BRONCHITIS, ACUTE

Acute bronchitis generally refers to acute inflammation of the central airways that is usually self-limited and associated with near-complete healing within 4 to 8 weeks. Viral infections are the most common cause, especially in the winter, but other factors such as air pollution, irritant fumes, and smoke exposure may also produce acute bronchitis. The infectious causes are often spread by aerosol inhalation to other close contacts.

The history is often suggestive of the diagnosis, although a specific cause or precipitant may not always be identified, especially if a viral infection is responsible.

An acute change in cough, especially with colored sputum production, in addition to upper airway symptoms such as sore throat and nasal congestion may be seen. Muscle aches, low-grade fever, and wheezing are also common. Complications of acute bronchitis include bronchopneumonia, cough-related chest wall pain, and sleep deprivation. The severity of the symptoms also depends on the underlying state of the heart and lungs; for example, breathing may be greatly worsened in patients who have severe chronic obstructive pulmonary disease.

Rest, oral fluids, and suppression of fever as well as cough are usually adequate to treat most viral infectious flares of acute bronchitis. However, antibiotics may be necessary in patients with concomitant chronic lung disease who have increased volume of colored sputum and fever, or in patients who require hospitalization. Sputum analysis and culture may be helpful in guiding specific therapy. A chest x-ray should be done if bronchopneumonia is suspected or other complications are being considered. Smoking cessation, if relevant, is advised. Use of antibiotics may produce side effects in the form of treatment-related diarrhea or yeast infections.

• Do rest and take in extra fluid. Contact your doctor if you suspect a noninfectious cause of your acute bronchitis, such as exposure to strong fumes at work or in other places, or if you need help to stop smoking. Complete a full course of antibiotics, if prescribed, even if you feel better after 2 or 3 days.

• Do not take an antibiotic unless prescribed by your doctor. Cough suppressants should be used cautiously in patients with severe obstructive lung disease. Additional medications and possibly even a course of corticosteroids may be required in patients who have acute bronchitis as well as asthma.

• You should contact your doctor if your symptoms are not improving; if you have worsening respiratory symptoms with shortness of breath, wheezing, and productive cough; or if you have concerns about any medication side effects. In individuals with asthma or chronic obstructive pulmonary disease, earlier notification of your physician may be required to discuss the need for any additional treatment or hospitalization.

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