eMedicine Specialties > Pulmonology > Obstructive Airways Diseases

Bronchitis: Differential Diagnoses & Workup

Author: Jazeela Fayyaz, DO, Senior Fellow, Department of Pulmonology, Lenox Hill Hospital
Coauthor(s): Ali Hmidi, MD, Staff Physician, Department of Internal Medicine, Brooklyn Hospital Center, Cornell University; Jeffrey Nascimento, DO, MS, Fellow, Department of Pulmonary Medicine, Lenox Hill Hospital; Roger B Olade, MD, MPH, Medical Director, Providence Health Group; Klaus-Dieter Lessnau, MD, FCCP, Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital
Contributor Information and Disclosures

Updated: Jun 17, 2009

Differential Diagnoses

Alpha1-Antitrypsin Deficiency
Gastroesophageal Reflux Disease
Asthma
Influenza
Bronchiectasis
Pharyngitis, Bacterial
Bronchiolitis
Pharyngitis, Viral
Chronic Bronchitis
Pneumonia
Chronic Obstructive Pulmonary Disease
Sinusitis, Acute
Cough
Sinusitis, Chronic
Expectoration
Streptococcus Group A Infections

Other Problems to Be Considered

  • Exercise-induced asthma
  • Bacterial tracheitis
  • Cough
  • Cystic fibrosis
  • Influenza
  • Hyperreactive airway disease
  • Retained foreign body
  • Tonsillitis
  • Occupational exposures
  • Pediatric considerations: These include bronchiolitis, croup, and laryngotracheobronchitis and pertussis.
  • Streptococcal pharyngitis
    • This condition is most commonly caused by group A streptococci (45%) and anaerobes (18%), which often occur as a co-infection. Penicillin is the drug of choice, as opposed to broad-spectrum antimicrobials such as amoxicillin/clavulanic acid, quinolones, or macrolides. If the patient is allergic to penicillin, clindamycin is a good alternative.
    • The rapid group A streptococcal antigen tests offer a quick answer but lack the specificity and sensitivity of culture. Much of the concern about diagnosing streptococcal pharyngitis is related to the complications of infection, particularly acute rheumatic fever and poststreptococcal glomerulonephritis as a late complication. Therefore, maintaining a high level of suspicion for streptococci group A in the presence of pharyngitis is advisable.

Workup

Laboratory Studies

  • Bronchitis may be suspected in patients with an acute respiratory infection with cough; however, because many more serious diseases of the lower respiratory tract cause cough, bronchitis must be considered a diagnosis of exclusion.
  • Obtain cultures of respiratory secretions for influenza virus, M pneumoniae, and Bordetella pertussis when these organisms are suspected. Culture methods and immunofluorescence tests have been developed for laboratory diagnosis of C pneumoniae infection.
  • Obtain a throat swab.
  • Culture and Gram stain of sputum is often performed; however, these tests usually show no growth or only normal respiratory florae.1
  • Obtain a CBC count with differential.
  • Blood culture may sometimes be helpful if bacterial superinfection is suspected.
  • Sputum cytology may be helpful if the cough is persistent.

Imaging Studies

  • Chest radiography should be performed in those patients whose physical examination findings suggest pneumonia.
  • Bronchoscopy may be needed to exclude foreign body aspiration, tuberculosis, tumors, and other chronic diseases of the tracheobronchial tree and lungs.

Other Tests

  • Influenza tests may be useful. Additional serologic tests, such as for atypical pneumonia, are not indicated.

Procedures

  • Laryngoscopy can exclude epiglottitis.

Histologic Findings

Goblet cell hyperplasia, mucosal and submucosal inflammatory cells, edema, peribronchial fibrosis, intraluminal mucous plugs, and increased smooth muscle are characteristic findings in small airways in chronic obstructive lung disease.

More on Bronchitis

Overview: Bronchitis
Differential Diagnoses & Workup: Bronchitis
Treatment & Medication: Bronchitis
Follow-up: Bronchitis
References
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References

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  2. Macfarlane J, Holmes W, Gard P, et al. Prospective study of the incidence, aetiology and outcome of adult lower respiratory tract illness in the community. Thorax. Feb 2001;56(2):109-14. [Medline].

