologist needs to know. Curr Opin Otolaryngol Head Neck Surg.
2011 Jun;19(3):204-9. [PubMed: 21499103]

Publication Details

Author Information

Authors

Anumeha Singh1; Elise Zahn.

Affiliations
1 UConn/Hartford Hospital

Publication History

Last Update: November 15, 2018.

Copyright
Copyright © 2018, StatPearls Publishing LLC.

This book is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits
use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, a
link is provided to the Creative Commons license, and any changes made are indicated.

https://www.ncbi.nlm.nih.gov/books/NBK448067/ 6/7
2/12/2019 Acute Bronchitis - StatPearls - NCBI Bookshelf

Publisher

StatPearls Publishing, Treasure Island (FL)

NLM Citation

Singh A, Zahn E. Acute Bronchitis. [Updated 2018 Nov 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-.

https://www.ncbi.nlm.nih.gov/books/NBK448067/ 7/7

You might also like