eMedicine Specialties > Emergency Medicine > Pulmonary

Bronchitis

Author: Samuel Ong, MD, Visiting Assistant Professor, Department of Emergency Medicine, University of California at Los Angeles Medical Center-Olive View
Contributor Information and Disclosures

Updated: Jan 14, 2009

Introduction

Background

Acute bronchitis refers simply to inflammation of the tracheobronchial tree. The cause is usually infectious, but allergens and irritants can produce a similar clinical picture. Bronchitis typically occurs in the setting of an upper respiratory illness; thus, it is observed more frequently in the winter months. Asthma can be mistakenly diagnosed as acute bronchitis if the patient has no prior history of asthma. In one study, one third of patients who had been determined to have recurrent bouts of acute bronchitis were eventually identified as having asthma.

Chronic bronchitis and acute exacerbations of chronic bronchitis are discussed in the eMedicine article Chronic Obstructive Pulmonary Disease and Emphysema.

Pathophysiology

Although bronchitis refers to inflammation of the trachea and bronchi, other segments of the respiratory tract may also be involved because acute bronchitis usually occurs in relation to the common cold or other respiratory illness.

Frequency

United States

According to the National Center for Health Statistics, more than 12 million cases of acute bronchitis occurred in 1994, a number roughly equal to 5% of the US population.1 In comparison, 91 million cases of influenza, 66 million cases of the common cold, and 31 million cases of other acute upper respiratory infections occurred during that same year.

International

Acute bronchitis is common throughout the world and is one of the top 5 reasons for seeking health care in countries that track such data.

Mortality/Morbidity

Bronchitis is nearly always self-limited in the otherwise healthy individual, although it frequently results in absenteeism from work and school. Severe cases occasionally produce deterioration in those with significant underlying cardiopulmonary disease or other comorbid conditions.

Sex

Although bronchitis seems to be diagnosed in women more frequently than in men, little difference is observed.

Age

Although found in all age groups, bronchitis is diagnosed most frequently in children younger than 5 years. In 1994, bronchitis was diagnosed in more than 11 of every 100 children younger than 5 years.1 This compared with only 4 of every 100 individuals in every other age group.

Clinical

History

  • A purulent cough is generally the defining presentation for acute bronchitis.
  • The following symptoms may also be present:
    • Fever
    • Malaise
    • Rhinorrhea or nasal congestion
    • Sore throat
    • Wheezing
    • Dyspnea
    • Chest pain
    • Myalgias or arthralgias
  • Occupational history may be important in determining whether irritants play a role.

Physical

  • No uniform definition describes acute bronchitis. The physical examination findings may include rhonchi or wheezes; in most cases, the examination findings are unremarkable.
  • Occasionally, findings may suggest a particular etiology.

Causes

  • Influenza, parainfluenza, adenovirus, rhinovirus, and numerous other viruses have been implicated.
  • M pneumoniae and Chlamydia pneumoniae have also been implicated, but the role of other bacterial pathogens remains difficult to validate given the difficulties associated with collecting adequate sputum samples and the problem of asymptomatic carriage of putative pathogens such as Streptococcus pneumoniae and Haemophilus influenzae.
  • Bordetella pertussis should be considered in children who are incompletely vaccinated; however, studies increasingly report this bacterium as the causative agent in adults as well.2

More on Bronchitis

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

  1. National Center for Health Statistics. Current estimates from the national health interview survey: United States, 1994. Vital health statistics. 1995;10. [Medline].

  2. Black S. Epidemiology of pertussis. Pediatr Infect Dis J. Apr 1997;16(4 Suppl):S85-9. [Medline].

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

  4. 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].

  5. Franks P, Gleiner JA. The treatment of acute bronchitis with trimethoprim and sulfamethoxazole. J Fam Pract. Aug 1984;19(2):185-90. [Medline].

  6. Mossad SB, Macknin ML, Medendorp SV, Mason P. Zinc gluconate lozenges for treating the common cold. A randomized, double-blind, placebo-controlled study. Ann Intern Med. Jul 15 1996;125(2):81-8. [Medline].

  7. 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].

