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Acute bronchitis

Definition
Acute bronchitis is a transient inflammation of the tracheobronchial tree in response to infection without a history of chronic pulmonary disease or evidence of pneumonia or sinusitis.
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Pathophysiology
The most common cause of acute bronchitis are viruses (90%) including adenovirus, influenza, measles, respiratory syncytial, parainfluenza, and HSV. Nonvirus (10%) causes include bacteria (Mycoplasma pneumoniae, Bordetella pertussis, and Chlamydia pneumoniae) and inhaled lung irritants.
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Disease course
Inflammation of the tracheobronchial tree results in acute bronchitis, which causes clinical manifestations of cough (dry or productive), chest tightness, burning with or without wheezing, headache, low-grade fever, rhinorrhea, sore throat, malaise, and myalgia.
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Prognosis and risk of recurrence
Acute bronchitis is not associated with an increase in mortality.
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Key sources
The following summarized guidelines for the evaluation and management of acute bronchitis are prepared by our editorial team based on guidelines from the American College of Physicians (ACP 2021), the American College of Chest Physicians (ACCP 2020; 2006), the American Academy of Family Physicians (AAFP 2016), the American College of Physicians (ACP/CDC 2016), and the Infectious Diseases Society of America (IDSA 2016).
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Guidelines

1.Screening and diagnosis

Diagnostic criteria: diagnose acute bronchitis in patients with an acute respiratory infection manifested predominantly by cough, with or without sputum production, lasting ≤ 3 weeks, if there is no clinical or radiographic evidence of pneumonia, common cold, acute asthma, and COPD exacerbation.
E
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2.Diagnostic investigations

Chest X-ray: as per ACCP 2020 guidelines, avoid obtaining routine CXRs in immunocompetent adult outpatients with cough due to suspected acute bronchitis.

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  • Laboratory tests

  • Spirometry

  • Further evaluation

3.Medical management

Antibiotic therapy: as per ACP 2021 guidelines, limit antibiotic treatment duration to 5 days when managing patients with acute uncomplicated bronchitis with clinical signs of a bacterial infection (presence of increased sputum purulence in addition to increased dyspnea, and/or increased sputum volume).
B

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  • Antiviral therapy

  • Symptomatic therapy

4.Specific circumstances

Patients with Aspergillus bronchitis
Obtain both PCR and galactomannan on respiratory secretions, usually sputum, for the detection of Aspergillus species to confirm the diagnosis of Aspergillus bronchitis in non-transplant patients.
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Consider initiating oral itraconazole or voriconazole with therapeutic drug monitoring in non-transplant patients with Aspergillus bronchitis.
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