Makindo Medical Notes

Related Subjects: Prednisolone | COPD | Asthma | Respiratory failure

🫁 Acute Bronchitis is an acute inflammation of the bronchi, most often due to viral infection. It is one of the most common reasons for GP consultations, particularly in the winter months. Characterised by cough, sputum production, and sometimes wheeze, it is generally self-limiting but important to distinguish from pneumonia or asthma/COPD exacerbations.

📖 About

• Infection of the lower respiratory tract, usually without pneumonia.
• Often follows an upper respiratory tract infection (URTI).
• More frequent in those with chronic lung disease (e.g. COPD, emphysema) and smokers.
• May cause temporary airflow obstruction due to inflammation and mucus plugging.

🧬 Aetiology & Pathophysiology

• Viral infections (90%): Rhinovirus, influenza, parainfluenza, coronavirus, RSV.
• Bacterial (secondary): Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis.
• Pathophysiology: Infection triggers inflammation → mucosal oedema + ↑ mucus production → cough and airflow obstruction. Airway hyperreactivity may mimic asthma.
• At-risk groups: Elderly, smokers, immunocompromised, and those with chronic respiratory disease.

🩺 Clinical Features

• Persistent cough (often >5 days, may last up to 3 weeks).
• Sputum: may be clear, yellow, green — not necessarily bacterial.
• Chest discomfort, burning or aching.
• Wheeze or rhonchi; coarse crackles may be present.
• Mild dyspnoea and fatigue.
• Fever: usually low-grade (higher fever → consider pneumonia).
• Reduction in exercise tolerance.

⚖️ Differentials

• Asthma (episodic, variable wheeze, diurnal pattern).
• COPD exacerbation (in known smokers or chronic bronchitics).
• Pneumonia (higher fever, focal chest signs, consolidation on CXR).
• Bronchiectasis (recurrent infections, copious purulent sputum).
• Heart failure (pulmonary oedema mimicking infection).

🔎 Investigations

• Bloods: FBC, U&E, CRP (raised WCC/CRP if bacterial).
• CXR: Usually normal; may show hyperinflation. Essential to exclude pneumonia if focal signs or persistent fever.
• Pulmonary function tests (PFTs): May show temporary obstructive defect (↓ FEV1/FVC).
• Sputum culture: Rarely required unless severe/recurrent disease.

💊 Management

• 🛑 Smoking cessation: Key for prevention and recovery.
• 🌬️ Bronchodilators: Salbutamol or Ipratropium for wheeze and airflow obstruction.
• 💊 Steroids: Short course oral prednisolone (e.g. 30 mg for 5–7 days) if severe wheeze or COPD/asthma overlap.
• 🦠 Antibiotics: Not routinely indicated; only if bacterial infection suspected (high fever, purulent sputum, elderly/comorbid). First line: doxycycline or amoxicillin.
• ❄️ Supportive care: Rest, hydration, analgesics (paracetamol/NSAIDs), honey or simple linctus for cough.
• 🧪 Antivirals: Consider neuraminidase inhibitors (oseltamivir) if influenza confirmed and <48 hrs onset, especially in at-risk groups.
• 💨 Oxygen therapy: Controlled O₂ (sats 88–92%) if hypoxic.

🚨 Red Flags (Exclude Pneumonia/Severe Disease)

• High fever (>38.5 °C), rigors.
• Pleuritic chest pain, focal crepitations, or bronchial breathing.
• Haemoptysis.
• Hypoxia, tachypnoea, or confusion (CURB-65 features).
• Failure to improve after 3 weeks.

📚 References

• NICE CKS: Acute Bronchitis
• BMJ Best Practice: Acute Bronchitis
• Kumar & Clark’s Clinical Medicine, 10th Ed.