Evaluation of acute bronchitis in adults

Acute bronchitis should be suspected in patients with an acute onset but persistent cough (often lasting approximately five days to three weeks) who do not have clinical findings suggestive of pneumonia and do not have COPD. For most patients, the diagnosis can be based the history and physical examination. Apart from testing for COVID-19 during the pandemic, testing is generally reserved for cases in which pneumonia suspected, when the clinical diagnosis is uncertain, or when results would change management (eg, treatment of pertussis). As multiplex molecular assays become increasingly available and include testing for SARS-CoV-2, they will likely be used to make specific microbiologic diagnoses in patients with respiratory tract infections, but they have not had proven benefit at this juncture.

COPD: chronic obstructive pulmonary disease; URI: upper respiratory infection; COVID-19: coronavirus disease 2019; GERD: gastroesophageal reflux disease; ACE: angiotensin converting enzyme; bpm: beats per minute; RT-PCR: reverse-transcription polymerase chain reaction.
* By definition, acute bronchitis occurs in the absence of COPD. Similar symptoms in a patient with COPD would be considered a COPD exacerbation.
¶ RT-PCR on an upper respiratory tract specimen is the preferred text. Refer to UpToDate content on COVID-19 for additional detail on clinical features, testing, treatment, and infection control.
Δ Additional factors, such as moderate/severe dyspnea, hemoptysis, older age, and/or dementia, may raise the likelihood of pneumonia or other underlying pulmonary disorders.
◊ Most pathogens that cause acute bronchitis do not require specific treatment; thus, testing is not needed. Circumstances that might warrant testing include suspicion for pertussis (based on characteristic cough or known exposure), COVID-19 during the pandemic, or influenza (in a high-risk patient early in the course of illness). Refer to UpToDate text for additional detail on when suspect specific pathogens.
§ Refer to UpToDate content for detail on when additional testing is needed for patients with known or suspected pneumonia.

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Evaluation of acute bronchitis in adults