From the Guidelines
Bronchitis is diagnosed based on clinical symptoms, including an acute lower respiratory tract infection manifested predominantly by cough with or without sputum production, lasting no more than 3 weeks with no clinical or radiographic evidence to suggest an alternative explanation, as defined by the Chest expert panel report 1. The diagnostic criteria for bronchitis prioritize clinical assessment, with a focus on symptom pattern and duration. Key symptoms include:
- Cough with or without sputum production
- Chest discomfort
- Shortness of breath
- Wheezing
- Low-grade fever
- Fatigue Physical examination findings, such as abnormal breath sounds like rhonchi or wheezes, also support the diagnosis. According to the Chest expert panel report, for immunocompetent adult outpatients with cough due to suspected acute bronchitis, no routine investigation with chest x-ray, spirometry, peak flow measurement, sputum for microbial culture, respiratory tract samples for viral PCR, serum C-Reactive Protein (CRP) or procalcitonin is suggested 1. Instead, targeted investigations, such as chest x-ray, sputum for microbial culture, and peak expiratory flow rate recording, may be considered if the acute bronchitis persists or worsens 1. The diagnosis of bronchitis is primarily clinical, with testing reserved for ruling out other conditions or in complicated cases, and the initial clinical evaluation is crucial in the longitudinal care of patients 1.
From the Research
Diagnostic Criteria for Bronchitis
The diagnostic criteria for bronchitis typically involve a combination of clinical symptoms and physical examination findings. According to 2, cough is the most common symptom bringing patients to the primary care physician's office, and acute bronchitis is usually the diagnosis in these patients.
- Symptoms of bronchitis typically last about three weeks
- The presence or absence of colored sputum does not reliably differentiate between bacterial and viral lower respiratory tract infections
- Viruses are responsible for more than 90 percent of acute bronchitis infections
Differentiation from Other Conditions
It is essential to differentiate acute bronchitis from other common diagnoses, such as pneumonia and asthma, because these conditions may need specific therapies not indicated for bronchitis. As stated in 2, acute bronchitis should be differentiated from other common diagnoses, such as pneumonia and asthma.
- Pneumonia is an important cause of morbidity and mortality, and patients with asthma are more likely to be hospitalized with pneumonia than those without asthma 3
- Asthma and chronic obstructive pulmonary disease (COPD) are associated with decreased lung function and increased risk of respiratory disease 4
Treatment and Management
The treatment and management of bronchitis typically involve symptomatic relief and supportive care. According to 5, neither amoxicillin-clavulanic acid nor ibuprofen increased the probability of cough resolution compared with placebo.
- Antibiotics are generally not indicated for bronchitis, and should be used only if pertussis is suspected to reduce transmission or if the patient is at increased risk of developing pneumonia 2
- The supplement pelargonium may help reduce symptom severity in adults 2
- There is limited evidence of clinical benefit to support the use of antibiotics in acute bronchitis, and antibiotics may have a modest beneficial effect in some patients, such as frail, elderly people with multimorbidity 6