Diagnosis And Treatment Of Acute Bronchitis
ROSS H. ALBERT, MD, PhD, Hartford Hospital, Hartford, Connecticut
Am Fam Physician. 2010 Dec 1 82:1345-1350.
Patient information: See related handout on treatment of bronchitis, written by the author of this article.
Cough is the most common symptom for which patients present to their primary care physicians, and acute bronchitis is the most common diagnosis in these patients.1 However, studies show that most patients with acute bronchitis are treated with inappropriate or ineffective therapies.2 Although some physicians cite patient expectations and time constraints for using these therapies, recent warnings from the U.S. Food and Drug Administration about the dangers of certain commonly used agents underscore the importance of using only evidence-based, effective therapies for bronchitis.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Antibiotics should not be used routinely for the treatment of acute bronchitis
The following therapies may be considered to manage bronchitis-related symptoms:
Antitussives in patients six years and older
Beta-agonist inhalers in patients with wheezing
The following medicines should not be used to manage bronchitis-related symptoms:
Beta-agonist inhalers in patients without wheezing
Antitussives in children younger than six years
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Antibiotics should not be used routinely for the treatment of acute bronchitis
Summary Of Main Results
We found mixed results across studies, with some suggesting marginal benefits for antibiotics, which are however of doubtful clinical significance. The inclusion of the largest multicentre study of the effectiveness of antibiotics in people with lower respiratory tract infections strengthens the evidence and also highlights a statistically significant increase in adverse events in the antibiotictreated groups. However, it is possible that older patients with multimorbidity may not have been recruited to trials, so the evidence guiding decisionmaking in this group of patients is less certain.
When To See Your Gp
Most cases of bronchitis can be treated easily at home with rest, non-steroidal anti-inflammatory drugs and plenty of fluids.
You only need to see your GP if your symptoms are severe or unusual for example, if:
- your cough is severe or lasts longer than three weeks
- you have a constant fever for more than three days
- you cough up mucus streaked with blood
- you have an underlying heart or lung condition, such as asthma or heart failure
Your GP may need to rule out other lung infections, such as pneumonia, which has symptoms similar to those of bronchitis. If your GP thinks you may have pneumonia, you will probably need a chest X-ray, and a sample of mucus may be taken for testing.
If your GP thinks you might have an undiagnosed underlying condition, they may also suggest a pulmonary function test. You will be asked to take a deep breath and blow into a device called a spirometer, which measures the volume of air in your lungs. Decreased lung capacity can indicate an underlying health problem.
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Details For This Review
Study Population: Patients with acute bronchitis or acute productive cough with persistent cold or flulike illness
Efficacy End Points: Overall clinical improvement, patient-reported cough symptoms, feelings of illness, and limitations on activity, as assessed during follow-up at two to 14 days
Harm End Points: Adverse effects of antibiotic use , headache, skin rash, and vaginitis
Narrative: Acute bronchitis is a lower respiratory tract infection, most commonly viral, that accounts for a significant number of health care visits .1 It is characterized by acute onset and persistence of cough for one to three weeks. Reassurance and symptom control are the foundation of care for this self-limited condition however, studies indicate that 50% to 90% of patients are prescribed antibiotics.2
The Cochrane review summarized here assessed the effect of antibiotics in patients with acute bronchitis.3 The review analyzed 17 randomized trials that compared any antibiotic therapy with placebo or with no treatment. The studies included 5,099 patients of either sex with acute bronchitis or cough, with persistent cold- or flulike illness, and who did not have preexisting pulmonary disease. Most trials excluded patients with clinical findings of pneumonia four trials excluded patients based on radiographic findings. Eight of the studies enrolled adults, whereas the remainder included children and adolescents of varying ages. Antibiotics included dox
Read the full article.
Which Children Are At Risk For Acute Bronchitis
Children who have a higher chance of developing acute bronchitis are those who have:
These symptoms often last 7 to 14 days. But the cough may continue for 3 to 4 weeks. These symptoms may look like other health problems. Make sure your child sees his or her healthcare provider for a diagnosis.
What Matters Most To You
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to take antibiotics
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Quality Of The Evidence
Since there is no gold standard test, the diagnosis of acute bronchitis must be made on clinical grounds. All of the trials excluded people with chronic pulmonary disease and enrolled participants with recent onset of a respiratory illness with a productive cough. The results of the studies in the primary analysis that included participants with a productive cough, without specifically stating that the participants had acute bronchitis, were similar to the studies that used this specific terminology, as one showed some benefits from antibiotics , and one did not . Clinical characteristics of participants regarding the duration of illness and associated symptoms and physical findings did vary somewhat among studies, but were consistent with definitions generally used by primary care physicians . These results would therefore appear to be generalisable to the management of acute bronchitis in community practices.
