Symptoms of Bronchitis
Acute bronchitis presents predominantly with cough (with or without sputum production) lasting up to 3 weeks, and may be accompanied by constitutional symptoms such as fever, muscle aches, and fatigue. 1
Primary Symptoms
Respiratory Manifestations
- Cough is the hallmark symptom, present in 93% of cases, and may be productive or nonproductive 1
- Sputum production ranges from mucoid to frankly purulent, though purulent sputum does not distinguish bronchitis from pneumonia 1
- Nasal congestion occurs in approximately 91% of patients 1
- Dyspnea (shortness of breath) may occur, particularly in cases caused by Mycoplasma pneumoniae or Chlamydophila pneumoniae 1
Constitutional Symptoms
- Fever is present in 68% of influenza-related cases, though bronchitis can occur without fever 1
- Weakness and myalgia (muscle aches) occur in 94% of influenza-related acute bronchitis 1
- Fatigue commonly accompanies the respiratory symptoms 1
Upper Airway Symptoms
- Throat clearing and sensation of postnasal drip frequently occur, as acute bronchitis often presents with an upper airway cough syndrome 1
- Sore throat may be present, particularly early in the illness 1
Physical Examination Findings
On chest examination, patients may demonstrate transient airflow obstruction and bronchial hyperresponsiveness in approximately 40% of cases, with reversibility of FEV1 >15% in 17% of patients 1
Critical Diagnostic Distinctions
Differentiating from Pneumonia
The absence of ALL four of the following findings makes pneumonia unlikely and obviates the need for chest radiograph: 1
- Heart rate >100 beats/min
- Respiratory rate >24 breaths/min
- Oral temperature >38°C
- Chest examination findings of focal consolidation, egophony, or fremitus
Differentiating from Common Cold
The common cold presents with nasal stuffiness and discharge, sneezing, and sore throat as predominant features, whereas acute bronchitis is characterized by cough as the primary symptom 1
Differentiating from Asthma
In patients with recurrent episodes (≥2 similar episodes in the past 5 years), 65% can be identified as having mild asthma rather than recurrent acute bronchitis 1. Prospective evaluation is necessary to distinguish isolated acute bronchitis from asthma.
Duration and Natural History
Symptoms typically last no more than 3 weeks, with most patients seeking care within the first week of illness (66%) 1. When cough persists beyond 3 weeks, alternative diagnoses must be considered, including postinfectious cough, upper airway cough syndrome, asthma, or gastroesophageal reflux disease 1.
Important Clinical Pitfall
Approximately one-third of patients presenting with acute cough and diagnosed with acute bronchitis actually have acute asthma, highlighting the importance of careful evaluation and follow-up 1.