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

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

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

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