Bronchitis Differential Diagnoses
- Author: Jazeela Fayyaz, DO; Chief Editor: Zab Mosenifar, MD more...
Diagnostic Considerations
Streptococcal pharyngitis is most commonly caused by group A streptococci (45%) and anaerobes (18%), which often occur as a co-infection.
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.
Other medical issues/problems to consider include the following:
- Exercise-induced asthma
- Bacterial tracheitis
- Cough
- Cystic fibrosis
- Influenza
- Hyperreactive airway disease
- Retained foreign body
- Tonsillitis
- Occupational exposures
Differential Diagnoses
- Alpha1-Antitrypsin Deficiency
- Asthma
- Bronchiectasis
- Bronchiolitis
- Chronic Bronchitis
- Chronic Obstructive Pulmonary Disease
- Gastroesophageal Reflux Disease
- Influenza
- Pharyngitis, Bacterial
- Pharyngitis, Viral
- Sinusitis, Acute
- Sinusitis, Chronic
- Streptococcus Group A Infections
Knutson D, Braun C. Diagnosis and management of acute bronchitis. Am Fam Physician. May 15 2002;65(10):2039-44. [Medline].
Black S. Epidemiology of pertussis. Pediatr Infect Dis J. Apr 1997;16(4 Suppl):S85-9. [Medline].
Jivcu C, Gotfried M. Gemifloxacin use in the treatment of acute bacterial exacerbation of chronic bronchitis. Int J Chron Obstruct Pulmon Dis. 2009;4:291-300. [Medline]. [Full Text].
Sethi S, Murphy TF. Infection in the pathogenesis and course of chronic obstructive pulmonary disease. N Engl J Med. Nov 27 2008;359(22):2355-65. [Medline].
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].
Wenzel RP, Fowler AA 3rd. Clinical practice. Acute bronchitis. N Engl J Med. Nov 16 2006;355(20):2125-30. [Medline].
Schuetz P, Christ-Crain M, Thomann R, et al. Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial. JAMA. Sep 9 2009;302(10):1059-66. [Medline].
Briel M, Schuetz P, Mueller B, et al. Procalcitonin-guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care. Arch Intern Med. Oct 13 2008;168(18):2000-7; discussion 2007-8. [Medline].
[Guideline] Braman SS. Chronic cough due to acute bronchitis: ACCP evidence-based clinical practice guidelines. Chest. Jan 2006;129(1 Suppl):95S-103S. [Medline].
[Guideline] Braman SS. Chronic cough due to chronic bronchitis: ACCP evidence-based clinical practice guidelines. Chest. Jan 2006;129(1 Suppl):104S-115S. [Medline].
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].
[Best Evidence] Smucny J, Becker L, Glazier R. Beta2-agonists for acute bronchitis. Cochrane Database Syst Rev. Oct 18 2006;CD001726. [Medline].
[Best Evidence] Poole PJ, Black PN. Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease. Cochrane Database Syst Rev. Feb 17 2010;2:CD001287. [Medline].
Aagaard E, Gonzales R. Management of acute bronchitis in healthy adults. Infect Dis Clin North Am. Dec 2004;18(4):919-37; x. [Medline].
Gonzales R, Steiner JF, Lum A, Barrett PH Jr. Decreasing antibiotic use in ambulatory practice: impact of a multidimensional intervention on the treatment of uncomplicated acute bronchitis in adults. JAMA. Apr 28 1999;281(16):1512-9. [Medline].
Tan T, Little P, Stokes T. Antibiotic prescribing for self limiting respiratory tract infections in primary care: summary of NICE guidance. BMJ. Jul 23 2008;337:a437. [Medline].
Ram FS, Rodriguez-Roisin R, Granados-Navarrete A, Garcia-Aymerich J, Barnes NC. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. Apr 19 2006;CD004403. [Medline].
Roede BM, Bresser P, Prins JM, Schellevis F, Verheij TJ, Bindels PJ. Reduced risk of next exacerbation and mortality associated with antibiotic use in COPD. Eur Respir J. Feb 2009;33(2):282-8. [Medline].
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].
Korbila IP, Manta KG, Siempos II, Dimopoulos G, Falagas ME. Penicillins vs trimethoprim-based regimens for acute bacterial exacerbations of chronic bronchitis: meta-analysis of randomized controlled trials. Can Fam Physician. Jan 2009;55(1):60-7. [Medline].
[Best Evidence] El Moussaoui R, Roede BM, Speelman P, Bresser P, Prins JM, Bossuyt PM. Short-course antibiotic treatment in acute exacerbations of chronic bronchitis and COPD: a meta-analysis of double-blind studies. Thorax. May 2008;63(5):415-22. [Medline].
Nichol KL, Wuorenma J, von Sternberg T. Benefits of influenza vaccination for low-, intermediate-, and high-risk senior citizens. Arch Intern Med. Sep 14 1998;158(16):1769-76. [Medline].
United States Food and Drug Administration. Zicam cold remedy nasal products (Cold Remedy Nasal Gel, Cold Remedy Nasal Swabs, and Cold Remedy Saws, Kids Size). MedWatch Public Health Advisory. Available at http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm166996.htm. Accessed June 16, 2009.
Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA. Sep 17 1997;278(11):901-4. [Medline].
Franks P, Gleiner JA. The treatment of acute bronchitis with trimethoprim and sulfamethoxazole. J Fam Pract. Aug 1984;19(2):185-90. [Medline].
Centers for Disease Control and Prevention. Interim results: state-specific seasonal influenza vaccination coverage - United States, August 2009-January 2010. MMWR Morb Mortal Wkly Rep. Apr 30 2010;59(16):477-84. [Medline].

