Acute Cough Illness Acute Bronchitis

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					         Acute Cough Illness (Acute Bronchitis)
 Acute bronchitis is an acute respiratory infection with a normal chest radiograph that is manifested by cough
           with or without phlegm production that lasts for up to 3 weeks (Chest 2006;129:95S-103S).

 Principles apply to the appropriate treatment of cough illness lasting less than 3 weeks in otherwise
 healthy adults.

                      Refer to acute cough illness as a “chest cold”
               to reduce patient expectation for antibiotics (Am J Med 2000;108-83).
Pi i l   l             h            i             f   h ill               l    i    l      h      3      k i        h      i    h lh
Background                                    Treatment                                               TIPS TO REDUCE
■ Greater than 90% of cases of acute cough    ■ Empiric antibiotic treatment is not                   ANTIBIOTIC USE
  illness are non-bacterial.                    indicated for acute bronchitis.
                                                                                                      ■ Tell patients that anti-
  - Viral etiologies include influenza,         - Meta-analyses of randomized,                          biotic use increases the
    parainfluenza, RSV, and adenovirus.           controlled trials all concluded that                  risk of an antibiotic-
  - Bacterial agents include Bordatella           routine antibiotic treatment is not                   resistant infection.
    pertussis, Mycoplasma pneumoniae,             justified (BMJ 1998;316:906; Chest
    and Chlamydophila pneumoniae.                2006;129:95S-103S).                                  ■ Identify and validate
                                                                                                        patient concerns.
■ The presence of purulent sputum is not      ■ If influenza therapy is considered, it
  predictive of bacterial infection.            should be initiated within 48 hours of                ■ Recommend specific
 - >95% of patients with purulent sputum do     symptom onset for clinical benefit.                     symptomatic therapy.
   not have pneumonia (J Chron Di 1984;        - During the 2005-06 Flu season CDC
   37:215).                                      recommends that neither amantadine nor
                                                                                                      ■ Spend time answering
                                                 rimantadine be used for treatment or                   questions and offer a
Diagnosis                                        prevention of influenza A infections                   contingency plan if
                                                 because of high levels of resistance                   symptoms worsen.
■ Evaluation should focus on excluding           (MMWR 2006 Jan 20;55(2):44-6).
  severe illness, particularly pneumonia.                                                             ■ Provide patient education
                                               - Neuramidase inhibitors such as oseltamivir
                                                                                                        materials on antibiotic
                                                 or zanamivir have activity against influenza
Clinical Assessment for                          A and B viruses.                                       resistance.
Pneumonia                                      - Antiviral therapy reduces symptom duration           ■ REMEMBER: Effective
                                                 by approximately 1 day.                                communication is more
■ Pneumonia is unlikely if all of the 
  following findings are absent (JAMA                                                                   important than an
  1997;278:1440).                             ■ If pertussis is suspected, empiric therapy              antibiotic for patient
                                                may be initiated while obtaining a                      satisfaction.
 Sign               Abnormal                    diagnostic test for confirmation.
                                                                                                      ■ See
                                               - Antibiotic treatment decreases transmission            getsmart or contact your
 Fever              ≥ 38 C                       but has little effect on symptom resolution.           local health department
 Tachypnea          ≥ 24 breaths/min          ■ Over-the-counter cough suppressants                     for more information and
 Tachycardia        ≥ 100 beats/min             have limited efficacy in relief of cough                patient education
                                                due to acute bronchitis (Chest 2006;                    materials.
 Evidence of        rales, egophony,
 consolidation      fremitus
 on chest exam
                                                                                                      Key Reference
■ Consider chest radiograph for patients                                                              Gozales R et al. Principles of
                                                                                                      appropriate antibiotic use for
  with any of these findings or cough                                                                 treatment of uncomplicated acute
  lasting >3 weeks.                                                                                   bronchitis: Background. Annals of
                                                                                                      Internal Medicine 2001;

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Description: Acute Cough Illness Acute Bronchitis