Bronchitis

Acute bronchitis in previously fit individuals is a common condition that is usually mild and self limiting. Chronic bronchitis remains a common cause of morbidity and mortality, and the cost to the nation due to lost working days and to health services is enormous. Cigarette smoking is the major etiologic factor, although exacerbations may be caused by viruses, environmental pollutants, allergic responses, and bacterial infections. New insights into the underlying basic mechanisms of bronchial inflammation are being made. Antibiotics are commonly used to treat exacerbations, although evidence of efficacy is sometimes lacking. Some patients may be prone to recurrent exacerbations and this influences their chance of recovery. Clinical trials must include an assessment of the severity of the exacerbation, and protocols would be improved by increased definition of the type of patient being enrolled and by inclusion of more detailed measures of benefit. Influenza and pneumococcal vaccination should be encouraged in appropriate patients.