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Acute Bronchitis
Bjorn Buhagiar
Abstract Introduction
Acute bronchitis is a common respiratory tract infection Acute bronchitis is a self-limited inflammation of the large
usually caused by viruses and encountered often by family airways of the lungs. It affects approximately 5% of adults
doctors. Diagnosis is usually made on clinical symptoms, annually, with a higher incidence observed during winter and
as findings on physical examination are usually limited and autumn rather than in summer and spring.1,2 Acute bronchitis
investigations give non-specific results. Numerous studies represents almost 20% of respiratory tract infections with an
have shown that antimicrobial agents are useless in acute incidence of around 29 episodes per thousand person years.3
bronchitis, and have a negligible effect on symptoms. The In children, 5% of visits to the family doctor are for acute
use of other medications such as β 2-agonists and cough bronchitis, representing around 12% of visits for respiratory
suppressants has also been questioned and these medications tract infections.4,5 On the other hand, in adults, acute bronchitis
are usually reserved for patients suffering from chronic lung comprises 23% of respiratory tract infections encountered by
conditions. Delayed prescription has been considered as a family doctors.6
means of reducing antibiotic overprescribing in respiratory tract
infections, however, the effect of such measures on antibiotic A typical clinical scenario
use and resolution of symptoms is questionable, as are studies A 34 year-old male presented with a three day history of
on the patients’ satisfaction with delayed prescribing. Patients’ increasing cough, progressing from a dry one, to one producing
knowledge on respiratory tract infections and their treatment yellowish sputum. He also complained of night-time low-
must also be considered, as it has been shown that family grade fever which was relieved with paracetamol. The patient
practitioners should be aware of the patients’ expectations when confirmed mild shortness of breath on exertion but denied chest
they attend with a respiratory tract infection. pain. He did not suffer from asthma and had quit smoking ten
years previously. On examination, the patient was afebrile
and auscultation of the chest disclosed faint wheezing on
expiration.
Aetiology
Viruses are the most common cause of acute bronchitis: the
main culprits being influenza A and B viruses, parainfluenza
virus, respiratory syncytial virus, coronavirus, adenovirus
and rhinovirus.7 Bacterial species commonly implicated in
community-acquired pneumonias are also isolated from the
Keywords sputum in a minority of patients suffering from acute bronchitis.1
Acute bronchitis, antimicrobials, delayed prescriptions, These include Streptococcus pneumoniae, Haemophilus
patient expectations influenzae and Moraxella catharralis.8 However, the role of
these species in the disease remains unclear as bronchial biopsies
have not shown bacterial invasion. In some cases, atypical
bacteria such as Bordetella pertussis, Chlamydia pneumoniae
and Mycoplasma pneumoniae may be implicated.1
Clinical presentation
Management of acute bronchitis in the community is very
much dependent on comprehensive history taking and a high
Bjorn Buhagiar MD index of suspicion.
Department of Primary Health Care, Floriana
Email: bjornbuh@maltanet.net