Acute bronchitis can be classified as uncomplicated or complicated , based on current smoking status and / or underlying pulmonary disease . Testing and treatment differ for these subsets .
Diagnosis
History
• Acute-onset cough lasting more than five days , with or without phlegm .
• Cough generally lasts two to three weeks .
Physical
• Signs and symptoms may include sputum production , dyspnea , wheezing , chest pain , hoarseness , malaise , rhonchi , and rales .
• Fever is relatively unusual and suggests either influenza or pneumonia .
• Sputum may be clear , white , yellow , green , or blood-tinged . Sputum production should not be deemed to indicate bacterial infection .
Testing
• Chest radiography is not indicated in uncomplicated bronchitis .
Red Flag Indicators :
� tachycardia ( pulse greater than 100 / minute )
� tachypnea ( respiratory rate greater than 24 )
� fever ( temperature greater than 38 ° C / 100.4˚ F )
� rales or signs of consolidation on chest examination
� hypoxemia
� mental confusion
� signs of systemic illness .
• Indications for chest radiography and / or antibiotics , antitussives , anti-inflammatory therapies :
� unexplained cough lasting three week or longer
� fever and hemoptysis
Uncomplicated Acute Bronchitis
Causes Viruses are usually considered the cause .
Treatment
According to guidelines by the American College of Chest Physicians , routine treatment of uncomplicated ( non-smokers , no history of underlying pulmonary disease ) bronchitis with antibiotics is not justified . Antitussive agents are only occasionally useful and there is no routine role for inhaled bronchodilators or mucolytic agents .
Patient Education
Counsel patients on the role of antibiotics in the treatment of viruses .
Follow-up and Referrals
Complicated Acute Bronchitis
• Schedule a follow-up appointment with the patient in two weeks to ensure resolution of symptoms .
• If the patient was seen at the emergency room , have a follow up appointment two weeks after the visit .
• Consider referral to a pulmonary specialist if treatment is ineffective or complications arise .
Diagnosis Acute bronchitis in patients who currently smoke and / or have a history of underlying pulmonary disease .
Testing Expand to include consideration of chest x-ray , PFTs , peak flow measurement , and sputum culture .
Treatment Expand to include consideration of chest x-ray , peak flow measurement , and sputum culture . Pulmonary function studies can establish the patient ' s baseline .
Patient Education Smoking cessation if the patient is a smoker .
Follow-up and Referrals
• Schedule a follow up appointment with the patient in two weeks to ensure resolution of symptoms .
• If patient was seen at the emergency room , have a follow up appointment two weeks after the visit .
References |
1 . |
Up To Date : Acute bronchitis in adults , 2016 . Retrieved from www . uptodate . com . |
2 . |
U . S . Food & Drug Administration ( 2016 ). FDA Drug Safety Communication : FDA advises restricting fluoroquinolone antibiotic use for certain uncomplicated |
infections : warns about disabling side effects that can occur together . https :// www . fda . gov / drugs / drugsafety / ucm500143 . html . |
3 . |
Center for Disease Control and Prevention ( 2017 ). Bronchitis . https :// www . cdc . gov / getsmart / community / for-patients / common-illnesses / bronchitis . html . |
4 . |
American College of Chest Physicians |
This clinical guideline outlines the recommendations of Mount Carmel Health Partners for this medical condition and is based upon the referenced best practices . It is not intended to serve as a substitute for professional medical judgment in the diagnosis and treatment of a particular patient . Decisions regarding care are subject to individual consideration and should be made by the patient and treating physician in concert .
Original Issue Date : November 2011 Revision Date : January 2013 , March 2015 , May 2017
Acute Bronchitis - 2