The full content of Annals is available to subscribers

Subscribe/Learn More  >
Updates |

Uncomplicated Acute Bronchitis

Ralph Gonzales, MD, MSPH; and Merle A. Sande, MD
[+] Article, Author, and Disclosure Information

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 2000;133(12):981-991. doi:10.7326/0003-4819-133-12-200012190-00014
Text Size: A A A

Acute bronchitis is an acute cough illness in otherwise healthy adults that usually lasts 1 to 3 weeks. This review describes the pathophysiology of the condition and provides a practical approach to the evaluation and treatment of adults with uncomplicated acute bronchitis. Practical points to be made are:

1. Respiratory viruses appear to cause the large majority of cases of uncomplicated acute bronchitis.

2. Pertussis infection is present in up to 10% to 20% of adults with cough illness of more than 2 to 3 weeks' duration. No clinical features distinguish pertussis from nonpertussis infection in adults who were immunized against pertussis as children.

3. Transient bronchial hyperresponsiveness appears to be the predominant mechanism of the bothersome cough of acute bronchitis.

4. Ruling out pneumonia is the primary objective in evaluating adults with acute cough illness in whom comorbid conditions and occult asthma are absent or unlikely. In the absence of abnormalities in vital signs (heart rate > 100 beats/min, respiratory rate > 24 breaths/min, and oral body temperature > 38 °C), the likelihood of pneumonia is very low.

5. Randomized, placebo-controlled trials do not support routine antibiotic treatment of uncomplicated acute bronchitis.

6. Randomized, placebo-controlled trials have shown that inhaled albuterol decreases the duration of cough in adults with uncomplicated acute bronchitis.

7. Intervention studies suggest that antibiotic treatment of acute bronchitis can be reduced by using a combination of patient and physician education. Decreased rates of antibiotic treatment are not associated with increased utilization, return visits, or dissatisfaction with care.


Grahic Jump Location
Proposed algorithm for evaluation and management of adults with acute cough illness.

* Pneumonia in elderly persons, those with immunosuppression, and those with chronic obstructive pulmonary disease ( ) or congestive heart failure ( ) often presents atypically. A high index of suspicion is warranted when evaluating cough illness in these patients, even when vital signs and chest examination appear normal. †Consider pertussis treatment if the patient has known exposure to pertussis. Follow local health department testing guidelines; pending results, treat with erythromycin for 14 days. NSAID = nonsteroidal anti-inflammatory drug.

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.