Acute bronchitis explained

Acute bronchitis
Synonyms:Chest cold
Field:Pulmonology
Symptoms:Cough with sputum, wheezing, shortness of breath, fever, chest discomfort
Duration:Up to 6 weeks
Causes:Typically viral infection
Risks:Tobacco smoke, dust, air pollution
Diagnosis:Based on symptoms
Differential:Asthma, pneumonia, bronchiolitis, bronchiectasis, COPD
Prevention:Avoiding air pollution, handwashing
Treatment:Rest, paracetamol (acetaminophen), NSAIDs
Frequency:~5% one or more episodes a year

Acute bronchitis, also known as a chest cold, is short-term bronchitis – inflammation of the bronchi (large and medium-sized airways) of the lungs.[1] The most common symptom is a cough. Other symptoms include coughing up mucus, wheezing, shortness of breath, fever, and chest discomfort.[1] The infection may last from a few to ten days.[1] The cough may persist for several weeks afterward with the total duration of symptoms usually around three weeks.[1] Some have symptoms for up to six weeks.

In more than 90% of cases, the cause is a viral infection. These viruses may be spread through the air when people cough or by direct contact.[1] Risk factors include exposure to tobacco smoke, dust, and other air pollution.[1] A small number of cases are due to high levels of air pollution or bacteria such as Mycoplasma pneumoniae or Bordetella pertussis.[2] Diagnosis is typically based on a person's signs and symptom.[3] The color of the sputum does not indicate if the infection is viral or bacterial. Determining the underlying organism is typically not needed. Other causes of similar symptoms include asthma, pneumonia, bronchiolitis, bronchiectasis, and COPD.[4] A chest X-ray may be useful to detect pneumonia.[4]

Prevention is by not smoking and avoiding other lung irritants. Frequent hand washing and flu vaccination may also be protective.[5] [6] Treatment of acute bronchitis typically involves rest, paracetamol (acetaminophen), and NSAIDs to help with the fever.[7] Cough medicine has little support for its use and is not recommended in children less than six years of age.[4] [8] Antibiotics should generally not be used.[9] An exception is when acute bronchitis is due to pertussis.[4] Tentative evidence supports honey and pelargonium to help with symptoms.[4]

Acute bronchitis is one of the most common diseases. About 5% of adults are affected and about 6% of children have at least one episode a year.[10] It occurs more often in the winter.[11] More than 10 million people in the United States visit a doctor each year for this condition with approximately 70% receiving antibiotics, most of which are not needed.[12] There are efforts to decrease the use of antibiotics in acute bronchitis.[13]

Signs and symptoms

The primary symptom is cough with sputum that may be purulent. The illness may also cause shortness of breath or wheezing. Upper respiratory tract infections (URTI's) often precede acute bronchitis, with overlapping symptoms including headache, nasal congestion, sore throat. About a third of patients will experience a fever, but fevers due to acute bronchitis rarely rise above 100F or last for longer than a few days.[14] As fever and other systemic symptoms are less common in acute bronchitis than in pneumonia, their presence raises suspicion for the latter,[15] [16] especially high or persistent fevers.[14]

Cause

Acute bronchitis can be caused by contagious pathogens, most commonly viruses. Typical viruses include respiratory syncytial virus, rhinovirus, influenza, and others. Bacteria are uncommon pathogens but may include Mycoplasma pneumoniae, Chlamydophila pneumoniae, Bordetella pertussis, Streptococcus pneumoniae, and Haemophilus influenzae.[17]

Diagnosis

A physical examination will often reveal decreased intensity of breath sounds, wheezing, rhonchi, and prolonged expiration. During examination, physicians rely on history and the presence of persistent or acute onset of cough, followed by a URTI with no traces of pneumonia. Acute bronchitis is typically a clinical diagnosis that relies on patients history and exam, and should be suspected in patients with an acute onset of cough, which often follows a URTI without traces of pneumonia.[18]

Although there is no universally-accepted clinical definition for acute bronchitis, there is a proposed set of practical criteria (Macfarlane, 2001[19]) that include:

A variety of tests may be performed in people presenting with cough and shortness of breath:[20]

Decreased breath sounds, crackles, wheezing, and rhonchi that clears with coughs may be heard in the chest. Dullness to percussion and pleural rub suggest disease extension beyond the bronchi such as seen with pneumonia. Paroxysms of cough followed by inspiratory whoop and vomiting suggests pertussis.[21]

Prevention

Prevention is by not smoking and avoiding other lung irritants.[5] Frequent hand washing may also be protective.[5] Furthermore, an oral whole cell nontypeable Haemophilus influenzae vaccine given in the fall has demonstrated short term effectiveness in reducing the frequency and severity of the disease during the winter.[22]

Treatment

Most cases are self-limited and resolve themselves in a few weeks.Pain medications may help with symptoms.[23] Other recommendations may include rest and keeping well hydrated.[24]