  3. [Best Evidence] Poole PJ, Black PN. Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease. Cochrane Database Syst Rev. Jul 19 2006;3:CD001287. [Medline].

  4. [Guideline] Braman SS. Chronic cough due to acute bronchitis: ACCP evidence-based clinical practice guidelines. Chest. Jan 2006;129(1 Suppl):95S-103S. [Medline].

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  6. American Academy of Pediatrics. Committee on Drugs. Use of codeine- and dextromethorphan-containing cough remedies in children. American Academy of Pediatrics. Committee on Drugs. Pediatrics. Jun 1997;99(6):918-20. [Medline].

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  10. Siempos II, Dimopoulos G, Korbila IP, Manta K, Falagas ME. Macrolides, quinolones and amoxicillin/clavulanate for chronic bronchitis: a meta-analysis. Eur Respir J. Jun 2007;29(6):1127-37. [Medline].

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Further Reading

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Keywords

bronchitis, acute bronchitis, chronic bronchitis, upper respiratory tract infection, URTI, flu, influenza, chronic obstructive pulmonary disease, COPD, excessive tracheobronchial mucus production, simple chronic bronchitis, chronic mucopurulent bronchitis, chronic bronchitis with obstruction, flu, bronchopneumonia, bronchiectasis, inflammation of bronchial tubes, Mycoplasma pneumoniae, M pneumoniae, Chlamydia pneumoniae, C pneumoniae, Streptococcus pneumoniae, S pneumoniae, Moraxella catarrhalis, M catarrhalis, Haemophilus influenzae, H influenzae, mycoplasmal pneumonia, pharyngeal erythema, localized lymphadenopathy, right ventricular hypertrophy, cystic fibrosis, parainfluenza, adenovirus, rhinovirus, respiratory syncytial virus, cigarette smoking, air pollution

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Contributor Information and Disclosures

Author

Jazeela Fayyaz, DO, Senior Fellow, Department of Pulmonology, Lenox Hill Hospital
Jazeela Fayyaz, DO is a member of the following medical societies: American College of Physicians and American Thoracic Society
Disclosure: Nothing to disclose.

Coauthor(s)

Ali Hmidi, MD, Staff Physician, Department of Internal Medicine, Brooklyn Hospital Center, Cornell University
Disclosure: Nothing to disclose.

Jeffrey Nascimento, DO, MS, Fellow, Department of Pulmonary Medicine, Lenox Hill Hospital
Jeffrey Nascimento, DO, MS is a member of the following medical societies: American College of Chest Physicians, American Medical Association, American Osteopathic Association, American Thoracic Society, New York County Medical Society, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Roger B Olade, MD, MPH, Medical Director, Providence Health Group
Roger B Olade, MD, MPH is a member of the following medical societies: American College of Occupational and Environmental Medicine and American College of Physicians
Disclosure: Nothing to disclose.

Klaus-Dieter Lessnau, MD, FCCP, Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital
Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Artificial Internal Organs, American Thoracic Society, Physicians for Social Responsibility, and Society of Critical Care Medicine
Disclosure: sepracor Ownership interest None

Medical Editor

Helen M Hollingsworth, MD, Director, Adult Asthma and Allergy Services, Associate Professor, Department of Internal Medicine, Division of Pulmonary and Critical Care, Boston Medical Center
Helen M Hollingsworth, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Chest Physicians, American Thoracic Society, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Gregg T Anders, DO, Medical Director, Great Plains Regional Medical Command , Brook Army Medical Center; Clinical Associate Professor, Department of Internal Medicine, Division of Pulmonary Disease, University of Texas Health Science Center at San Antonio
Gregg T Anders, DO is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society
Disclosure: Nothing to disclose.

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD, Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center; Professor of Medicine, David Geffen School of Medicine at UCLA
Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society
Disclosure: Nothing to disclose.

 
 
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