- A nonspecific term used to describe patients with or without
underlying lung disease who develop an acute productive cough without
evidence of pneumonia. By definition, the inflammation is limited to the
trachea and to large and medium-sized bronchi. The most common causative
organisms are respiratory viruses (RSV; rhino-, corona-, and
adenoviruses; influenza and parainfluenza viruses) and, to a lesser
extent, atypical bacteria (M. pneumoniae, C. pneumoniae, Bordetella
- Cough (productive or not) may persist for
1–3 weeks, often with initial
- URI symptoms (rhinorrhea or sore throat).
- Lung exam findings range from clear to wheezes (from bronchospasm)
- It is important to rule out community-acquired pneumonia.
- Consider B. pertussis in children with a “whooping” cough and in
adults with a severe paroxysmal cough.
- Other conditions that may → chronic cough include
- Postnasal drip
- Foreign body
- CHF and
- Chronic cough may also be a side effect of ACEI use.
- Diagnosis is made clinically.
- CXR is not routinely indicated except, possibly, to rule out
- Given that the most common etiologies are viral, antibiotics are not
generally indicated and should be reserved for the elderly, those with
underlying cardiopulmonary disease, or immunocompromised patients.
- Expectorants can be used for symptomatic treatment.
- Bronchodilators may be used if there is a reactive airway component.
ITE 2012, Q224. A 24-year-old female presents with a 10-day history of cough
productive of green sputum. Her past medical history is unremarkable and she
is up to date on all immunizations. The patient’s temperature is 37.2°C
(98.9°F), blood pressure 127/76 mm Hg, pulse rate 89 beats/min, respiratory
rate 24/min, and O2 saturation 95% on room air. Her physical examination is
unremarkable except for a loose cough.
Which one of the following is best supported by evidence for management of
this patient’s condition?
A) A macrolide antibiotic such as azithromycin (Zithromax)
B) An oral corticosteroid such as prednisone
C) An inhaled -agonist such as albuterol (Proventil, Ventolin)
D) An expectorant such as guaifenesin
E) Reassurance that symptoms will likely resolve on their own within 3 weeks
- This patient has acute bronchitis. The most appropriate management
option is to provide reassurance that symptoms will likely resolve on
their own within 3 weeks.
- Approximately 90% of cases are caused by viruses, and antibiotics do
not significantly change the course of the condition. For this reason,
and because of concerns about antibiotic resistance and side effects
from antibiotic use, antibiotics should not be used routinely for the
treatment of acute bronchitis (SOR B).
- Despite this, approximately two-thirds of patients in the United
States diagnosed with bronchitis are still treated with antibiotics.
- Corticosteroids and agonists are not indicated in the absence of
asthma or wheezing on examination.
- Expectorants have not been shown to be effective in the treatment of
bronchitis (SOR B).
Ref: Braman SS: Chronic cough due to acute bronchitis: ACCP
evidence-based clinical practice guidelines. Chest 2006;129(1
Suppl):95S-103S. 2) Albert RH: Diagnosis and treatment of acute
bronchitis. Am Fam Physician 2010;82(11):1345-1350.