What is bronchitis and how is it managed?

As non-medical prescribers, we often come across patients suffering from bronchitis during the winter months. However, it is essential to question if we fully understand what bronchitis is, and how it can be accurately diagnosed and managed. Acute bronchitis is a clinical condition characterised by the self-limited inflammation of the large airways of the lungs, resulting in a cough without pneumonia (Wenzel and Fowler, 2006). Typically, it is caused by viral infections such as rhinovirus, enterovirus, influenza A and B, parainfluenza, coronavirus, human metapneumovirus and respiratory syncytial virus (Clark et al, 2016). Although bacteria have been found in 1-10% of cases of acute bronchitis, they are less frequent and include Mycoplasma pneumoniae, Chlamydophila pneumoniae and the less common Bordetella pertussis (Clark et al, 2016).

One of the primary symptoms of acute bronchitis is a cough, which can be productive or unproductive. Other symptoms or clinical signs that may suggest lower respiratory tract infection and no alternative explanation should also be considered (ERS White book, 2022). Clinical signs can include but not limited to; tachypnoea, pyrexia, tachycardia. Additional investigations may be required to consider the causes of these symptoms including blood tests (ESR, CRP, WCC) and a chest x-ray. According to Tackett and Atkins (2012), the pathogenesis of acute bronchitis is because of the inflammation of the bronchial epithelium, which is often secondary to an airway infection or environmental trigger. This inflammation results in constriction of the large airways, causing an increase in resistance during inhalation and exhalation.