  8. Brickfield FX, Carter WH, Johnson RE. Erythromycin in the treatment of acute bronchitis in a community practice. J Fam Pract. Aug 1986;23(2):119-22. [Medline].

  9. Croughan-Minihane MS, Petitti DB, Rodnick JE. Clinical trial examining effectiveness of three cough syrups. J Am Board Fam Pract. Mar-Apr 1993;6(2):109-15. [Medline].

  10. Dunlay J, Reinhardt R, Roi LD. A placebo-controlled, double-blind trial of erythromycin in adults with acute bronchitis. J Fam Pract. Aug 1987;25(2):137-41. [Medline].

  11. Gonzales R, Bartlett JG, Besser RE. Principles of appropriate antibiotic use for treatment of uncomplicated acute bronchitis: background. Ann Emerg Med. Jun 2001;37(6):720-7. [Medline].

  12. Gonzales R, Wilson A, Crane LA, Barrett PH. What's in a name? Public knowledge, attitudes, and experiences with antibiotic use for acute bronchitis. Am J Med. Jan 2000;108(1):83-5. [Medline].

  13. Huchon GJ, Gialdroni-Grassi G, Leophonte P, et al. Initial antibiotic therapy for lower respiratory tract infection in the community: a European survey. Eur Respir J. Aug 1996;9(8):1590-5. [Medline].

  14. Hueston WJ. A comparison of albuterol and erythromycin for the treatment of acute bronchitis. J Fam Pract. Nov 1991;33(5):476-80. [Medline].

  15. Hueston WJ. Albuterol delivered by metered-dose inhaler to treat acute bronchitis. J Fam Pract. Nov 1994;39(5):437-40. [Medline].

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  17. Meza RA, Bridges-Webb C, Sayer GP, et al. The management of acute bronchitis in general practice: results from the Australian Morbidity and Treatment Survey, 1990-1991. Aust Fam Physician. Aug 1994;23(8):1550-3. [Medline].

  18. Molfino NA. Genetics of COPD. Chest. May 2004;125(5):1929-40. [Medline].

  19. Palmer DA, Bauchner H. Parents' and physicians' views on antibiotics. Pediatrics. Jun 1997;99(6):E6. [Medline].

  20. Siegel D, Sande MA. Patterns of antibiotic use in a busy metropolitan emergency room: analysis of efficacy and cost-appropriateness. West J Med. May 1983;138(5):737-41. [Medline].

  21. Smith NM, Bresee JS, Shay DK. Prevention and Control of Influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. Jul 28 2006;55(RR-10):1-42. [Medline].

  22. Smucny J, Fahey T, Becker L, Glazier R. Antibiotics for acute bronchitis. Cochrane Database Syst Rev. 2004;CD000245. [Medline].

  23. Snyder LD, Eisner MD. Obstructive lung disease among the urban homeless. Chest. May 2004;125(5):1719-25. [Medline].

  24. Stott NC, West RR. Randomised controlled trial of antibiotics in patients with cough and purulent sputum. Br Med J. Sep 4 1976;2(6035):556-9. [Medline].

  25. Taylor JA, Novack AH, Almquist JR. Efficacy of cough suppressants in children. J Pediatr. May 1993;122(5 Pt 1):799-802. [Medline].

  26. Williamson HA. A randomized, controlled trial of doxycycline in the treatment of acute bronchitis. J Fam Pract. Oct 1984;19(4):481-6. [Medline].

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Further Reading

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Contributor Information and Disclosures

Author

Samuel Ong, MD, Visiting Assistant Professor, Department of Emergency Medicine, University of California at Los Angeles Medical Center-Olive View
Disclosure: Nothing to disclose.

Medical Editor

David FM Brown, MD, Assistant Professor, Department of Medicine, Division of Emergency Medicine, Harvard Medical School; Associate-Chief, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital
David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Schering  Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Paul Blackburn, DO, FACOEP, FACEP, Program Director, Department of Emergency Medicine, Maricopa Medical Center; Assistant Professor, Department of Surgery, University of Arizona
Paul Blackburn, DO, FACOEP, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American Medical Association, and Arizona Medical Association
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: eMedicine.com, Inc. Consulting fee Consulting

 
 
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