1. Risk Factors
1.1. History of Smoking
1.2. History of Asthma
1.3. Crowded Living Spaces
1.4. Exposure to allergens such as perfumes and pollens
1.5. Recent Cold illness
1.6. Recent Sick Exposure
2. Diagnostic Tests
2.1. A complete thorough history, HPI, and physical examination is needed
2.1.1. Exposure to toxic substances of smoke
2.1.2. Reports a recent proceeding cold or flu like symptoms.
2.1.3. Physical Exam Should include examination of Cardiac, Respiratory, Skin, and Head, Ears, Eyes, Nose, and Throat systems.
2.1.4. Immune Status
2.1.5. History of other Medical Conditions
2.2. A Diagnostic Workup is typically not needed for Acute Bronchitis, but certain tests can be performed if there is a concern for another illness and to help rule out other differential diagnoses.
2.2.1. Chest X-Ray to help rule out Pneumonia (Lateral and Anterior-Posterior View).
2.2.2. Complete Blood Count with Differential
2.2.3. Procalcitonin Levels help determine if it is a bacterial or nonbacterial infection. * May be ordered if there is concern the patient has a bacterial infection (File, 2019).
2.2.4. Rapid Influenza Test
2.2.5. Sputum Culture
3. Common Laboratory and Physical Exam Findings
3.1. A negative Chest X-Ray if performed
3.2. Upon Respiratory Exam Lungs may be clear to auscultation, or the patient may have wheezing which may be significant. Rhonchi may also be heard on auscultation, but is cleared when coughing ( File, 2019).
3.3. A productive or non-productive paroxysm cough which is usually worse in the morning (Ferri, 2018).
3.4. Vital signs are typically within normal but patient may have a low grade fever
3.5. Chest Wall or substernal musculoskeletal pain as a result of extended coughing (File, 2019).
4. Complications
4.1. Pneumonia
4.2. Acute Respiratory Distress and/ or Failure
5. Pathophysiologic Etiology
5.1. Bronchitis is a lower respiratory tract infection which causes inflammation in the bronchi or airways and there is typically no evidence of pneumonia (Ferri, 2018).
5.2. Majority of cases caused by an acute viral infection and are uncommonly caused by bacterial infection.
5.3. Acute bronchitis typically occurs after an inflammation of the bronchi which happens due to several triggers such as viruses, allergens, and pollutants (Ferri, 2018).
5.3.1. The inflammation of the bronchial walls results in thickening of the mucosal, desquamation of the epithelial cell, and the stripping of the basement membrane (Khudair et al., 2017).
6. Causative Factors
6.1. Viral
6.1.1. Common viruses includes Influenza Viruses, Rhinovirus, RSV, Coronaviruses, Adenoviruses, and parainfluenza
6.2. Bacterial
6.2.1. Although an uncommon cause for bronchitis, the most common bacteria are Bordetella Pertussis, Mycoplasma pneumoniae, and Chlamydia pneumoniae ( Ferri, 2018).
6.3. Environmental
6.3.1. Exposure to Dust, Cigarette smoke, Pollen, and Pollutions can trigger acute bronchitis.
7. Symptoms
7.1. Cough that has lasted 1-3 weeks. Cough is the main presenting symptoms.
7.1.1. Cough May be non-productive or productive with reports of sputum becoming yellow/ green in color
7.2. Fatigue
7.3. Substernal chest discomfort that is made worse by coughing (Ferri, 2018).
7.4. Nasal Congestion, Post-Nasal Drip, Sore Throat
7.5. Complaints of a recent cold or other viral infection.
7.6. Afebrile or low grade fever
8. Treatment
8.1. No Antibiotics are necessary for treatment of acute bronchitis
8.2. Increase Fluid Intake
8.3. Avoid Smoke or other irritants
8.4. Vaporizer to increase humidity to help loosen secretions
8.5. Rest
8.6. Symptomatic Relief
8.6.1. For cough OTC guaifenesin or dextromethorphan (File, 2019).
8.6.2. Inhaled Bronchodilators maybe indicted for patient's with wheezing or bothersome cough
8.7. Reassurance
8.7.1. Cough may last for 10-14 days after office visit (Ferri, 2018).
8.7.2. Most patient's will recover in 7- 10 days (Ferri, 2018).