Related Subjects:
Prednisolone
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COPD
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Asthma
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Respiratory failure
🫁 Acute bronchitis is an acute lower respiratory tract infection affecting the bronchi, usually caused by a viral infection and occurring without pneumonia.
It commonly causes cough, sometimes with sputum, and is usually self-limiting.
The key clinical task is to distinguish it from pneumonia, asthma/COPD exacerbation, or other serious illness, and to avoid unnecessary antibiotics.
📖 About
- Usually follows a viral upper respiratory tract infection.
- Commonly presents with acute cough, with or without sputum, malaise, wheeze, or mild breathlessness.
- Most cases improve without antibiotics.
- Cough often lasts around 2–3 weeks and may persist longer in some people.
🧬 Aetiology & Pathophysiology
- Usually caused by viral infection.
- Bronchial inflammation causes mucosal oedema, increased mucus production, and temporary airway hyperreactivity.
- This explains why patients may have wheeze or chest tightness even without asthma.
- Sputum colour alone does not reliably distinguish viral from bacterial infection.
🩺 Clinical Features
- Acute cough (with or without sputum).
- Retrosternal discomfort or chest soreness from coughing.
- Malaise, fatigue, mild breathlessness, or wheeze.
- Low-grade fever may occur.
- Examination may be normal, or show scattered wheeze/rhonchi; crackles may clear with coughing.
⚖️ Differentials
- Pneumonia — focal chest signs, higher fever, pleuritic pain, systemic upset, hypoxia.
- Asthma exacerbation.
- COPD exacerbation.
- Heart failure.
- Pulmonary embolism if clinically suggested.
- Post-viral cough or other causes of persistent cough.
🔎 Assessment
- Mainly a clinical diagnosis in primary care.
- Assess severity and look for features suggesting pneumonia, sepsis, cardiorespiratory failure, or another serious diagnosis.
- Consider oxygen saturation, respiratory rate, pulse, temperature, and blood pressure if the person appears more unwell.
- Further investigations are usually only needed if diagnosis is uncertain, symptoms are severe, or pneumonia/another condition is suspected.
💊 Management
- Self-care advice: rest, fluids, and simple analgesia such as paracetamol if needed.
- Do not routinely offer antibiotics if the person is not systemically very unwell and is not at higher risk of complications.
- Do not routinely offer bronchodilators or steroids for acute bronchitis unless there is an underlying airways disease such as asthma.
- Give safety-netting advice about when to seek further medical review.
- Consider an immediate or back-up antibiotic prescription only if the person is systemically very unwell or at higher risk of complications, in line with NICE acute cough guidance.
🦠 Antibiotics
- Not usually needed in uncomplicated acute bronchitis.
- Antibiotics make little difference to symptom duration in most people.
- If indicated under NICE acute cough guidance, follow current recommended antibiotic choice and course length.
🚨 Red Flags
- Breathlessness, hypoxia, or marked tachypnoea.
- Confusion or new delirium.
- Pleuritic chest pain or focal chest signs.
- Haemoptysis.
- High fever or systemic toxicity.
- Concern about pneumonia, sepsis, asthma/COPD exacerbation, or cardiorespiratory failure.
- Cough persisting beyond the expected time course or other concerning features such as weight loss.
📚 References
