Acute Bronchitis
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Introduction
Acute bronchitis is an infection of the tracheobronchial tree, causing inflammation, bronchial edema, and mucus formation.
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.
Causes and Risk Factors
Up to 80% of cases of bronchitis are viral, with the most common pathogens being rhinovirus, coronavirus, adenovirus, influenza, parainfluenza, and RSV.
The remaining 20% of cases are bacterial/mycoplasmal, commonly M. pneumoniae, C. pneumoniae, and S. pneumoniae.
Pathophysiology
Signs and Symptoms
Acute bronchitis is typically a clinical diagnosis.
- history
- physical exam
History
Bacterial infections tend to give higher fever, excessive amounts of purulent sputum production, and may be associated with concomitant COPD.
Not all purulent sputum is bacterial, however.
Physical Exam
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
While sputum cultures/gram stains can be done, they are not normally informative.
Diagnostic Imaging
Differential Diagnosis
- URTI
- asthma
- acute exacerbation of chronic bronchitis
- sinusitis/post-nasal drip
- pneumonia
- bronchiolitis
- pertussis
- environmental/occupational exposures
- reflux esophagitis
- congestive heart failure
- bronchogenic carcinoma
- aspiration
- cyctic fibrosis
Treatments
Primary prevention
Primary prevention includes frequent handwashing, smoking cessation, and avoidance of irritant exposure.
Symptom relief
Rest, fluids, humidity, analgesics, and antitussives can be used for symptom relief.
Bronchidilators (ie albuterol) can also improve suffering.
Medications
As most cases of bronchitis are viral, antibiotics are not likely helpful. However, they should be prescribed in the elderly, in people with comorbidities, if pneumonia is suspected, or the patient is toxic.
Antibiotics have no benefit in children.
Consequences and Course
Resources and References
Topic Development
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