Orientation notes for study. Check local guidelines before prescribing.
Definition
Bronchitis is inflammation of the bronchi. There are two quite different conditions:
- Acute bronchitis: a short, self-limiting infection of the large airways, usually viral.
- Chronic bronchitis: a clinical diagnosis: productive cough on most days for at least 3 months in each of 2 consecutive years, with other causes excluded. It is a component of COPD.
Acute bronchitis
Causes: mostly viruses (rhinovirus, influenza, parainfluenza, RSV, coronavirus, adenovirus). Bacteria are uncommon (Mycoplasma pneumoniae, Chlamydophila, Bordetella pertussis). Irritants (smoke, dust, fumes) can contribute.
Clinical features:
- Cough (first dry, then productive, may be purulent), lasting up to 3 weeks; sore throat, rhinitis, low-grade fever, malaise, chest tightness or wheeze, mild retrosternal discomfort.
- Signs: scattered rhonchi and coarse crackles that clear on coughing; no consolidation signs; normal respiratory rate and saturation.
Differentiate from pneumonia: pneumonia has focal signs, fever and tachypnoea, and consolidation on X-ray. Chest X-ray is not routine unless pneumonia is suspected (older patient, high fever, tachycardia, tachypnoea, focal signs).
Management:
- Reassure: the cough may last 2–3 weeks.
- Symptomatic: fluids, paracetamol or ibuprofen, honey, rest; stop smoking.
- Antibiotics are NOT usually indicated (mostly viral, little benefit). Consider if the patient is systemically unwell, very frail, has comorbidity (COPD, heart failure), or pertussis is suspected (macrolide).
- Bronchodilator for wheeze if present.
- Return if breathless, high fever, cough over 3 weeks, haemoptysis, weight loss, or HIV (consider pneumonia or TB).
Complications: pneumonia, post-infectious cough, asthma exacerbation.
Chronic bronchitis
Cause: long-term exposure to irritants: tobacco smoke (commonest), biomass fuel smoke (wood, charcoal: very important in Kenya), occupational dusts and fumes, air pollution; recurrent infection.
Pathology: mucous gland hypertrophy and goblet cell hyperplasia (increased Reid index above 0.5), mucus hypersecretion, chronic inflammation, ciliary dysfunction, bronchial wall thickening and airway narrowing.
Clinical features:
- Chronic productive cough, worse in the morning; recurrent exacerbations with purulent sputum, wheeze and breathlessness.
- Signs: coarse crackles and rhonchi, wheeze, cyanosis and fluid retention (cor pulmonale) in advanced disease ("blue bloater": overweight, cyanosed, hypoxic, oedematous, CO2 retention).
Investigations:
- Spirometry (post-bronchodilator FEV1/FVC below 0.7 = COPD); chest X-ray (increased bronchovascular markings, to exclude other causes); sputum culture in exacerbations; FBC (polycythaemia), ABG.
- Exclude TB, bronchiectasis, cancer and asthma in a patient with chronic cough.
Management:
- Stop smoking (the only intervention that slows decline) and reduce biomass smoke (clean cookstoves, ventilation).
- Inhaled bronchodilators, pulmonary rehabilitation, vaccines (influenza, pneumococcal).
- Exacerbations: bronchodilators, oral steroids, and antibiotics if sputum is purulent (for example amoxicillin or doxycycline).
- See the COPD note for complete management.
Pharmacology at a glance
Tap a drug name for its full card (how it works, adverse effects, cautions, dose), then use Back to this note to return to this spot.
| Drug | Class | Role here | Watch for |
|---|---|---|---|
| Paracetamol | Analgesic and antipyretic | Fever and chest discomfort in acute bronchitis | Liver injury in overdose |
| Ibuprofen | NSAID | Alternative for fever and aches | Stomach irritation; avoid in asthma if aspirin-sensitive |
| Salbutamol | Short-acting β₂-agonist | Wheeze or chest tightness | Tremor, palpitations |
| Amoxicillin | Penicillin | Only if systemically unwell, frail or in a purulent chronic bronchitis exacerbation | Rash, diarrhoea |
| Doxycycline | Tetracycline | Alternative antibiotic for a purulent exacerbation | Photosensitivity, oesophagitis |
| Azithromycin | Macrolide | Suspected pertussis (whooping cough) | QT prolongation |
Most acute bronchitis is viral: antibiotics do not shorten it and are not routinely needed.
Comparison
| Acute bronchitis | Chronic bronchitis | |
|---|---|---|
| Cause | Usually viral | Smoke and irritants |
| Duration | Up to 3 weeks | 3 months a year for 2 years |
| Course | Self-limiting | Chronic, progressive, with exacerbations |
| Antibiotics | Usually not needed | In purulent exacerbations |
| Link to COPD | None | Part of COPD |
Exam points
- Acute bronchitis is mostly viral: do not routinely give antibiotics.
- Chronic bronchitis is defined by cough and sputum 3 months for 2 successive years.
- A chronic cough always needs TB and cancer excluded in Kenya.
- Smoking cessation is the key treatment.
Practice questions
1. A healthy 25-year-old has a 5-day dry then productive cough, low-grade fever and scattered rhonchi, with a normal chest X-ray. Best management: A. Ceftriaxone · B. Reassurance and symptomatic treatment · C. Steroids · D. Isolate for TB · E. Admit Answer: B.
2. The definition of chronic bronchitis includes cough with sputum for: A. 2 weeks · B. 1 month · C. 3 months in each of 2 consecutive years · D. 1 year only · E. 6 weeks Answer: C.