Acute bronchitisMANAGEMENT

RESPIRATORY PRESENTATIONS · 12 SECTIONS

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397 items

☷ Legend

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Cardiovascular Presentations66▾

Respiratory Presentations47▾

Acute bronchitis Acute Respiratory Distress Syndrome (ARDS)Acute respiratory failure Apparent Life-Threatening Event (ALTE-BRUE)Aspiration pneumonia Asthma exacerbation Bacterial Tracheitis Bronchiolitis Bronchiolitis (RSV)Chylothorax Community-acquired pneumonia COPD exacerbation COVID-19 pneumonia Croup Croup (laryngotracheobronchitis)Cystic Fibrosis Exacerbation Empyema Epiglottitis Epiglottitis (Pediatric)Fat Embolism Syndrome Foreign Body Aspiration Foreign Body Aspiration (Pediatric)Healthcare-Associated Pneumonia Hemothorax Hospital-acquired pneumonia Legionnaires' Disease Lung Abscess Pertussis Pleural effusion Pleurisy Pneumocystis jirovecii Pneumonia Pneumocystis Pneumonia Pneumomediastinum Pneumothorax (Simple)Pneumothorax (traumatic)Psittacosis Pulmonary Alveolar Proteinosis Pulmonary contusion Pulmonary Edema (Non-cardiogenic)Sarcoidosis Exacerbation Smoke Inhalation Injury Spontaneous pneumothorax Status Asthmaticus Sudden Infant Death Syndrome (SIDS)Tension Pneumothorax Tracheal Stenosis Viral Pneumonia

