29 - Acute bronchitis and acute exacerbations of chronic airways disease

Summary

Bronchial infections with viral and bacterial microorganisms cause considerable morbidity, as well as economic costs incurred through health care and loss of productivity. These infections affect all age groups. An important consideration is whether or not an individual has underlying chronic lung disease, as that alters the etiology, clinical presentation, laboratory findings, and indications for therapy. In this chapter, we discuss acute infectious bronchitis in individuals without underlying chronic lung disease, before outlining approaches when an individual has an acute exacerbation of a chronic lung disease such as asthma, chronic obstructive pulmonary disease (COPD), or non-cystic fibrosis bronchiectasis.

ACUTE BRONCHITIS

Acute bronchitis is a common condition in both children and adults. It has been defined as “an acute illness, occurring in a patient without chronic lung disease, with symptoms including cough, which may or may not be productive and associated with other symptoms or clinical signs that suggest LRTI [lower respiratory tract infection] and no alternative explanation (e.g., sinusitis or asthma).” Most people will experience this at some time during their lives, and in most cases it is self-limiting and will not result in those affected seeking medical attention.

Nonetheless, this condition is a frequent cause of attendance to primary care providers and has been identified as a potential target for reducing unnecessary antibiotic prescribing in the community. Additionally, those who seek medical care for acute bronchitis, especially if this is frequent, should be considered for investigation as to whether or not they have an underlying chronic airways disease.