Sputum Production in Acute Bronchitis
Yes, sputum production commonly occurs with acute bronchitis and is a defining feature of the condition. Acute bronchitis is specifically defined as an acute respiratory infection manifested predominantly by cough with or without sputum production lasting no more than 3 weeks 1.
Clinical Presentation
Sputum production is present in many, but not all cases of acute bronchitis, making it a variable but characteristic symptom 1.
The diagnosis should be made in patients with sudden onset of cough, with or without sputum expectoration, as long as pneumonia, common cold, acute asthma, or acute exacerbation of COPD have been ruled out 1.
When present, sputum production reflects the underlying pathophysiology of mucosal injury, epithelial cell damage, and release of proinflammatory mediators in the bronchial tree 1.
Important Clinical Distinction
A critical pitfall is confusing acute bronchitis with chronic bronchitis exacerbations, where sputum characteristics differ significantly:
In acute exacerbations of chronic bronchitis, patients experience increased sputum volume and sputum purulence as defining features 1.
In uncomplicated acute bronchitis (in otherwise healthy patients), sputum may be present but purulence and increased volume are not diagnostic criteria 1.
Diagnostic Approach
The presence or absence of colored (green) sputum does not reliably differentiate between bacterial and viral infections in acute bronchitis 2.
No routine sputum analysis, viral cultures, or serologic assays should be performed because the responsible organism is rarely identified and does not change management 1.
Viruses cause more than 90% of acute bronchitis cases, making sputum production primarily a reflection of viral-induced airway inflammation rather than bacterial infection 2.