Neurological Presentations77▾

Gastrointestinal Presentations63▾

Genitourinary and Reproductive Presentations44▾

Infectious Disease Presentations146▾

Trauma Presentations88▾

Toxicologic Presentations67▾

Psychiatric Presentations25▾

Musculoskeletal and Rheumatologic Presentations89▾

Dermatology Presentations21▾

Environmental and Exposure Presentations26▾

Hematologic and Oncologic Presentations30▾

Pediatric-Specific Presentations13▾

Endocrine and Metabolic Presentations42▾

ENT and Maxillofacial Presentations21▾

Ophthalmologic Presentations15▾

Obstetric Presentations17▾

Systemic and Miscellaneous Presentations15▾

01Approach to the Critical Patient/attcp46

Immediate stabilization

›Stabilization priorities

›Airway

›If impending respiratory failure, airway team activation

›If altered mental status with hypoventilation, ventilatory support

›Breathing

›Pulse oximetry target SpO2 92-96%

›If SpO2 < 90% on room air, supplemental oxygen

›If severe work of breathing, noninvasive ventilation candidacy

›Circulation

›If hypotension, alternative diagnosis over uncomplicated bronchitis

›If shock, sepsis pathway and broad evaluation

›Escalation triggers

›If SpO2 < 90% despite oxygen, higher level of care

›If RR ≥ 30 breaths/min, consider pneumonia or asthma/COPD exacerbation

›If new cyanosis, immediate resuscitation bay

High-risk screen

›High-risk features

›Pneumonia concern

›Heart rate ≥ 100 beats/min

›Respiratory rate ≥ 24 breaths/min

›Oral temperature ≥ 38.0 C

›Focal consolidation

›Egophony

›Increased tactile fremitus

›Alternative diagnosis concern

›Pleuritic chest pain

›Hemoptysis

›Syncope or presyncope

›Unilateral leg swelling

›New confusion

›Severe immunocompromise

›Comorbidity modifiers

›COPD

›Asthma

›Heart failure

›Chronic kidney disease

›Advanced age with frailty

Key concepts

›Clinical framing

›Syndrome definition

›Acute cough with lower airway inflammation

›Typical duration up to 3 weeks

›Etiology patterns

›Viral predominance

›Bacterial causes uncommon in immunocompetent adults

›Management anchor

›Pneumonia exclusion over routine antibiotics

›Symptom control over pathogen-directed therapy in uncomplicated cases

02History/hx51

Symptom characterization

›Presenting symptom pattern

›Cough timeline

›Onset date

›Duration

›Worsening versus improving trend

›Sputum features

›Presence or absence

›Volume

›Purulence

›Blood streaking

›Associated symptoms

›Fever

›Chills

›Dyspnea

›Chest tightness

›Pleuritic pain

›Rhinorrhea

›Sore throat

Exposure and epidemiology

›Exposure risks

›Viral exposure

›Household contacts with URI

›Daycare or school contacts

›Influenza and COVID context

›Known outbreak setting

›Recent travel

›Pertussis context

›Paroxysmal cough

›Post-tussive emesis

›Whoop

›Underimmunization

›Irritant context

›Tobacco

›Vaping

›Occupational fumes

›Air pollution

Red flags and modifiers

›Severity and complications

›Functional limitation

›Dyspnea at rest

›Inability to speak full sentences

›Systemic toxicity

›Persistent high fever

›Rigors

›Poor oral intake

›Thromboembolism risk

›Recent immobilization

›Prior VTE

›Estrogen therapy

›Comorbid lung disease

›Baseline inhaler use

›Prior exacerbations

›Prior hospitalizations

03Physical Exam/exam37

Vitals and general

›Bedside assessment

›Vitals

›Temperature

›Heart rate

›Respiratory rate

›Blood pressure

›SpO2 on room air

›Respiratory effort

›Accessory muscle use

›Ability to speak

›Mental status

›Hydration

›Mucous membranes

›Capillary refill

Lung and cardiac exam

›Thoracic exam

›Auscultation

›Diffuse wheeze

›Rhonchi

›Crackles

›Focal findings

›Consolidation signs

›Egophony

›Increased tactile fremitus

›Dullness to percussion

›Cardiac exam

›New murmur

›Volume overload signs

›Peripheral exam

›Unilateral leg edema

›Calf tenderness

Pitfalls

›Common pitfalls

›Colored sputum

›Poor discriminator of bacterial infection

›Not an antibiotic indication alone

›Missed pneumonia

›Older adults with blunted fever

›Immunocompromise with atypical exam

04Differential Diagnosis/ddx34

Primary and mimics

›Diagnostic alternatives

›Pneumonia

›ICD-10 J18.9

›Focal lung findings

›Influenza

›ICD-10 J10.1

›Abrupt onset myalgias

›COVID-19

›ICD-10 U07.1

›Viral syndrome with exposure risk

›Pertussis

›ICD-10 A37.9

›Paroxysms and post-tussive emesis

›Asthma exacerbation

›ICD-10 J45.901

›Wheeze with triggers

›COPD exacerbation

›ICD-10 J44.1

›Increased dyspnea and sputum volume

›Heart failure

›ICD-10 I50.9

›Orthopnea and edema

›Pulmonary embolism

›ICD-10 I26.99

›Pleuritic pain and tachycardia

›Upper airway cough syndrome

›Postnasal drip features

›Throat clearing

›GERD-related cough

›Heartburn

›Nocturnal cough

Coding alignment

›Acute bronchitis codes

›ICD-10 J20.9 acute bronchitis, unspecified

›SNOMED CT 10509002 acute bronchitis (disorder)