Antibiotics

Evidence does not support the general use of antibiotics in acute bronchitis.[9] A systematic review found antibiotics reduced cough by an average of 12 hours (out of a total average of about 14–28 days). Antibiotics caused more side effects such as nausea and diarrhoea, and also may promote antibiotic-resistant bacteria. It is possible they are useful in susceptible groups such as the frail and elderly but there was not enough research information to determine this.[25]

Calling acute bronchitis with benign-sounding labels such as chest cold or viral infections may reduce antibiotic usage by improving patients satisfaction when antibiotics are not prescribed.[26]

Smoking cessation

To help the bronchial tree heal faster and not make bronchitis worse, smokers should quit smoking completely.[27]

Alternative therapeutic approaches

Salbutamol is not effective in children with an acute cough who do not have restricted airways.[28] There is weak evidence that salbutamol may be useful in adults with wheezing due to a restricted airway; however, it may result in nervousness, shakiness or a tremor.

Prognosis

Acute bronchitis usually lasts a few days or weeks.[29] It may accompany or closely follow a cold or the flu, or may occur on its own. Bronchitis usually begins with a dry cough, including waking the patient at night. After a few days, it progresses to a wetter or productive cough, which may be accompanied by fever, fatigue, and headache. The fever, fatigue, and malaise may last only a few days, but the wet cough may last up to several weeks.[30]

Epidemiology

Acute bronchitis is one of the most common diseases.[12] [13] About 5% of adults are affected and about 6% of children have at least one episode a year.[11] [10] It occurs more often in the winter.[11]

In infants under one year of age, acute bronchitis was the most common reason for admission to the hospital after an emergency department visit in the US in 2011.[31]

