Acute Cough Due To Acute Bronchitis In Immunocompetent Adult Outpatients

Publication Date: February 1, 2020
Last Updated: March 14, 2022

Suggestions

1. For immunocompetent adult outpatients with cough due to suspected acute bronchitis, we suggest no routine investigation with chest x-ray, spirometry, peak flow measurement, sputum for microbial culture, respiratory tract samples for viral PCR, serum C-Reactive Protein (CRP) or procalcitonin. (U-CBS)
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2. For immunocompetent adult outpatients with cough due to suspected acute bronchitis, to help establish the etiology if the acute bronchitis persists or worsens, we suggest that the patient is advised to seek reassessment and targeted investigation(s) be considered. (U-CBS)
Remarks: Suggested targeted investigations could include chest x-ray, sputum for microbial culture, peak expiratory flow rate recording(s), complete blood count and inflammatory markers such as CRP.
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3. For immunocompetent adult outpatients with cough due to acute bronchitis, we suggest no routine prescription of antibiotic therapy, antiviral therapy, antitussives, inhaled beta agonists, inhaled anticholinergics, inhaled corticosteroids, oral corticosteroids, oral NSAIDs or other therapies until such treatments have been shown to be safe and effective at making cough less severe or resolve sooner. (U-CBS)
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4. For immunocompetent adult outpatients with cough due to acute bronchitis, if the acute bronchitis worsens, we suggest consideration for treatment with antibiotic therapy if a complicating bacterial infection is thought likely. (U-CBS)
Remarks: Differential diagnoses, such as exacerbations of chronic airways diseases (COPD, asthma, bronchiectasis) that may require other therapeutic management (such as with oral corticosteroids) should also be considered.
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Recommendation Grading

Overview

Title

Acute Cough Due To Acute Bronchitis In Immunocompetent Adult Outpatients

Authoring Organization

American College of Chest Physicians

Publication Month/Year

February 1, 2020

Last Updated Month/Year

December 16, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

This document sought to update the 2006 guidelines, reviewing the role of investigations in the diagnosis of acute bronchitis and the efficacy for medications in the management of cough due to acute bronchitis in immunocompetent adult patients. The suggestions made are intended to be useful for clinical practitioners assessing immunocompetent adult patients with cough due to suspected acute bronchitis, both in primary care and EDs.

Target Patient Population

Patients with cough due to suspected acute bronchitis,

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Emergency care, Long term care, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D003371 - Cough, D001991 - Bronchitis, D001351 - Infectious bronchitis virus

Keywords

bronchitis, infection, cough, acute cough

Source Citation

Smith MP, Lown M, Singh S, Ireland B, Hill AT, Linder JA, Irwin RS; CHEST Expert Cough Panel. Acute Cough Due to Acute Bronchitis in Immunocompetent Adult Outpatients: CHEST Expert Panel Report. Chest. 2020 May;157(5):1256-1265. doi: 10.1016/j.chest.2020.01.044. Epub 2020 Feb 21. PMID: 32092323; PMCID: PMC8173775.

Supplemental Methodology Resources

Data Supplement