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com/professional/pulmonary-disorders/acute-bronchitis/acute-
bronchitis

Acute Bronchitis
By Sanjay Sethi, MD, School of Medicine and Biomedical Sciences, University at
Buffalo SUNY

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Patient Education

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Acute Bronchitis
Acute Bronchitis

Acute bronchitis is inflammation of the tracheobronchial tree, commonly following a URI,

that occurs in patients without chronic lung disorders. The cause is almost always a viral
infection. The pathogen is rarely identified. The most common symptom is cough, with or
without fever, and possibly sputum production. Diagnosis is based on clinical findings.
Treatment is supportive; antibiotics are usually unnecessary. Prognosis is excellent.

Acute bronchitis is frequently a component of a URI caused by rhinovirus, parainfluenza,

influenza A or B virus, respiratory syncytial virus, coronavirus, or human metapneumovirus.
Less common causes may be Mycoplasma pneumoniae, Bordetella pertussis, and Chlamydia
pneumoniae. Less than 5% of cases are caused by bacteria, sometimes in outbreaks.

Acute inflammation of the tracheobronchial tree in patients with underlying chronic bronchial
disorders (eg, COPD, bronchiectasis, cystic fibrosis) is considered an acute exacerbation of
that disorder rather than acute bronchitis. In these patients, the etiology, treatment, and
outcome differ from those of acute bronchitis (see also Treatment of Acute COPD
Exacerbation).

Pearls & Pitfalls

Acute cough in patients with COPD, bronchiectasis, or cystic fibrosis should

typically be considered an exacerbation of that disorder rather than simple acute
bronchitis.
Symptoms and Signs
Symptoms are a nonproductive or mildly productive cough accompanied or preceded by URI
symptoms, usually by > 5 days. Subjective dyspnea results from chest pain or tightness with
breathing, not from hypoxia. Signs are often absent but may include scattered rhonchi and
wheezing. Sputum may be clear, purulent, or occasionally contain blood. Sputum
characteristics do not correspond with a particular etiology (ie, viral vs bacterial). Mild fever
may be present, but high or prolonged fever is unusual and suggests influenza or pneumonia.

On resolution, cough is the last symptom to subside and often takes 2 to 3 wk or even longer
to do so.

Diagnosis
Clinical evaluation
Sometimes chest x-ray to exclude other disorders

Diagnosis is based on clinical presentation. Testing is usually unnecessary. However, patients

who complain of dyspnea should have pulse oximetry to rule out hypoxemia. Chest x-ray is
done if findings suggest serious illness or pneumonia (eg, ill appearance, mental status
change, high fever, tachypnea, hypoxemia, crackles, signs of consolidation or pleural
effusion). Elderly patients are the occasional exception, as they may have pneumonia without
fever and auscultatory findings, presenting instead with altered mental status and tachypnea.

Sputum Gram stain and culture usually have no role. Nasopharyngeal samples can be tested
for influenza and pertussis if these disorders are clinically suspected (eg, for pertussis,
persistent and paroxysmal cough after 10 to 14 days of illness, only sometimes with the
characteristic whoop and/or retching, exposure to a confirmed casesee also Pertussis :
Diagnosis).

Cough resolves within 2 wk in 75% of patients. Patients with persistent cough should
undergo a chest x-ray. Evaluation for noninfectious causes, including postnasal drip and
gastroesophageal reflux disease, can usually be done clinically. Differentiation of cough-
variant asthma may require pulmonary function testing.

Treatment
Symptom relief (eg, acetaminophen, hydration, possibly antitussives)
Inhaled -agonist or anticholinergic for wheezing

Acute bronchitis in otherwise healthy patients is a major reason that antibiotics are overused.
Nearly all patients require only symptomatic treatment, such as acetaminophen and
hydration. Evidence supporting efficacy of routine use of other symptomatic treatments, such
as antitussives, mucolytics, and bronchodilators, is weak. Antitussives should be considered
only if the cough is interfering with sleep (see Treatment). Patients with wheezing may
benefit from an inhaled 2-agonist (eg, albuterol) or an anticholinergic (eg, ipratropium) for a
few days. Oral antibiotics are typically not used except in patients with pertussis or during
known outbreaks of bacterial infection. A macrolide such as azithromycin 500 mg po once,
then 250 mg po once/day for 4 days or clarithromycin 500 mg po bid for 14 days is given.

Pearls & Pitfalls

Treat most cases of acute bronchitis in healthy patients without using antibiotics.

Key Points
Acute bronchitis is viral in > 95% of cases, often part of a URI.
Diagnose acute bronchitis mainly by clinical evaluation; do chest x-ray and/or other
tests only in patients who have manifestations of more serious illness.
Treat most patients only to relieve symptoms.

Last full review/revision April 2014 by Sanjay Sethi, MD