Acute Bronchitis

Pt with no h/o asthma presents with acute onset cough. Symptom onset >10 days ago. No altered mental status, rhinorrhea, coughing paroxysms, post-tussive emesis. Afebrile with HR and RR WNL; no crackles on exam.

• Not currently peak influenza season and presenting with intermediate influenza risk within 36h of symptom onset: Obtain influenza PCR

• Unvaccinated pt with cough lasting >3 weeks and whooping sound s/p cough: Obtain B. pertussis PCR, serology

• Low suspicion for PNA; do not obtain CXR

• Treatment

  • Pt < 6 y/o: Parents cautioned against use of cough/cold preparation

  • Pt > 1 y/o: Parents encouraged to try dark honey

• Adult Treatment

  • Pt encouraged to try dark honey, echinacea, pelargonium

  • Trial of dextromethorphan 20 mg q6 hours

  • Pt wheezing: Administer PRN albuterol inhaler and consider episodic high-dose episodic inhaled corticosteroids

  • Patient advised that symptoms can last up to 3 weeks; f/u encouraged to fill pocket prescription if symptoms do not resolve by this time

Notes

• Etiology

  • 90% of cases are due to viral infection

    • Common cold generally last < 10 days while acute bronchitis can last up to 3 weeks

    • Presence or absence of green sputum cannot be used to differentiate between viral and bacterial illness

  • Do not test for influenza during peak season or outside of flu season due to high pretest probability and low positive predictive value, respectively

  • Pertussis suspected with pt presents with coughing paroxysms, whooping sounds, post-tussive emesis, etc.

• Treatment

  • Dextromethorphan is not effective for cough suppression in children

  • Using the term "chest cold" can reduce use of antibiotics