Acute bronchitis

Question 1

Define acute bronchitis.

Answer 1

Acute (<21 days), self-limiting, LRTI which causes inflammation in the bronchial airways. Presents with cough and at least 1 other symptom e.g. sputum, wheeze, chest pain + there is no other explanation for the symptoms.

Question 2

How common is acute bronchitis?

Answer 2

One of the most common conditions encountered in clinical practice
10% of ambulatory care visits
Most common in autumn and winter

Question 3

What is the aetiology of acute bronchitis?

Answer 3

Mostly viral and same as those causing URTIs e.g. coronaviruses, rhinovirus, RSV, adenovirus
Chlamydia pneumoniae and Mycoplasma pneumoniae common in younger military/students

Question 4

What is the pathophysiology of bronchitis?

Answer 4

Acute infiammation of bronchial wall –> mucus production and oedema –> productive cough

Repair of the bronchial wall may take several weeks after the cough subsides

50% have a cough for >2 weeks, 25% for >1month

Question 5

What are the clinical features of acute bronchitis?

Answer 5

• Productive cough - lasts >2weeks in most
• Intermittent wheeze or dyspnoea
• Related to other signs of respiratory illness e.g. rhinorrhoea, sore throat, low grade fever
• Coryza, nasal congestion, pharyngeal oedema

Exclude asthma and pneumonia (dyspnoea, cough, pleuritic chest pain, fever, rigors, malaise, haemoptysis)

Question 6

How do you diagnose acute bronchitis?

Answer 6

Investigations not needed
Clinical diagnosis if asthma/pneumonia excluded

But measure CRP if considering giving Abx to guide therapy

Question 7

What is the difference in procalcitonin levels in bacterial vs viral infections?

Answer 7

High in bacterial
Low in viral

Question 8

What is the management of acute bronchitis?

Answer 8

Self-limiting
Minimise symptoms until illness resolves e.g.
* cough supressants -
* bronchodilators - salbutamol
* antibiotics - usually not recommended as caused by a virus in most cases

Question 9

When does NICE recommend considering Abx in acute bronchitis?

Answer 9

Systematically unwell
Comorbidities
>80yrs with 1 of/ or >65yrs with 2 of:
* Hospitalisation in the last year
* Current steroid use
* Diabetes type 1 or 2
* History of CHF

Order CRP and don’t give abx if <20mg/L

Question 10

What are the complications of acute bronchitis?

Answer 10

Chronic cough - post bronchitis syndrome is if cough continues for 6 months
Pneumonia

Question 11

What is the prognosis with acute bronchitis?

Answer 11

Usually recover within 6 weeks and return to normal function
Recurrence is common especially in smokers