Acute bronchitis is one of the most common infections of the upper/large airways (trachea and bronchi). It is usually caused by a viral infection, which damages the lining of the airways and leads to cough and possibly some sputum production.
Acute bronchitis usually presents with cough and possibly mild fever – it is a self-limiting condition, although the cough may last for up to 3 weeks. As the cause is usually a viral infection, antibiotics are of no use in its treatment – several medical reports indicate that antibiotics are overprescribed in nearly 70% of cases. (This is probably a combination of pressure from the patient for medication and fear on the doctor’s side that he may be missing something.)
If the cough is associated with high fevers and purulent sputum, then pneumonia is likely, rather than just bronchitis – this can be diagnosed with a chest X-ray and the appropriate antibiotics should be given. Mildly purulent sputum can be present in bronchitis, as the lining of the airways may be damaged and tiny pieces of the lining coughed up. This is not an indication for antibiotics.
Acute bronchitis should be differentiated from asthma, COPD exacerbation, acid reflux associated cough and pneumonia. Careful history taking and examination will help to differentiate bronchitis from these other causes requiring specific treatment.
Patients who smoke or have other respiratory diseases have a greater risk of secondary bacterial infection, which may be suggested by a change in sputum colour and increase in volume, new fever or change in their effort tolerance. In this situation a return visit to your doctor is indicated to decide if antibiotics are now indicated.
Usually no special investigations are indicated during an attack of acute bronchitis, because it is a self-limiting acute condition. If an alternative diagnosis, such as pneumonia or asthma is considered, specific tests to confirm/exclude these should be performed.
Antibiotics are not helpful in acute bronchitis. Cough mixtures are generally of little value although if sleep is disturbed there are some medications that will suppress the cough and allow better sleep (ask you pharmacist). Symptomatic treatment with paracetamol and anti-inflammatories will give some relief. Without doubt, smoking cessation should be reinforced at every opportunity and this would be one of them. Smoking not only increases your risk for pneumonia and bronchitis but TB as well!
If you are asthmatic or have COPD you might need to increase your medication during the acute attack. If you are concerned that you may have developed a bacterial infection, see your doctor.
When to call the doctor
Acute bronchitis is usually a mild condition and does not require any medical intervention. If you have high fevers, strongly discolored sputum or are short of breath, it is important to see your doctor. As the cough may last up to three weeks, a degree of patience is required for the disease to resolve, as repeated courses of antibiotics are likely to be pointless.
Written by Prof J.R. Joubert, MSc, MBChB (Stell), FCP (SA), MMed (Int. Med), MD (Stell)
Revised by Richard van Zyl-Smit, MBCHB, MRCP(UK), DIP HIV Man (SA), FCP(SA) Cert Pulm (SA), Specialist Physician and Pulmonologist, Division of Pulmonology and UCT Lung Institute, Department of Medicine, University of Cape Town, (October 2010)