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Types Of Antibiotics For Pneumonia
There are multiple types of antibiotics that work in slightly different ways. Some are more commonly used to treat pneumonia than others based on things like:
- The bacteria causing infection
- The severity of the infection
- If youre in a patient group at greatest risk from pneumonia
The types of antibiotics that your doctor might typically prescribe for pneumonia include the following:
Antibiotics prescribed for children with pneumonia include the following:
- Infants, preschoolers, and school-aged children with suspected bacterial pneumonia may be treated with amoxicillin.
- Children with suspected atypical pneumonia can be treated with macrolides.
- Children allergic to penicillin will be treated with other antibiotics as needed for the specific pathogen.
- Hospitalized, immunized children can be treated with ampicillin or penicillin G.
- Hospitalized children and infants who are not fully vaccinated may be treated with a cephalosporin.
- Hospitalized children with suspected M. pneumoniae or C. pneumoniae infection may be treated with combination therapy of a macrolide and a beta-lactam antibiotic .
- Hospitalized children with suspected S. aureus infections might be treated with a combination of Vancocin or clindamycin and a beta-lactam.
What Is The Outlook For People With Bronchitis
People who have acute bronchitis generally have very few problems with their recovery as long as they get the treatment they need. You can expect to stay home from work or school for a few days while you are recovering.
Although chronic bronchitis/COPD cannot be cured, its symptoms can be treated and your quality of life can be improved. Your prognosis, or outlook, for the future will depend on how well your lungs are functioning and your symptoms. It will also depend on how well you respond to and follow your treatment plan.
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Taking Nutrition And Dietary Supplements
There is some evidence that supplements may benefit people with bronchitis. People should get advice from a healthcare provider when considering supplements. Some supplements interact with medicines or have side effects.
N-acetylcysteine is a derivative of the amino acid L-cysteine. One review found that NAC could help prevent sudden worsening of chronic bronchitis symptoms.
Probiotics are live microorganisms. When consumed as food or supplements, they are thought to maintain or restore beneficial bacteria in the digestive tract.
What Are The Symptoms Of Bronchitis
A case of bronchitis is diagnosed based upon your symptoms. Some symptoms of bronchitis may include:
- Fever and chills
- Chest discomfort
- Production of sputum This mucus can be yellowish or green, white, clear, and sometimes streaked with blood
Generally, with acute bronchitis you might feel like you have the symptoms of a cold, but you may have a nagging cough that lingers on and on for much longer. With chronic bronchitis, your cough will be productive and last for at least three months.
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Description Of The Condition
Acute bronchitis is a common illness characterised by fever and cough that is often wheezy in nature and that may or may not be productive. The condition occurs when the bronchi become inflamed due to either viral or bacterial infection. Symptoms generally last for two weeks, but the associated cough can last for up to eight weeks . Acute bronchitis is the ninth most common outpatient illness recorded by physicians in ambulatory practice in the USA , and the fifth most common outpatient illness encountered by Australian general practitioners, for whom it represents 3.5% of encounters and 2.4% of problems seen . In the UK, there are 300 to 400 consultations for treatment of respiratory tract infections per 1000 registered patients each year, and while antibiotic prescribing for these conditions declined between 1995 and 2000, it has since stabilised . Data provided by the European Centre for Disease Prevention and Control on trends in antimicrobial consumption across Europe suggests that overall antibiotic use varies across Europe, with most countries showing an increase between 1997 and 2010 .
Avoidance Of Antibiotic Treatment For Acute Bronchitis/bronchiolitis
EHP, Priority Partners, and USFHP. Members age 3 months and older.
Percentage of episodes for members ages 3 months and older with a diagnosis of acute bronchitis/bronchiolitis, who were not dispensed an antibiotic medication on or 3 days after the episode. Looks at episodes between July 1 of the year prior to the measurement year through June 30 of the measurement year. The measure is reported as an inverted rate: A higher rate indicates appropriate treatment .
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Agreements And Disagreements With Other Studies Or Reviews
In the current update of the review we have included a large multi country trial that shows no benefits from antibiotics even in older patients. Further analyses of the data from this study are ongoing as part of Workpackage 10 of the GRACE program . It should be noted that a recent large observational study examining symptom resolution in 2714 people with acute cough who had been prescribed amoxicillin across 13 European countries found that symptom resolution was quicker in those receiving no antibiotic .
Top 10 List Of Common Infections Treated With Antibiotics
Most antibiotics fall into their individual antibiotic classes. An antibiotic class is a grouping of different drugs that have similar chemical and pharmacologic properties. Their chemical structures may look comparable, and drugs within the same class may kill the same or related bacteria.
