The level of evidence grades (A-D) are provided for the most significant recommendations and are defined at the end of the "Major Recommendations" field.

Assessment

• Perform thorough history (including tobacco use status [A]) and physical exam
• Assess the likelihood of uncomplicated acute bronchitis using the following items:
  • Acute respiratory infection (ARI) manifested predominantly by cough, with or without sputum production lasting no more than 3 weeks
  • No clinical evidence of pneumonia
  • Common cold, acute asthma, or exacerbation of chronic obstructive pulmonary disease (COPD) have been ruled out as cause of cough
  • Consider other diagnoses if cough persists greater than 3 weeks

Diagnosis

Clinical Information and Testing

• Presumed diagnosis of acute bronchitis:
  • Acute respiratory infection (ARI) and cough with or without sputum production lasting no more than 3 weeks
  • No clinical evidence of pneumonia
• Viral cultures, serologic assays and sputum analyses should not be routinely performed [C]
• Chest x-ray is not indicated if all of the following are present [B]:
  • Acute cough and sputum production suggestive of acute bronchitis
  • Heart rate <100 beats/min
  • Respiratory rate <24 breaths/min
  • Oral temperature <38° Celsius  (100.4° Fahrenheit)
  • Chest exam lacks findings of focal consolidation, egophony or fremitus

Treatment

• Condition is a self-limited respiratory disorder. Symptomatic treatment only. Routine treatment with antibiotics is not justified and should not be offered. Avoid antibiotics [A]
• Beta₂ agonist bronchodilators should not be routinely used to alleviate cough. In select patients with wheezing, treatment with beta₂ agonist bronchodilators may be useful [C]
• Antitussive agents can be offered for short-term symptomatic relief of coughing [C]
• Mucokinetic (mucolytic) agents are not recommended (no consistent favorable effect) [D]

Education and Counseling

Educate Patient/Family Regarding

The type of supporting evidence is provided for the most significant recommendations (See "Major Recommendations" field).

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