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