Acute bronchitis overview

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]; Nate Michalak, B.A.

Overview

Acute bronchitis is a self-limited lower respiratory tract infection that is more common in young children and the elderly, especially during cold seasons.[1][2][3] Viruses, especially influenza, are the most common causative agents.[4][2][5] Symptoms include: cough, sputum production and wheezing as well as constitutional symptoms. It must be differentiated from pneumonia, asthma, and GERD.[3] Reassurance and symptomatic medications are mainstays of acute bronchitis.[2][6] Acute bronchitis may be prevented by hand hygiene, vaccination, and environmental control.[3][7] Smoking cessation plays a great role in reducing the course of the disease.[8]

Historical Perspective

Acute bronchitis was first described by Charles Badham in 1808 in England.[9] In 1821, Dr. Rene Laennec, known as the "father of chest medicine," described bronchitis in details.[10]

Pathophysiology

The causative agent is transmitted through the large and medium size airway tracts and inoculates the tracheobranchial epithelium. This leads to inflammation, thickening, and increased mucus production in the airways.[1] Epithelial-cell desquamation and denuding of the airway to the level of the basement membrane in association with the presence of a lymphocytic cellular infiltrate have been demonstrated on microscopic examination.[1]

Causes

Common causes of acute bronchitis include viruses, bacteria and environmental factors. Among them, influenza is the most common.[4][2][5]

Differential Diagnosis of Acute Bronchitis

Acute bronchitis must be differentiated from other diseases that may cause cough, dyspnea, and wheezing[3] including, pneumonia,[11] Asthma[12] Chronic bronchitis,[13] and GERD[14][15]

Epidemiology

Acute bronchitis is the ninth most common illness among outpatient visits in the U.S. It's prevalence depends on season of the year, vaccination status and outbreaks during that particular year. It is common among young children and the elderly.[16][2][17]

Risk factors

The main determining risk factors for acute bronchitis are age, season of the year and the immunization status[1][2][3].

Natural History

If left untreated, acute bronchitis usually resolves within 2 weeks but may last up to 2 months.[1][18] Prognosis is generally excellent and majority of patients recover after 5-10 days.[2] Recurrent episodes of acute bronchitis in subsequent years occur in 20% of patients.[3]

Diagnosis

History and symptoms[2][6]

Physical examination

  • Acute bronchitis presents with signs of prolonged expiration, wheezing, fever and abnormal breath sounds.[3][2]

Laboratory Tests

  • Diagnostic tests are rarely needed to confirm the diagnosis of acute bronchitis. In very specific conditions, serologic tests, viral cultures or sputum analyses may be applied. Generally, inflammatory markers, such as CRP, rise during the course of acute bronchitis. Procalcitonin is helpful to differentiate bacterial from other causes.

Chest x-ray

  • Normal lung view is the typical finding on chest x-ray.[3][19]

Treatment

Medical therapy

  • Reassurance and symptomatic therapy are the mainstay of treatment. NSAIDs, albuterol and antitussives may help alleviate symptoms.
  • The most important treatment aspect is to NOT routinely prescribe antibiotics.[20][21][7][2][22]

Primary prevention

  • The major preventive measures for acute bronchitis include: hands hygiene, environmental control, wearing physical barriers, and vaccination for preventable pathogens, such as influenza and pertussis[3][7].

Secondary prevention

  • Smoking cessation or reduction is helpful in reducing the severity of acute bronchitis symptoms.[23]

