Acute bronchitis

Acute bronchitis

Acute bronchitis is defined as an acute self-limited lower respiratory tract infection manifested predominantly by cough, with or without sputum production, lasting no more than 3 weeks, with no clinical or recent radiographic evidence to suggest an alternative explanation.

In acute bronchitis, isolated causative organisms include:

Viral causes

• Influenza A virus

• Influenza B virus

• Parainfluenza virus

• Respiratory syncytial virus (RSV)

• Coronavirus

• Adenovirus

• Rhinovirus

Bacterial causes

• Bordetella pertussis

• Chlamydophila (Chlamydia) pneumoniae

• Mycoplasma pneumoniae

Clinical presentation

• Patients with acute bronchitis present with a cough lasting more than five days (typically one to three weeks), which may be associated with sputum production.

• Cough in the absence of fever, tachycardia, and tachypnoea suggests bronchitis.

• Acute bronchitis should be distinguished from chronic bronchitis (see below); it is not a form of COPD.

Investigations in COPD (bronchitis and emphysema)

• FBP

• ESR/CRP or Procalcitonin

• Serum alpha-1 antitrypsin levels

• Chest radiography (if the patient is elderly or physical findings suggest pneumonia)

• Sputum cytology (if the cough is persistent)

• Blood culture and microbial sensitivity (if bacterial super-infection is suspected)

• Bronchoscopy (to exclude foreign body aspiration, tuberculosis, tumours, and other chronic diseases, and in patients with worsening symptoms)

• Lung function tests (spirometry and peak expiratory flow rate)

Symptomatic treatment

• Non-steroidal anti-inflammatory drugs:

  • Paracetamol

  • Acetyl salicylic acid

• Cough management: Refer to Section 9.1.1

• There is NO benefit from antibiotic use in acute bronchitis.

• Discourage smoking and other irritating factors.