External links

Notes and References

  1. Web site: What Is Bronchitis?. 1 April 2015. August 4, 2011. live. https://web.archive.org/web/20150402153154/http://www.nhlbi.nih.gov/health/health-topics/topics/brnchi. 2 April 2015.
  2. Web site: What Causes Bronchitis?. 1 April 2015. August 4, 2011. live. https://web.archive.org/web/20150402130114/http://www.nhlbi.nih.gov/health/health-topics/topics/brnchi/causes. 2 April 2015.
  3. Web site: How Is Bronchitis Diagnosed?. 1 April 2015. August 4, 2011. live. https://web.archive.org/web/20150402195428/http://www.nhlbi.nih.gov/health/health-topics/topics/brnchi/diagnosis. 2 April 2015.
  4. Albert. RH. Diagnosis and treatment of acute bronchitis.. American Family Physician. 1 December 2010. 82. 11. 1345–50. 21121518.
  5. Web site: How Can Bronchitis Be Prevented?. 1 April 2015. August 4, 2011. live. https://web.archive.org/web/20150402184916/http://www.nhlbi.nih.gov/health/health-topics/topics/brnchi/prevention. 2 April 2015.
  6. Book: Singh . Anumeha . Zahn . Elise . Acute Bronchitis . 2018 . StatPearls Publishing . 28846312 . 23 January 2019 .
  7. Web site: How Is Bronchitis Treated?. 1 April 2015. August 4, 2011. live. https://web.archive.org/web/20150402113109/http://www.nhlbi.nih.gov/health/health-topics/topics/brnchi/treatment. 2 April 2015.
  8. Smith. SM. Schroeder. K. Fahey. T. Over-the-counter (OTC) medications for acute cough in children and adults in community settings.. The Cochrane Database of Systematic Reviews. 24 November 2014. 2014. 11. CD001831. 25420096. 10.1002/14651858.CD001831.pub5. 7061814.
  9. Smith. SM. Fahey. T. Smucny. J. Becker. LA. 19 Jun 2017. Antibiotics for acute bronchitis.. The Cochrane Database of Systematic Reviews. 2017. 6. CD000245. 10.1002/14651858.CD000245.pub4. 28626858. 6481481.
  10. Fleming. DM. Elliot. AJ. The management of acute bronchitis in children.. Expert Opinion on Pharmacotherapy. March 2007. 8. 4. 415–26. 17309336. 10.1517/14656566.8.4.415. 46247982.
  11. Wenzel. RP. Fowler AA. 3rd. Clinical practice. Acute bronchitis.. The New England Journal of Medicine. 16 November 2006. 355. 20. 2125–30. 17108344. 10.1056/nejmcp061493.
  12. Tackett. KL. Atkins. A. Evidence-based acute bronchitis therapy.. Journal of Pharmacy Practice. December 2012. 25. 6. 586–90. 23076965. 10.1177/0897190012460826. 37651935. free.
  13. Braman. SS. Chronic cough due to acute bronchitis: ACCP evidence-based clinical practice guidelines.. Chest. January 2006. 129. 1 Suppl. 95S–103S. 16428698. 10.1378/chest.129.1_suppl.95S. 7094612.
  14. Kinkade . Scott . Long . Natalie A. . Acute Bronchitis . American Family Physician . 94 . 7 . 2016-10-01 . 560–565 . 27929206 . 2024-01-30.
  15. Wenzel. Richard P.. Fowler. Alpha A.. 2006-11-16. Clinical practice. Acute bronchitis. The New England Journal of Medicine. 355. 20. 2125–2130. 10.1056/NEJMcp061493. 1533-4406. 17108344.
  16. Ebell. Mark H.. Lundgren. Jerold. Youngpairoj. Surasak. 2013. How long does a cough last? Comparing patients' expectations with data from a systematic review of the literature. Annals of Family Medicine. 11. 1. 5–13. 10.1370/afm.1430. 1544-1717. 3596033. 23319500.
  17. Chang. Anne B.. Upham. John W.. Masters. I. Brent. Redding. Gregory R.. Gibson. Peter G.. Marchant. Julie M.. Grimwood. Keith. March 2016. Protracted bacterial bronchitis: The last decade and the road ahead. Pediatric Pulmonology. 51. 3. 225–242. 10.1002/ppul.23351. 1099-0496. 26636654. 7167774.
  18. Web site: Diagnosis for Acute Bronchitis. The Lecturio Medical Concept Library . 2021-06-12.
  19. Macfarlane. J.. Homes. W.. Gard. P.. Macfarlane. R.. Rose. D.. Weston. V.. Leinonen. M.. Saikku. P.. Myint. S.. 2001-02-01. Prospective study of the incidence, aetiology and outcome of adult lower respiratory tract illness in the community. Thorax. 56. 2. 109–14. 10.1136/thorax.56.2.109. 11209098. 1746009.
  20. Web site: Test for Acute & Chronic Bronchitis. University of Utah Healthcare . 6 April 2021 . 2021-06-12.
  21. Ward. Joel I.. Cherry. James D.. Chang. Swei-Ju. Partridge. Susan. Lee. Hang. Treanor. John. Greenberg. David P.. Keitel. Wendy. Barenkamp. Stephen. 2005-10-13. Efficacy of an acellular pertussis vaccine among adolescents and adults. The New England Journal of Medicine. 353. 15. 1555–1563. 10.1056/NEJMoa050824. 1533-4406. 16221778. 22341895 . free.
  22. Foxwell. A. R.. Cripps. A. W.. Dear. K. B. G.. 2003. Haemophilus influenzae oral whole cell vaccination for preventing acute exacerbations of chronic bronchitis. The Cochrane Database of Systematic Reviews. 3. CD001958. 10.1002/14651858.CD001958. 1469-493X. 12917917. Foxwell. Ruth. 10072/136658. free.
  23. Web site: Diagnosing and treating acute bronchitis . American Lung Association . 24 January 2019.
  24. Web site: Treatment for Acute bronchitis. The Ohio State University Wexner Medical Center . 2021-06-12.
  25. Smith. Susan M.. Fahey. Tom. Smucny. John. Becker. Lorne A.. 19 June 2017. Antibiotics for acute bronchitis. The Cochrane Database of Systematic Reviews. 2017. 6. CD000245. 10.1002/14651858.CD000245.pub4. 1469-493X. 28626858. 6481481.
  26. Phillips. T. Grant. Hickner. John. November 2005. Calling acute bronchitis a chest cold may improve patient satisfaction with appropriate antibiotic use. The Journal of the American Board of Family Practice. 18. 6. 459–463. 10.3122/jabfm.18.6.459. 0893-8652. 16322409. free.
  27. Web site: Lifestyle modifications For Acute bronchitis Patients. The Lecturio Medical Concept Library . 2021-06-12.
  28. Becker. Lorne A.. Hom. Jeffrey. Villasis-Keever. Miguel. van der Wouden. Johannes C.. 2015-09-03. Beta2-agonists for acute cough or a clinical diagnosis of acute bronchitis. The Cochrane Database of Systematic Reviews. 2015 . 9. CD001726. 10.1002/14651858.CD001726.pub5. 1469-493X. 7078572. 26333656.
  29. Web site: Bronchitis . Mayo Foundation for Medical Education and Research . 2007-04-20 . 2008-05-30 . live . https://web.archive.org/web/20080325133230/http://www.mayoclinic.com/health/bronchitis/DS00031/DSECTION%3D1 . 2008-03-25 .
  30. Web site: Symptoms Of Acute Bronchitis. The University of Utah . 6 April 2021 . 2021-06-12.
  31. Overview of Emergency Department Visits in the United States, 2011. Weiss. A.J.. Wier. L.M.. June 2014. Agency for Healthcare Research and Quality. Rockville, MD. https://web.archive.org/web/20140803154735/http://www.hcup-us.ahrq.gov/reports/statbriefs/sb174-Emergency-Department-Visits-Overview.jsp. 2014-08-03. live. Stocks. C.. Blanchard. J.. HCUP Statistical Brief . 174. 25144109 .

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