References

  1. 1.0 1.1 1.2 1.3 1.4 Gonzales R, Sande MA (2000). "Uncomplicated acute bronchitis". Ann. Intern. Med. 133 (12): 981–91. PMID 11119400. 
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 Wenzel RP, Fowler AA (2006). "Clinical practice. Acute bronchitis". N. Engl. J. Med. 355 (20): 2125–30. PMID 17108344. doi:10.1056/NEJMcp061493. 
  3. 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 Albert RH (2010). "Diagnosis and treatment of acute bronchitis". Am Fam Physician. 82 (11): 1345–50. PMID 21121518. 
  4. 4.0 4.1 Boldy DA, Skidmore SJ, Ayres JG (1990). "Acute bronchitis in the community: clinical features, infective factors, changes in pulmonary function and bronchial reactivity to histamine". Respir Med. 84 (5): 377–85. PMID 2174179. 
  5. 5.0 5.1 Jonsson JS, Sigurdsson JA, Kristinsson KG, Guthnadóttir M, Magnusson S (1997). "Acute bronchitis in adults. How close do we come to its aetiology in general practice?". Scand J Prim Health Care. 15 (3): 156–60. PMID 9323784. 
  6. 6.0 6.1 Graffelman AW, le Cessie S, Knuistingh Neven A, Wilemssen FE, Zonderland HM, van den Broek PJ (2007). "Can history and exam alone reliably predict pneumonia?". J Fam Pract. 56 (6): 465–70. PMID 17543257. 
  7. 7.0 7.1 7.2 Braman SS (2006). "Chronic cough due to acute bronchitis: ACCP evidence-based clinical practice guidelines". Chest. 129 (1 Suppl): 95S–103S. PMID 16428698. doi:10.1378/chest.129.1_suppl.95S. 
  8. The American Academy of Family Physicians: Acute Bronchitis. January 2006. Accessed 20 March 2007.
  9. Klippe HJ, Kirsten D (2009). "[200 years of bronchitis--from 1808 to 2008]". Pneumologie (in German). 63 (4): 228–30. PMID 19343614. doi:10.1055/s-0028-1119572. 
  10. terms(2016)https://lunginstitute.com/blog/history-of-chronic-bronchitis/accessed on September,13 2016
  11. Prina E, Ranzani OT, Torres A (2015). "Community-acquired pneumonia". Lancet. 386 (9998): 1097–108. PMID 26277247. doi:10.1016/S0140-6736(15)60733-4. 
  12. Busse WW (2011). "Asthma diagnosis and treatment: filling in the information gaps". J. Allergy Clin. Immunol. 128 (4): 740–50. PMID 21875745. doi:10.1016/j.jaci.2011.08.014. 
  13. Celli BR, MacNee W (2004). "Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper". Eur. Respir. J. 23 (6): 932–46. PMID 15219010. 
  14. Singh A (2009). "Asthma in older adults". CMAJ. 181 (12): 929. PMC 2789137Freely accessible. PMID 19969583. doi:10.1503/cmaj.109-2049. 
  15. Irwin RS, Baumann MH, Bolser DC, Boulet LP, Braman SS, Brightling CE, Brown KK, Canning BJ, Chang AB, Dicpinigaitis PV, Eccles R, Glomb WB, Goldstein LB, Graham LM, Hargreave FE, Kvale PA, Lewis SZ, McCool FD, McCrory DC, Prakash UB, Pratter MR, Rosen MJ, Schulman E, Shannon JJ, Smith Hammond C, Tarlo SM (2006). "Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines". Chest. 129 (1 Suppl): 1S–23S. PMC 3345522Freely accessible. PMID 16428686. doi:10.1378/chest.129.1_suppl.1S. 
  16. Macfarlane J, Holmes W, Gard P, Macfarlane R, Rose D, Weston V, Leinonen M, Saikku P, Myint S (2001). "Prospective study of the incidence, aetiology and outcome of adult lower respiratory tract illness in the community". Thorax. 56 (2): 109–14. PMC 1746009Freely accessible. PMID 11209098. 
  17. Ferri FF. Ferri's Clinical Advisor 2016, 5 Books in 1. Elsevier Health Sciences; 2015.
  18. Landau LI (2006). "Acute and chronic cough". Paediatr Respir Rev. 7 Suppl 1: S64–7. PMID 16798599. doi:10.1016/j.prrv.2006.04.172. 
  19. Gonzales R, Bartlett JG, Besser RE, Cooper RJ, Hickner JM, Hoffman JR, Sande MA (2001). "Principles of appropriate antibiotic use for treatment of uncomplicated acute bronchitis: background". Ann. Intern. Med. 134 (6): 521–9. PMID 11255532. 
  20. Little P, Rumsby K, Kelly J, Watson L, Moore M, Warner G, Fahey T, Williamson I (2005). "Information leaflet and antibiotic prescribing strategies for acute lower respiratory tract infection: a randomized controlled trial". JAMA. 293 (24): 3029–35. PMID 15972565. doi:10.1001/jama.293.24.3029. 
  21. Smith SM, Fahey T, Smucny J, Becker LA (2014). "Antibiotics for acute bronchitis". Cochrane Database Syst Rev (3): CD000245. PMID 24585130. doi:10.1002/14651858.CD000245.pub3. 
  22. Wong DM, Blumberg DA, Lowe LG (2006). "Guidelines for the use of antibiotics in acute upper respiratory tract infections". Am Fam Physician. 74 (6): 956–66. PMID 17002029. 
  23. The American Academy of Family Physicians: Acute Bronchitis. January 2006. Accessed 20 March 2007.

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