05Laboratory Tests/lt23

Routine labs strategy

›Lab selection principles

›Uncomplicated presentation

›No routine labs

›Antibiotic stewardship alignment

›If pneumonia or systemic illness concern

›Targeted labs for severity and alternative diagnoses

Suggested labs when indicated

›Targeted testing

›Complete blood count

›Leukocytosis nonspecific

›Neutrophilia not diagnostic of bacterial bronchitis

›Basic metabolic panel

›Dehydration assessment

›Medication safety for NSAIDs

›CRP or procalcitonin

›If diagnostic uncertainty for pneumonia

›Antibiotic reduction strategy in selected settings

Point-of-care testing

›POC and pathogen tests

›Influenza NAAT

›If seasonal activity and treatment window relevance

›Infection control and cohorting

›SARS-CoV-2 testing

›If compatible symptoms or exposure

›Risk stratification for antivirals

06Diagnostic Tests/dt30

Scoring Systems

›Severity and decision tools

›Pneumonia risk assessment

›CRB-65

›CURB-65

›Use when pneumonia diagnosed to guide disposition

›PE assessment

›Wells criteria

›PERC rule

›Use when pleuritic pain or VTE risk present

MRI

›MRI roles

›Rare indications

›Suspected malignancy complications with contraindication to CT contrast

›Complex mediastinal pathology

›Limitations

›Not first-line for acute cough syndromes

›Availability and time constraints

›CT roles

›If alternative diagnosis likely

›CT pulmonary angiography for PE pathway

›CT chest for mass or bronchiectasis complications

›If complications

›Abscess concern after pneumonia diagnosis

›Hemoptysis with high-risk features

Ultrasound

›Ultrasound applications

›Lung ultrasound

›B-lines and consolidation patterns for pneumonia support

›Pleural effusion detection

›Cardiac POCUS

›Volume status in dyspnea

›Heart failure clues

07Disposition/dispo17

Level of care

›Disposition framework

›ED discharge typical

›Normal vital signs

›No hypoxemia

›No focal consolidation signs

›Reliable follow-up

›Observation or admission

›Persistent hypoxemia

›Significant comorbidity with decompensation

›Inability to maintain hydration

›Concern for pneumonia or alternative serious diagnosis

Follow-up planning

›Follow-up needs

›Primary care follow-up

›If cough persists beyond expected course

›If recurrent episodes

›Return precautions

›Red flags provided in discharge instructions

08Treatment/t64

Nonpharmacologic

›Supportive measures

›Hydration

›Oral fluids

›Warm fluids for throat comfort

›Irritant avoidance

›Tobacco cessation counseling

›Vaping cessation counseling

›Humidification

›Cool-mist humidifier

›Steam exposure cautions

Symptom control

›Symptom-targeted therapy

›Cough

›Dextromethorphan PO 10-20 mg every 4 hours as needed

›Maximum 120 mg/day

›Avoid with serotonergic combinations

›Dextromethorphan PO 30 mg every 6-8 hours as needed

›Maximum 120 mg/day

›Avoid in young children per local labeling

›Benzonatate PO 100 mg three times daily as needed

›Titrate to 200 mg three times daily as needed

›Maximum 600 mg/day

›Avoid in children < 10 years

›Guaifenesin ER PO 600 mg every 12 hours as needed

›Titrate to 1200 mg every 12 hours as needed

›Maximum 2400 mg/day

›Fever or pain

›Acetaminophen PO 500 mg every 6 hours as needed

›Maximum 3000 mg/day typical outpatient limit

›Lower maximum if liver disease or alcohol use

›Ibuprofen PO 400 mg every 6-8 hours as needed

›Maximum 1200 mg/day OTC dosing

›Avoid in CKD, GI bleed risk, late pregnancy

›Wheeze or bronchospasm

›Albuterol MDI 90 mcg per puff

›2 puffs every 4-6 hours as needed

›Spacer use for technique

›Prefer when wheeze present over routine use

Antibiotics and antivirals

›Etiology-directed therapy

›Uncomplicated acute bronchitis

›No antibiotics

›Stewardship recommendation

›Class I recommendation for avoidance of antibiotics in uncomplicated cases

›Pertussis suspected or confirmed

›Azithromycin PO 500 mg day 1

›250 mg daily days 2-5

›Transmission reduction goal

›Clarithromycin PO 500 mg twice daily for 7 days

›Alternative to azithromycin

›Drug interaction review

›Influenza suspected or confirmed with treatment indication

›Oseltamivir PO 75 mg twice daily for 5 days

