Acute Bronchitis
Basics
- Acute inflammation of large airways without pneumonia or chronic lung disease
- Persistent cough, often productive; usually resolves in 1 to 3 weeks
- Predominantly viral etiology (~60%)
Epidemiology
- Affects all ages, male = female
- Accounts for ~10% of ambulatory visits (~100 million/year in US)
- Peaks in late fall and winter with respiratory virus season
Etiology and Pathophysiology
- Viral: Influenza A/B, parainfluenza, coronavirus 1-3, rhinovirus, RSV, metapneumovirus
- Bacterial (6%): Mycoplasma pneumoniae, Chlamydophila pneumoniae, Bordetella pertussis (up to 10% with cough >2 weeks)
- Fungal and chemical irritants possible but rare
- Mucosal injury β increased mucus production and bronchial wall thickening
Risk Factors
- Infants, elderly
- Smoking, secondhand smoke, air pollution
- Chronic bronchopulmonary diseases, sinusitis, allergies
- Immunosuppression, HIV, alcoholism
- GERD
Prevention
- Avoid smoking and secondhand smoke
- Manage underlying conditions (asthma, sinusitis, reflux)
- Vaccinations: influenza, pneumococcal
- Avoid exposure, especially daycare
Associated Conditions
- Allergic rhinitis, sinusitis, pharyngitis, influenza
- Croup, pneumonia, asthma, COPD, GERD
Diagnosis
History
- Cough >5 days, initially dry then productive
- Possible dyspnea, wheezing, fatigue
- Possible fever (suggests pneumonia/influenza)
- Exposure to sick contacts
Physical Exam
- Fever, tachypnea, injected pharynx
- Rhonchi, wheezing
- No signs of lung consolidation
Differential Diagnosis
- Pneumonia, COVID-19, asthma, sinusitis, postnasal drip, bronchiectasis
- Other pulmonary and cardiac causes
Diagnostic Tests
- Usually none needed; diagnosis clinical
- CBC, influenza testing if indicated
- SARS-CoV-2 testing during pandemic
- Pulse oximetry if pulmonary disease present
- CXR if dyspnea, tachycardia, high fever, or abnormal lung exam
Treatment
General Measures
- Supportive care: rest, hydration, steam inhalation, vaporizers
- Smoking cessation and avoidance of irritants
- Antitussives: honey (1 tbsp every 2-4 hours PRN), lozenges, tea
- Explain antibiotics usually not needed
Medications
- Antipyretics: acetaminophen, ibuprofen
- Decongestants if sinus symptoms/postnasal drip present
- Cough suppressants (benzonatate, guaifenesin-dextromethorphan) not for children <6 years
- Inhaled Ξ²-agonists and corticosteroids if bronchospasm present and known airflow obstruction
- Antivirals for influenza if <48 hours symptom onset
- Antibiotics ONLY if confirmed treatable bacterial cause (e.g., pertussis) or comorbidities present
Issues for Referral
- Suspected pneumonia or respiratory failure
- Comorbid COPD or asthma
- Chronic cough >3 months
Additional Therapies
- Antipyretics for fever control
- Inhaled Ξ²-agonists for bronchospasm
- Oral corticosteroids generally not indicated except in COVID-19
Admission and Nursing Considerations
- Hypoxia needing oxygen
- Severe bronchospasm or respiratory failure
- Underlying disease exacerbation
- Support hydration with IV fluids if needed
- Monitor oxygen saturation in lung disease patients
Ongoing Care
Follow-Up
- Usually self-limited; no routine follow-up needed
- Persistent cough should be reassessed, consider asthma or other diagnosis
Patient Monitoring
- Pulse oximetry until hypoxia resolves
- Monitor symptom progression and comorbid conditions
Diet
- Increase fluids (3-4 L/day if febrile)
Patient Education
- Emphasize no routine antibiotic use
- Teach cough management strategies
- Provide resources: American Lung Association, familydoctor.org, NIH COVID-19 guidelines
Prognosis
- Generally complete resolution
- Can be serious in elderly or debilitated
- Cough may persist for weeks after other symptoms improve
Complications
- Secondary bacterial bronchopneumonia
- Bronchiectasis
- Hemoptysis
- Acute respiratory failure
- Chronic cough