Mount Carmel Health Partners Clinical Guidelines Acute Bronchitis

Acute Bronchitis Clinical Guideline
Acute bronchitis
symptoms present
Perform history and
physical exam
Definition: Acute bronchitis is a disorder affecting approximately 5 percent of adults annually. It is a clinical
term implying a self-limited inflammation of the large airways of the lung that is characterized by cough without
pneumonia. Acute bronchitis is thought to reflect an inflammatory response to infections of the epithelium of
the bronchi. Acute bronchitis should be differentiated from chronic bronchitis, the diagnosis of which is reserved
for those patients who have a cough and sputum production most days of the months for at least two years.
Causes: Viruses are usually considered the cause of acute bronchitis.
Quick Guide to Acute Bronchitis Care


• Diagnosis usually designates an acute
respiratory tract infection with a cough
lasting 1-3 weeks, with or without phlegm.
Is it complex bronchitis
(currently smoking and/
or underlying pulmonary
disease)?
OR
Are red flags present
and identified?
Yes
• Chest radiography is not indicated in
uncomplicated bronchitis if there is an
absence of signs of pneumonia (fever,
asymmetric lung signs, dullness to
percussion, egophony).
Consider chest x-ray and/or
antibiotic.
(See Testing next page)
• Routine treatment of uncomplicated
bronchitis (non-smokers, no history of
underlying lung disease) with antibiotics is
not justified.
No
• Chest radiography and additional testing as
well as antibiotic treatment may be
considered in patients who are smokers
and/or have a history of underlying
pulmonary disease.
For simple bronchitis: treatment is symptomatic
and educational. While mucolytics, antitussives, or
bronchodilators are not routinely indicated, they
may be helpful for symptomatic relief in some
cases. Discuss follow-up.
• Antitussive agents are only occasionally
useful and there is no routine role for
inhaled bronchodilators or mucolytic agents.
• See patients within 2 weeks following an ER
visit.
Provide follow up care post-treatment.
Are diagnostics
consistent with
bronchitis?
Was the
treatment
effective?
No
Treat alternative
disease.
No
Yes
Warning:
Yes
Care is complete.
Yes
Is the bronchitis
resolved due to
treatment?
No
Adjust treatment and consider
specialist referral.
In 2016, the FDA stated that the serious
adverse effects associated with
fluoroquinolones generally outweigh the
benefits for patients with acute bronchitis.
This announcement was based on an FDA
safety review showing that systemic
fluoroquinolone use is associated with side
effects, which although uncommon, can be
disabling and potentially permanent,
including those involving the tendons,
muscles, joints, nerves, and central nervous
system.
May 2017