›If within treatment window or high-risk

›Renal dose adjustment when indicated

›COVID-19 with antiviral eligibility

›Nirmatrelvir-ritonavir per local protocol

›Drug interaction screening

›Renal and hepatic eligibility

Monitoring and reassessment

›Safety checks

›If bronchodilator used

›Heart rate response

›Tremor or anxiety

›If persistent fever

›Re-evaluation for pneumonia

›Consider repeat exam and imaging

09Special Populations/sp28

Pregnancy

›Pregnancy considerations

›Diagnostic strategy

›Lower threshold for influenza and COVID testing when clinically indicated

›Pneumonia evaluation if abnormal vitals or hypoxemia

›Medication safety

›Acetaminophen preferred for fever

›Avoid NSAIDs in later pregnancy

›Avoid codeine-containing cough suppressants when possible

Geriatric

›Geriatric considerations

›Presentation differences

›Blunted fever response

›Higher pneumonia risk with subtle findings

›Medication risks

›Anticholinergic burden from first-generation antihistamines

›Fall risk from sedating agents

›Disposition modifiers

›Lower threshold for imaging with abnormal vitals

›Follow-up reliability assessment

Pediatrics

›Pediatric considerations

›Alternative diagnoses

›Bronchiolitis

›Asthma or viral-induced wheeze

›Foreign body aspiration

›Medication cautions

›Avoid benzonatate in children < 10 years

›Honey only if age > 1 year

›Imaging threshold

›Consider CXR for severe distress or atypical course

10Background/b27

Epidemiology

›Epidemiology

›Frequency

›Common outpatient diagnosis in acute cough

›High driver of inappropriate antibiotic prescribing

›Etiology distribution

›Viral causes predominant

›Bacterial causes uncommon in immunocompetent adults

Pathophysiology

›Pathophysiology

›Airway inflammation

›Bronchial mucosal edema

›Increased mucus production

›Cough mechanism

›Airway hyperresponsiveness post-viral

›Transient bronchospasm in subset

›Natural history

›Cough persistence common for weeks

›Gradual resolution expected

Therapeutic Considerations

›Therapeutic rationale

›Antibiotic avoidance

›Limited benefit in uncomplicated disease

›Adverse effects and resistance risk

›Symptom therapy limits

›Evidence for many OTC agents limited

›Shared decision-making focus

›Bronchodilator targeting

›Benefit mainly with wheeze or airflow limitation

›Routine use not supported without bronchospasm

11Patient Discharge Instructions/pdi25

copy discharge instructions

›Discharge instructions

›What this is

›Airway irritation often after a viral cold

›Antibiotics usually not helpful

›What to expect

›Cough can last up to 3 weeks

›Gradual improvement over days to weeks

›Self-care

›Fluids and rest

›Avoid smoke and vaping

›Honey for cough if age > 1 year

›Use medications only as directed on the label or by clinician

›Return now or seek urgent care

›Trouble breathing at rest

›Blue lips or face

›Chest pain

›Fainting

›Coughing up blood

›Persistent fever

›Worsening symptoms after initial improvement

›New confusion

›SpO2 < 92% if home pulse oximeter available

›Follow-up

›Recheck if not improving within 7 days

›Recheck if cough persists beyond 3-4 weeks

12References/r15

Clinical guidelines and evidence

›Key sources

›CDC adult outpatient antibiotic prescribing guidance for acute bronchitis and pneumonia exclusion criteria

›Routine antibiotics not recommended for uncomplicated acute bronchitis

›Pneumonia unlikely without abnormal vitals or focal lung findings

›ACP and CDC high-value care advice for acute respiratory tract infections in adults

›No antibiotics for acute uncomplicated bronchitis unless pneumonia present

›Avoid testing or antibiotics unless pneumonia suspected

›NICE NG120 cough (acute) antimicrobial prescribing guideline

›Stewardship strategy for acute cough and acute bronchitis

›Self-care options with limited benefit evidence

›CHEST expert panel report on acute cough due to acute bronchitis

›Limited benefit of antibiotics in immunocompetent adults

›Symptom-focused management emphasis

›SNOMED CT concept

›10509002 acute bronchitis (disorder)

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed June 16, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.