to the editor: After reading the article “Acute Bronchitis” by Drs. Hueston and Mainous,¹ I have as many new questions as questions that were answered by the article. I think the authors wrote an informative review of the pathophysiology, epidemiology and etiologic agents of bronchitis. However, I wonder how a practicing family physician might approach the disease given this information.

The authors state that only about 5 percent of cases of bronchitis are bacterial in origin. They also point out that production of sputum is a poor diagnostic clue and that physical examination is unreliable in diagnosing the disease. They cite numerous studies showing that the use of antibiotics has no increased benefit over the use of placebo. Finally, they quote studies that demonstrate benefit from the use of bronchodilators in adults with bronchitis.

I would be interested to know how, in the authors' opinion, a physician might approach a patient who falls into the general category of “acute bronchitis.” Do the authors feel that antibiotics should never be used, or do they think they should only be used in certain groups of patients? If patients with bronchitis caused by Chlamydia infection are at increased risk of developing asthma, wouldn't it be important to treat those patients? Is it possible (and cost effective) to stratify a patient's risk for bronchitis caused by Chlamydia? If antibiotics are to be used selectively, what criteria should one use to identify patients who would benefit? Last, do the authors recommend a trial use of bronchodilators in every patient with bronchitis or only in those who have clinical signs and symptoms of bronchial obstruction?

As a family physician caring for patients on a daily basis, I want to treat disease in a reasonable, safe, effective and cost-efficient manner. I would appreciate the authors' advice on how best to do that when faced with the very common clinical picture of acute bronchitis.