Acute bronchitis

• What is acute bronchitis?

  Inflammation of trachea & major bronchi
• What is the pathophys of acute bronchitis?

  Symptoms are due to acute inflammation of the bronchial wall → increased mucous production & oedema of the bronchus → productive cough

  The infection may clear in several days, but the repair of the bronchial wall may take several weeks (in which pts with continue to cough)
• What are the investigations for acute bronchitis?

  Diagnosis is primarily clinical

  CRP (levels help to decide treatment)

  Pulmonary function test (help to exclude asthma)

  CXR (to exclude pneumonia)
• Levels of CRP and treatment received from acute bronchitis

  • <20 mg/L (no antibiotics)
  • 20-100 mg/L (delayed antibiotics)
  • 100 mg/L (immediate antibiotics)
• What are the DDx of acute bronchitis?

  COVID 19

  Pneumonia

  Allergic rhinitis

  Asthma

  Pertussis infection

  Congestive HF

  Reflux oesophagitis

  Upper resp tract infection/common cold

  Upper airway cough syndrome

  Medication/environmental exposures

  Lung cancer
• What are the RFs for acute bronchitis?

  Viral or atypical bacterial infection exposure

  Smoking

  Pollution exposure
• What are the signs & symptoms of acute bronchitis?

  Cough (may or may not be productive)

  Sore throat

  Rhinorrhoea (runny nose)

  Wheeze

  Low-grade fever
• What is the treatment & management of acute bronchitis?

  Aim is to minimise symptoms until illness resolves

  • Analgesia
  • Cough suppressants or bronchodilators
  • Good fluid intake
  • Consider antibiotics therapy it pts… (1st line = oral doxycycline)
  • are systemically very unwell
  • have pre-existing comorbidities
  • have CRP of 20-100 mg/L or CRP > 100 mg/L
• How can pneumonia be differentiated from acute bronchitis?


  Pts with pneumonia often have higher fever, may appear more ill & have rales on lung examination
• How can allergic rhinitis be differentiated from acute bronchitis?


  Often have post nasal drip -> leads to cough
• How can asthma be differentiated from acute bronchitis?


  Pts with asthma have bilateral wheeze

  Main difference is chronicity of bronchospasm (in asthma, it is recurrent & progressive)
• How can pertussis infection be differentiated from acute bronchitis?


  Cough has characteristic whoop (esp in children)
• How can congestive HF be differentiated from acute bronchitis?


  Pts with CHF can have cough, but will also have other symptoms of HF
• How can reflux oesophagitis be differentiated from acute bronchitis?


  Burning & chest pain will be present in reflux
• How can upper resp tract infection/common cold be differentiated from acute bronchitis?


  Often indistinguishable
• How can upper airway cough syndrome be differentiated from acute bronchitis?


  Cough > 8 weeks (usually dry)

  Unpleasant sensation in throat

  Postnasal drip

  Oropharyngeal examination reveals a cobblestone appearance to the posterior oropharyngeal wall and local upper airway structures
• How can lung cancer be differentiated from acute bronchitis?


  Symptoms persist beyond 30 days

  May see haemoptysis and/or systemic signs