bronchitis%20-%20uncomplicated%20acute
BRONCHITIS - UNCOMPLICATED ACUTE
Uncomplicated acute bronchitis is a self-limiting infection of the trachea and bronchi that usually lasts for 1 to 3 weeks. A healthy patient experiences sudden onset of cough, with or without sputum production.
An inflammatory response to infections of the bronchial epithelium of the large airways of the lungs that begins with mucosal injury, epithelial cell damage and release of proinflammatory mediators.
Transient airflow obstruction and bronchial hyperresponsiveness.
Purulence can result from either bacterial or viral infection.

Differential Diagnosis

Pertussis

  • An uncommon cause of uncomplicated acute bronchitis
  • May be present in up to 10-20% of adults with cough lasting >2-3 wk
    • Adults immunized as children but no longer having effective immunity may be a reservoir of B pertussis
    • No classic features of pertussis in adults (as there are in children) but generally presents as severe bronchitis
  • Pertussis may be considered in children suffering from severe spasmodic coughing, esp if terminated by vomiting or associated with redness of the face & catching of the breath
    • The incidence of pertussis in children has decreased due to widespread pertussis vaccination
  • Physicians should limit suspicion & treatment of adult pertussis to patients with a high probability of exposure (during outbreak in the community or if there is history of contact with a patient who has a known case)
  • If pertussis is suspected, a diagnostic test should be performed & antimicrobial therapy initiated
    • Diagnosis may be difficult to establish because of delay in suspicion of disease (cultures of nasopharyngeal secretions are usually negative after 2 weeks & reliable serologic tests may not be available)
    • Polymerase chain reaction (PCR) of nasopharyngeal swabs or aspirates improves detection

Asthma

  • Should be considered in patients with repetitive episodes of acute bronchitis
    • Full spirometric testing with bronchodilatation or provocative testing with a Methacholine challenge test can be given to help differentiate asthma from recurrent bronchitis
  • Acute bronchitis may cause transient pulmonary abnormalities & the diagnosis of asthma should be considered if abnormalities in pulmonary function persist after the acute phase of the illness

Influenza (Flu)

  • Flu viruses are the most common pathogens found in patients with uncomplicated acute bronchitis
  • During times of outbreak, diagnosis by clinical presentation is as accurate as rapid diagnostic tests
    • Patient may benefit from anti-influenza agents if treated within 48 hours of symptom onset

For more detailed diagnosis & treatment of influenza, see Influenza Disease Management Chart

Pneumonia

  • Potentially the most serious cause of acute cough illness & should be ruled out
  • In healthy, non-elderly adults, the absence of vital sign abnormalities (eg HR ≥100 beats/min, resp rate >24 breaths/min, oral body temp ≥38°C & signs of focal consolidation on chest exam) sufficiently reduces the likelihood of pneumonia to eliminate the need for a chest x-ray

For more detailed diagnosis of pneumonia, see Pneumonia - Community Acquired Disease Management Chart

Upper Respiratory Tract Infection (URTI)

  • In these settings, cough is not a predominant symptom eg common cold

Non-pulmonary Causes

  • Chronic heart failure (CHF) in elderly patients, gastroesophageal reflux disease (GERD) & bronchogenic tumor
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