From the Guidelines
Bronchitis is characterized by a persistent cough, often producing mucus, and is accompanied by symptoms such as shortness of breath, wheezing, and chest tightness, as noted in the ACCP evidence-based clinical practice guidelines 1. The clinical signs of bronchitis can be divided into two main categories: acute and chronic.
- Acute bronchitis typically presents with a sudden onset of cough, often producing mucus, and may be accompanied by a low-grade fever, fatigue, and body aches, as described in the ACCP guidelines for acute bronchitis 1.
- Chronic bronchitis, on the other hand, involves a productive cough lasting at least three months for two consecutive years, and may be accompanied by signs of airflow obstruction, such as barrel chest and pursed-lip breathing, as noted in the BTS guidelines for COPD 1. Some key clinical signs of bronchitis include:
- Persistent cough, often producing mucus
- Shortness of breath
- Wheezing
- Chest tightness or discomfort
- Low-grade fever
- Fatigue
- Body aches
- Sore throat from persistent coughing
- Rhonchi, wheezes, or coarse crackles on auscultation of the lungs
- Signs of airflow obstruction, such as barrel chest, pursed-lip breathing, and use of accessory respiratory muscles, particularly in patients with chronic bronchitis. It is essential to note that the diagnosis of bronchitis should be made only when other respiratory or cardiac causes for the chronic productive cough are excluded, as emphasized in the ACCP guidelines 1.
From the Research
Clinical Signs of Bronchitis
The clinical signs of bronchitis are characterized by:
- Acute cough with or without sputum, but without signs of pneumonia 2
- The presence of chronic obstructive pulmonary disease (COPD) with acute exacerbation (AE) of chronic bronchitis (CB) can exhibit additional symptoms 3
Causes and Treatment
- About 90% of cases are caused by viruses, making antibiotic treatment less effective 2
- Antibiotics have been associated with an approximately half-day reduction in duration of cough, but no significant differences in overall clinical improvement compared to placebo 2
- Azithromycin has been shown to have good effects in treating COPD patients with AE of CB in the stable stage, improving pulmonary function 3
Diagnosis and Management
- The use of rapid tests, delayed prescribing of antibiotics, and patient education through leaflets can help reduce unnecessary antibiotic utilization 2
- Fractional exhaled nitric oxide index (FeNO) can be used to monitor the increase in mucosal inflammatory cells and eosinophils of the airway in COPD patients with AE of CB 3