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Bronchitis is one of the most common
diagnoses made in primary care practices. Although bronchitis is secondary to infectious
agents, the severity of the illnesses and approach to treatment vary depending on risk
factors for pulmonary illness, specific infectious agents, and the age of the patient.
Symptoms
Symptoms of bronchitis are believed to arise from fluid accumulation in the respiratory
airways and excessive mucus production. They can mimic asthma in acute stages. For
patients in the early stages of bronchitis, pulmonary function tests may be similar to
those from patients with asthma. As the bronchitis improves, patients are sometimes left
with symptoms comparable to asthma. The predominant symptom in patients with either acute
bronchitis is a productive cough (cough with phlegm). Patients may also complain of
pleuritic chest pain (pain when patient breathes), shortness of breath, occasional blood
in the phlegm, and fever. In most cases, bronchitis symptoms are either preceded or
accompanied by symptoms of an upper respiratory tract infection.
Diagnosis
1. Clinical presentation. On physical examination, wheezes may be present.
2. Laboratory or radiologic evaluation. Generally, the diagnosis of acute bronchitis is
made using clinical criteria. Chest radiography may be useful occasionally to rule out
pneumonia.
3. Differential diagnosis. Particularly in younger patients, symptoms of recurrent or
chronic bronchitis may be indicators of underlying asthma and warrant further evaluation.
Treatment
1. Antibiotics: There is little evidence to support the use of routine antibiotics in
previously healthy patients with bronchitis.
2. Bronchodilators: Because patients with bronchitis often present with wheezing and have
reversible changes on pulmonary function tests, the use of aerosolized bronchodilating
agents, such as Proventil may be useful for reducing the duration of symptoms and
returning patients to their usual activity earlier.
3. Postbronchitic syndrome: Patients who have experienced bronchitis may continue to cough
for several months following their acute illness. This cough is usually not accompanied by
phlegm and may be exacerbated by exercise, changes in temperature or humidity, or other
factors that instigate airway reactivity.
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