eMedicine Specialties > Pulmonology > Obstructive Airways Diseases

Bronchitis: Follow-up

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

Follow-up

Further Outpatient Care

  • Routine follow-up care is usually not necessary. If symptoms worsen (eg, shortness of breath, high fever, vomiting, persistent cough), consider an alternate diagnosis. If symptoms recur (>3 episodes/y), further investigation is recommended. If symptoms persist for longer than 1 month, reassess patient for other causes of cough.
  • Influenza vaccines are 70-90% effective in preventing flu among healthy adults. In elderly or chronically ill persons, the influenza vaccine may be less effective in preventing illness than it is in preventing serious complications and death.15 In the United States, the flu season usually occurs from approximately October to April. Influenza vaccination of healthy patients may be beneficial for reducing absenteeism.
  • Annual influenza vaccination should be provided to the following groups of individuals:
    • Beginning with 2008-2009 influenza season, all children aged 6 months to 18 years
    • Residents of nursing homes and chronic-care facilities and persons older than 50 years
    • Adults and children at risk for medical complications, such as those with chronic diseases or immunosuppression
    • Women who will be pregnant during the flu season, but inactivated influenza vaccine should be used
    • Persons who live with or care for persons at high risk for influenza-related complications
    • In certain situations, such as in nursing homes, also administer oseltamivir or zanamivir when an index case is found until the vaccine has had a chance to take effect.

Inpatient & Outpatient Medications

  • Nonsteroidal anti-inflammatory drugs are helpful in treating constitutional symptoms of acute bronchitis, including mild-to-moderate pain.
  • Albuterol  and guaifenesin products treat cough, dyspnea, and wheezing.

Deterrence/Prevention

  • The influenza vaccine may reduce the incidence of upper respiratory tract infections and, subsequently, reduce the incidence of acute bacterial bronchitis.
  • Pneumococcal vaccination is recommended with chronic bronchitis.
  • The Advisory Committee on Immunization Practices has published guidelines on the prevention and control of influenza.16

Complications

  • Complications occur in approximately 10% of patients with acute bronchitis and include the following:
    • Bacterial superinfection
    • Lower respiratory tract infection and pneumonia: Less than 5% of patients with bronchitis develop pneumonia. The incidence of subsequent pneumonia, however, remains unaffected by the use of antibiotics.
    • Chronic bronchitis: Repeated episodes of acute bronchitis may lead to chronic bronchitis.
    • Reactive airway disease: Acute bronchitis may lead to reactive airway disease.
    • Hemoptysis

Prognosis

  • Patients with acute bronchitis have a good prognosis.

Patient Education

  • Patient education is essential in the prevention and treatment of acute bronchitis. Unfortunately, health care providers usually underemphasize education. Patients should be counseled to take the following measures:
    • Avoid smoking and secondhand smoke.
    • Live in a clean environment.
    • Receive the influenza vaccine yearly between October and December.
    • Receive the pneumonia vaccine every 5-10 years if aged 65 years or older or have chronic disease.
  • For excellent patient education resources, visit eMedicine's Asthma Center. Additionally, see eMedicine's patient education article Asthma.

Miscellaneous

Medicolegal Pitfalls

  • Carefully explain the course, treatment options, and all possible complications of acute bronchitis.
  • Telithromycin (Ketek) has been reported to cause acute liver failure. Telithromycin is no longer recommended to treat bronchitis.17 In February 2007, the US Food and Drug Administration withdrew approval of telithromycin for bronchitis.

Special Concerns

  • Patients may influence the decision regarding treatment (eg, by insisting on receiving prescribed antibiotics).3
  • Acute bronchitis continues to be treated with antibiotics, although little evidence supports the effectiveness of antimicrobial treatment in this illness. However, patients with an acute exacerbation of chronic bronchitis may benefit from antimicrobial therapy.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Samer Qarah, MD, to the development and writing of this article.



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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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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