From the Guidelines
Acute bronchitis is diagnosed primarily based on clinical presentation, with a cough lasting less than three weeks, often accompanied by sputum production, wheezing, chest discomfort, and sometimes fever, and diagnostic tests are generally not needed in otherwise healthy individuals 1.
Diagnostic Criteria
The diagnostic criteria for acute bronchitis include:
- A cough lasting less than three weeks
- Sputum production
- Wheezing
- Chest discomfort
- Sometimes fever It is essential to rule out other conditions that may present similarly, such as pneumonia, asthma, or heart failure.
Diagnostic Tests
Diagnostic tests are not routinely recommended for acute bronchitis in immunocompetent adult outpatients, but may include:
- Chest X-rays to rule out pneumonia in severe or persistent cases
- Sputum cultures if bacterial infection is suspected
- Peak expiratory flow rate recording(s)
- Complete blood count and inflammatory markers such as CRP The initial clinical evaluation is crucial in the longitudinal care of patients, and targeted investigations should be considered if the acute bronchitis persists or worsens 1.
Treatment
Treatment for acute bronchitis is generally focused on relieving symptoms, and routine prescription of antibiotic therapy, antiviral therapy, antitussives, inhaled beta agonists, inhaled anticholinergics, inhaled corticosteroids, oral corticosteroids, oral NSAIDs or other therapies is not recommended until such treatments have been shown to be safe and effective 1. However, antibiotic therapy may be considered if a complicating bacterial infection is thought likely 1.
From the Research
Diagnostic Criteria for Acute Bronchitis
The diagnostic criteria for acute bronchitis are primarily based on clinical presentation, as evidenced by studies 2, 3, 4, 5. The key symptoms and signs include:
- Cough, which is the most common symptom, typically lasting about two to three weeks 3, 4
- Acute inflammation of the trachea and large airways without evidence of pneumonia 3
- Productive cough and purulent sputum, which are more common in patients with acute bronchitis than in those with upper respiratory tract infections (URIs) 2
- Abnormal lung examinations, which are also more frequent in patients with acute bronchitis than in those with URIs 2
Differentiation from Other Conditions
It is essential to differentiate acute bronchitis from other conditions, such as:
- Pneumonia, which should be suspected in patients with tachypnea, tachycardia, dyspnea, or lung findings suggestive of pneumonia, and radiography is warranted 3
- Pertussis, which should be suspected in patients with cough persisting for more than two weeks, accompanied by symptoms such as paroxysmal cough, whooping cough, and post-tussive emesis, or recent pertussis exposure 3
- Asthma, which may require specific therapies not indicated for bronchitis 4
Laboratory Tests and Antibiotics
Laboratory tests, including chest roentgenograms, are not frequently used in making the diagnosis of acute bronchitis 2, 5. Antibiotics are generally not indicated for acute bronchitis, except in cases where pertussis is suspected or in patients at increased risk of developing pneumonia, such as those 65 years or older 3, 4, 5.