ACUTE BRONCHITIS

Dr. Ayman Al-Attar MRCGP Int

Egyptian Fellowship in Family Medicine
Arab Diploma in Family Medicine
Professional Diploma in Diabetes
 A new book in the “Concise Medical
Guides” series , designed in organized
easy to recall way in order to be concise
yet comprehensive source covering
the “never to forget” issues in our
daily practice and the “high yield”
points commonly tested in board
exams. I hope it fulfils this aim and
may Allah grant success for all of us
 CONCISE MEDICAL GUIDES BY DR. AYMAN AL-ATTAR ACUTE BRONCHITIS

❶ WHAT IS ACUTE BRONCHITIS ?

● DEFINITION AND PATHOPHYSIOLOGY :
- self-limiting acute lower respiratory tract infection causing acute
inflammation of the bronchial walls and increase in mucus secretion
- while the infection may clear in several days , repair of the bronchial
walls may take several weeks , during which patient continues coughing

● ETIOLOGY AND RISK FACTORS :

- most cases are viral infections , same viruses as for upper respiratory
infections as rhinovirus , respiratory syncytial virus , adenovirus & coronavirus
- high incidence in autumn and winter , called chest cold to denote
that viral bronchitis is simply an extension from URTIs in most cases
- smoking and occupational or environmental exposure to pollution

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 CONCISE MEDICAL GUIDES BY DR. AYMAN AL-ATTAR ACUTE BRONCHITIS

❷ WHEN TO SUSPECT ?
● PATIENT COMPLAINT :
- cough > 2 weeks is the main symptoms , worse at night or with exercise

- symptoms of bronchial obstruction as wheezes and dyspnea may present

- preceding URT symptoms as rhinorrhea and sore throat are often present

MacFarlane Criteria for Acute Bronchitis :

1. acute illness < 21 days (in 1/4 patients it lasts > 1 month)

2. cough is the predominant symptom

3. at least 1 other LRT symptom as sputum , wheezing or chest pain

4. no alternative explanation (no underlying respiratory chronic illness)

worrying symptoms as hemoptysis , pleuritic chest pain or high fever

and rigors should warrant further assessment for alternative diagnosis

● CLINICAL EXAMINATION :
- may show signs of URTIs as coryza , nasal congestion and throat hyperemia

- lung exam : diffusely scattered wheezes and prolonged expiratory phase

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 CONCISE MEDICAL GUIDES BY DR. AYMAN AL-ATTAR ACUTE BRONCHITIS

❸ HOW TO CONFIRM ?
- acute bronchitis is clinical diagnosis , with no need for further workup
● PULMONARY FUNCTION TESTS :
- pulmonary functions tests are not recommended in acute bronchitis
- if ordered to exclude other causes , acute bronchitis may show mild to
moderate bronchial obstruction that clears with resolution of infection

● MARKERS OF BACTERIAL INFECTION :

- C-Reactive Protein : elevated levels can indicate bacterial infection
- Procalcitonin : elevated levels can indicate bacterial infection
NB. Both can be used to guide need for antibiotic therapy :

C-Reactive Protein Procalcitonin

<2 no antibiotics < 0.25 discouraged
2-10 delayed antibiotics 0.25-0.5 encouraged
> 10 immediate antibiotics > 0.5 strongly encouraged

● IMAGING STUDIES :
- routine imaging is not indicated , consider to rule out other diagnoses when
suspected rather than to confirm acute bronchitis which has normal CXR
- consider imaging if worrying clinical signs as high fever , tachycardia ,
tachypnea , bloody or rusty sputum and focal consolidations signs

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 CONCISE MEDICAL GUIDES BY DR. AYMAN AL-ATTAR ACUTE BRONCHITIS

❹ HOW TO MANAGE ?
● SYMPTOMATIC TREATMENT :
- just observation and using safe home remedies can be enough if
minimal cough not disturbing daily life activities or interrupting sleep
- Antitussive : to suppress cough
Rx Dextromethorphan 30 mg PO three times daily
- Bronchodilator : for associated wheezing
Rx Salbutamol 1-2 puffs inhaled when required
- Antipyretic : for associated fever
Rx Paracetamol 500-1000 mg PO three times daily

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 CONCISE MEDICAL GUIDES BY DR. AYMAN AL-ATTAR ACUTE BRONCHITIS

● ANTIBIOTIC THERAPY :
- antibiotics not recommended in majority of patients , some patients
recover faster but insignificant difference (1/2 day over 8-10 days period)

- consider short course antibiotics if systemically unwell or high risk of

complications as elderly , immunocompromised (diabetes or current
steroid use) or comorbidities (cardiac , respiratory , hepatic or renal)

- guide antibiotic therapy by biomarkers (CRP or procalcitonin)

Rx Amoxicillin 500 mg PO 1x3x5

Rx Doxycycline 200 mg 1x1x5
Rx Clarithromycin 500 mg 1x2x5

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 CONCISE MEDICAL GUIDES BY DR. AYMAN AL-ATTAR ACUTE BRONCHITIS

● PATIENT EDUCATION :
- Safe Home Remedy : rest , adequate fluid intake , inhaling steam ,
gargling with warm salt water , honey and lemon or ginger and turmeric
- Post Bronchitis Syndrome : cough can last for several months (ongoing
repair to the bronchial walls after the clearance of the acute infection)

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CONCISE MEDICAL GUIDES
made to be easy for student , concise for GP and basic for intern

A new book in the “Concise Medical Guides” series ,

designed in organized easy to recall way in order to be
concise yet comprehensive source covering the “never
to forget” issues in our daily practice and the “high
yield” points commonly tested in board exams. I hope
it fulfils this aim and may Allah grant success for all of us