Acute Bronchitis: Rapid Evidence Review

Acute bronchitis is a clinical diagnosis and accounts for more than 3 million outpatient office visits in the United States annually. The differential diagnosis includes exacerbations of preexisting conditions, such as asthma, chronic obstructive pulmonary disease, and heart failure or other causes of acute cough, including pertussis, COVID-19, influenza, and community-acquired pneumonia. Acute cough may present with or without sputum production. Diagnostic testing is not indicated unless there is concern for other potential causes, such as community-acquired pneumonia, influenza, or COVID-19. Acute bronchitis is a self-limiting disease. Evidence does not support the use of antitussives, honey, antihistamines, anticholinergics, oral nonsteroidal anti-inflammatory drugs, or inhaled or oral corticosteroids. Antibiotics do not contribute to the overall improvement of acute bronchitis; although they may decrease the duration of cough by approximately 0.5 days, their use exposes patients to antibiotic-related adverse effects. Therefore, symptom relief and patient education regarding the expected duration of cough (2-3 weeks) are recommended for the management of acute bronchitis. Strategies shown to decrease antibiotic prescribing include delayed antibiotic prescriptions and describing acute bronchitis as a chest cold.