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Acute bronchitis is an inflammation of the large airways of the lung and is usually self-limited to a period of up to 3 weeks. Figure 67-0.1 demonstrates the inflamed lining of the bronchiole and narrowing caused by acute bronchitis. The primary manifestation is cough, with or without sputum, and pneumonia is excluded by clinical evaluation or by chest radiograph. This disorder affects approximately 5% of adults annually with a predominance for winter and fall.1 In the U.S., acute bronchitis is the ninth most common illness among outpatients, as reported by primary care physicians and ED physicians.

Figure 67-0.1.

Inflamed bronchiole with increased mucus production.

Acute bronchitis shares many of the same pathogens and symptoms of the common cold, and bronchitis often follows upper respiratory infections. A cough with or without phlegm production can also be the primary symptom of the common cold syndrome,2 and cough can be prevalent in up to 83% of cases within the first 2 days of the common cold.3 Cough associated with the common cold can be differentiated from bronchitis in that postnasal drip and throat clearing is an upper respiratory cough syndrome.2

Episodes of acute bronchitis account for more than 10 million office visits per year.4–6 Symptom relief is the major reason for seeking care and leads to 10 ambulatory visits per 1000 people per year.7 Colds and bronchitis are traditionally targeted by patients as conditions requiring antibiotic coverage.5 Factors associated with antibiotic treatment are listed in Table 67-1.

Table 67-1 Independent Predictors of Antibiotic Treatment of Acute Respiratory Tract Infections in U.S. Acute Care Settings


Respiratory viruses are considered the most common cause of acute bronchitis, although they are isolated in only a minority of patients because viral cultures and serologic assays are not routinely performed.8,9 Viral isolates of acute bronchitis, listed from most to least common, include influenza A and B viruses, parainfluenza virus, respiratory syncytial virus, coronavirus, adenovirus, and rhinovirus.1 The enterovirus is an uncommon cause and typically produces an undifferentiated febrile illness. ...

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