However, it is important not to use an antibiotic for an infection unless your doctor specifically prescribes it, even if it’s in the same class as another drug you were previously prescribed. Antibiotics are specific for the kind of bacteria they kill. Plus, you would need a full treatment regimen to effectively cure your infection, so don’t use or give away leftover antibiotics.
Note: Tables below are not all-inclusive, generics are available for many brands.
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Key Points To Remember
- Bronchitis is usually caused by a virus and often follows a cold or flu. Antibiotics usually do not help acute bronchitis, and they may be harmful.
- Experts recommend that you not use antibiotics to try to relieve symptoms of acute bronchitis if you have no other health problems.
- Most cases of acute bronchitis go away in 2 to 3 weeks, but some may last 4 weeks. Home treatment to relieve symptoms is usually all that you need.
- Taking antibiotics too often or when you don’t need them can be harmful. Not taking the full course of antibiotics when your doctor prescribes them also can be harmful. The medicine may not work the next time you take it when you really do need it. This is called antibiotic resistance.
- Antibiotics may help prevent complications from acute bronchitis in people who have other problems, such as chronic obstructive pulmonary disease , other long-term breathing problems , or heart failure.
Description Of The Intervention
The use of antibiotics in people with acute bronchial infections remains a controversial area in primary healthcare practice . Streptococcus pneumoniae,Haemophilus influenzae, andMoraxella catarrhalis have been isolated from sputum samples in up to 45% of people with acute bronchitis , but their role is difficult to assess due to potential oropharyngeal colonisation in healthy individuals . Unfortunately, there are no clinically useful criteria that accurately help distinguish bacterial from viral bronchial infections, therefore some authors have called for physicians to stop prescribing antibiotics for people with acute bronchitis . Nevertheless, antibiotics are prescribed for 60% to 83% of people who present to physicians with the condition .
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What Is The Difference Between Bronchitis And Pneumonia
In terms of symptoms, these two diseases may seem very similar. Both cause cough, fever, fatigue, and a heavy feeling in your chest. Bronchitis can sometimes progress to pneumonia.
Despite similarities, the conditions are different. First, bronchitis involves the bronchial tubes, while pneumonia affects the alveoli, or the air sacs in the lungs. Second, pneumonia symptoms are usually much worse. In addition, pneumonia can be life-threatening, especially in older people and other vulnerable groups.
If your symptoms do not get better in a week or so, it is best to contact your doctor.
Data Collection And Analysis
Selection of studies
One review author evaluated the titles and abstracts of the identified citations and applied the inclusion criteria. We obtained the full papers of trials deemed potentially relevant for further examination. Two review authors screened the fulltext papers to determine if they met the inclusion criteria. We discarded reports that were clearly irrelevant. We recorded studies that did not fulfil the inclusion criteria along with the reasons for their exclusion in the table..
Data extraction and management
Two or more review authors independently extracted data using a data collection form designed for this review. Any disagreements were resolved by discussion between the review authors. We transferred data into Review Manager 5 .
Assessment of risk of bias in included studies
Two review authors evaluated the methodological quality of each trial using Risk of Bias domains recommended in the Cochrane Handook as outlined in and . Disagreements were resolved by consensus.
‘Risk of bias’ graph: review authors’ judgements about each methodological quality item presented as percentages across all included studies.
Measures of treatment effect
The effect measures of choice were risk ratio for categorical outcomes and mean difference for continuous data.
Unit of analysis issues
Dealing with missing data
Assessment of heterogeneity
Assessment of reporting biases
GRADE and ‘Summary of findings’ table
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How Is Acute Bronchitis Spread
If bronchitis is caused by a viral or bacterial infection, it is spread the same ways that colds are spreadby germs traveling through the air when someone coughs or sneezes. You can breathe the germs in if you are close enough. You could also touch something that has germs on it, like a door, and then transfer the germs by touching your nose, mouth or eyes. That is why good hand washing practices are important for adults and children.
How Is Acute Bronchitis Diagnosed In A Child
Your childs healthcare provider can often diagnose acute bronchitis with a health history and physical exam. In some cases, your child may need tests to rule out other health problems, such as pneumonia or asthma. These tests may include:
Chest X-rays. This test makes images of internal tissues, bones, and organs.
Pulse oximetry. An oximeter is a small device that measures the amount of oxygen in the blood. For this test, the healthcare provider puts a small sensor on your child’s finger or toe. When the device is on, a small red light can be seen in the sensor. The sensor is painless and the red light does not get hot.
Sputum and nasal discharge samples. These tests can find the germ causing an infection.