Acute Bronchitis

 


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Am Fam Physician. 2016 Oct 1;94(7):560-565.

  Patient information: See related handout on acute bronchitis, written by the authors of this article.

Author disclosure: No relevant financial affiliations.

Cough is the most common illness-related reason for ambulatory care visits in the United States. Acute bronchitis is a clinical diagnosis characterized by cough due to acute inflammation of the trachea and large airways without evidence of pneumonia. Pneumonia should be suspected in patients with tachypnea, tachycardia, dyspnea, or lung findings suggestive of pneumonia, and radiography is warranted. Pertussis should be suspected in patients with cough persisting for more than two weeks that is accompanied by symptoms such as paroxysmal cough, whooping cough, and post-tussive emesis, or recent pertussis exposure. The cough associated with acute bronchitis typically lasts about two to three weeks, and this should be emphasized with patients. Acute bronchitis is usually caused by viruses, and antibiotics are not indicated in patients without chronic lung disease. Antibiotics have been shown to provide only minimal benefit, reducing the cough or illness by about half a day, and have adverse effects, including allergic reactions, nausea and vomiting, and Clostridium difficile infection. Evaluation and treatment of bronchitis include ruling out secondary causes for cough, such as pneumonia; educating patients about the natural course of the disease; and recommending symptomatic treatment and avoidance of unnecessary antibiotic use. Strategies to reduce inappropriate antibiotic use include delayed prescriptions, patient education, and calling the infection a chest cold.

Cough is the most common illness-related reason for ambulatory care visits, accounting for 2.7 million outpatient visits and more than 4 million emergency department visits annually.1 Acute bronchitis is a clinical diagnosis characterized by acute cough, with or without sputum production, and signs of lower respiratory tract infection in the absence of chronic lung disease, such as chronic obstructive pulmonary disease, or an identifiable cause, such as pneumonia or sinusitis.2

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Avoid prescribing antibiotics for uncomplicated acute bronchitis.

A

27, 41

Over-the-counter cough medications containing antihistamines and antitussives should not be used in children younger than four years because of the high potential for harm.

C

30

Consider using dextromethorphan, guaifenesin, or honey to manage acute bronchitis symptoms.

B

30, 34, 38

Avoid using beta2 agonists for the routine treatment of acute bronchitis unless wheezing is present.

B

35

Employ strategies to reduce antibiotic use, such as asking patients to call for or pick up an antibiotic or to hold an antibiotic prescription for a set amount of time.

A

42, 43


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Avoid prescribing antibiotics for uncomplicated acute bronchitis.

A

27, 41

Over-the-counter cough medications containing antihistamines and antitussives should not be used in children younger than four years because of the high potential for harm.

C

30

Consider using dextromethorphan, guaifenesin, or honey to manage acute bronchitis symptoms.

B

30, 34, 38

Avoid using beta2 agonists for the routine treatment of acute bronchitis unless wheezing is present.

B

35

Employ strategies to reduce antibiotic use, such as asking patients to call for or pick up an antibiotic or to hold an antibiotic prescription for a set amount of time.

A

42, 43


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

View/Print Table

BEST PRACTICES IN INFECTIOUS DISEASE: RECOMMENDATIONS FROM THE CHOOSING WISELY CAMPAIGN

RecommendationSponsoring organization

Cough and cold medicines should not be prescribed or recommended for respiratory illnesses in children younger than four years.

American Academy of Pediatrics

Antibiotics should not be used for apparent viral upper respiratory tract illnesses (sinusitis, pharyngitis, bronchitis).

American Academy of Pediatrics

Avoid prescribing antibiotics for upper respiratory tract infections.

Infectious Diseases Society of America


Source: For more information on the Choosing Wisely Campaign, see http://www.choosingwisely.org. For supporting citations and to search Choosing Wisely recommendations relevant to primary care, see http://www.aafp.org/afp/recommendations/search.htm.

BEST PRACTICES IN INFECTIOUS DISEASE: RECOMMENDATIONS FROM THE CHOOSING WISELY CAMPAIGN

RecommendationSponsoring organization

Cough and cold medicines should not be prescribed or recommended for r

The Authors

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SCOTT KINKADE, MD, MSPH, is an associate professor in the Department of Family and Community Medicine at the University of Missouri School of Medicine in Columbia....

NATALIE A. LONG, MD, is an assistant professor in the Department of Family and Community Medicine at the University of Missouri School of Medicine.

Address correspondence to Scott Kinkade, MD, MSPH, University of Missouri, MA303 Medical Sciences Bldg., DC032.00, Columbia, MO 65212 (e-mail: kinkades@health.missouri.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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