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.
It is 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.
There is 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 weeks
    • 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, especially if terminated by vomiting or associated with redness of the face and catching of the breath
    • The incidence of pertussis in children has decreased due to widespread pertussis vaccination
  • Physicians should limit suspicion and 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 and 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 and 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 and the diagnosis of asthma should be considered if abnormalities in pulmonary function persist after the acute phase of the illness
  • Please see Asthma disease management chart for further information

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
  • Please see Influenza disease management chart for further information

Pneumonia

  • Potentially the most serious cause of acute cough illness and should be ruled out
  • In healthy, non-elderly adults, the absence of vital sign abnormalities (eg heart rate ≥100 beats/minute, respiratory rate >24 breaths/minute, oral temperature ≥38°C and signs of focal consolidation on chest exam) sufficiently reduces the likelihood of pneumonia to eliminate the need for a chest x-ray
  • Please see Pneumonia - Community-Acquired disease management chart for further information

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) and bronchogenic tumor
  • Please see Heart Failure - Chronic & Gastroesophageal Reflux Disease disease management charts for further information
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Pearl Toh, 30 Sep 2020
For paediatric pneumonia with fast breathing (tachypnoea), the WHO*-recommended treatment with amoxicillin is still the preferred regimen, suggests the RETAPP** study.