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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.

Evaluation

Patients with Comorbidity 

  • Comorbid conditions: Chronic obstructive pulmonary disease (COPD), cardiovascular diseases, neurological diseases, diabetes mellitus (DM), chronic liver or renal failure, recent viral infection, immunodeficiency, etc
  • Evaluation and management must be tailored in light of the patient’s comorbid condition
    • Eg see Bronchitis - Chronic in Acute Exacerbation Disease Management Chart if patient has underlying COPD

Elderly Patients

  • Require a more careful evaluation and management
    • Eg chest x-ray, sputum culture, electrocardiogram (ECG)
    • Appropriate antibiotic therapy should not be withheld since clinical features are less reliable and pneumococcal infection is common in these patients

History

  • Perform a complete and detailed medical history including tobacco use and exposure to respiratory infections or toxic inhalants

Physical Examination

  • Wheezing, rhonchi, coarse rales, a prolonged expiratory phase or other obstructive signs may be present
    • Forced expiration may be done to detect wheezing

Laboratory Tests

Diagnostic Studies 

  • No available test can provide a definitive diagnosis of acute bronchitis
  • In patients presumed to have acute bronchitis, viral cultures, serologic assays and sputum analyses should not be done routinely because the responsible organism is rarely identified in clinical practice
  • Gram stain or sputum culture in the healthy adult with acute bronchitis is not helpful as most cases are caused by a virus
  • Transient pulmonary function abnormalities (very similar to those of mild asthma) may occur in acute bronchitis; peak expiratory flow rate may be measured in these patients
  • Chest x-ray is typically unnecessary
    • Purulent sputum is not an indication for a chest x-ray
    • Consider performing a chest x-ray if vital signs show a heart rate of >100 beats/minute, respiratory rate of >24 breaths/minute, and an oral temperature of >100.4°F (>38°C), and if focal pulmonary consolidation is present on exam
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