Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Acute Bronchitis

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In one line

·A virus swells the big breathing tubes (bronchi), making them pour out extra mucus and setting off a cough that can last up to three weeks. It is almost never bacteria, so antibiotics do not help.

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Normal physiology

·Air comes in through your nose or mouth, travels down your windpipe (trachea), and splits into two big tubes called bronchi—one going to each lung. Those bronchi keep branching into smaller and smaller tubes, like a tree, until they reach tiny air sacs (alveoli) where oxygen jumps into your blood. The bronchi are lined with a thin layer of cells and tiny waving hairs (cilia) that sweep mucus and germs back up so you can cough or swallow them away.

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What goes wrong

·A virus lands on the lining of the bronchi and infects the cells there. Your body sends inflammation (redness, heat, and swelling) to fight the virus. The lining puffs up, makes extra mucus, and some damaged cells fall off. The airways get jumpy and can tighten easily, so you cough and sometimes wheeze a little. The important part: the swelling stays in the big airways. It does NOT fill the tiny air sacs deep in the lung the way pneumonia does, so your oxygen level usually stays normal.

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Hallmark signs

·Cough that lasts one to three weeks
·Cough may be dry or bring up mucus (clear, white, yellow, or green)
·Cold symptoms came first (runny nose, sore throat, low-grade fever)
·Chest feels sore or tight from coughing
·Feeling tired or worn out
·Mild wheeze or whistling sound when breathing
·No pneumonia signs: normal breathing rate, normal oxygen level, clear lungs when listening
·High fever (over 100.4°F or 38°C), fast breathing, or trouble breathing at rest

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Red flags · escalate now

·High fever, fast heart rate, fast breathing, or low oxygen level—think pneumonia and get a chest X-ray
·Shortness of breath at rest, blue lips, or working hard to breathe—a deeper lung problem, not simple bronchitis
·Coughing up blood—needs a workup for pneumonia, tuberculosis, blood clot in the lung, or cancer
·Cough lasting more than three weeks—reconsider whooping cough (pertussis), asthma, acid reflux, or another cause
·Coughing fits that end in a whoop or vomiting, or contact with someone who has whooping cough—suspect pertussis

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Workup

·Clinical diagnosis (history and physical exam)
·Chest X-ray (only if pneumonia is a real concern)
·Pulse oximetry (oxygen level measured with a sensor on the finger)
·Pertussis (whooping cough) testing—nasopharyngeal swab PCR or culture
·Rapid influenza test or COVID-19 PCR (only during flu or COVID season, or if there is known exposure)
·Coughed-up mucus (Sputum) culture or Gram stain (almost never done in otherwise healthy people with acute bronchitis)

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Treatment

·Supportive care: rest, fluids, and time
·Symptom relief: fever reducers and pain relievers (acetaminophen or ibuprofen), honey (1 teaspoon) for cough in children over one year old
·NO antibiotics for otherwise healthy patients
·Inhaled bronchodilator (albuterol metered-dose inhaler, 2 puffs every 4–6 hours as needed) only if there is wheeze or a sense of chest tightness
·Avoid over-the-counter cough and cold medicines in children under 4 years old
·Patient education: explain the natural course, when to return, and why antibiotics are not needed

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NCLEX trap

·The color of mucus does NOT tell you bacteria are there. Almost all cases of sudden bronchitis (swelling of the breathing tubes) are caused by viruses. Antibiotics do not help viruses at all. Rules from the CDC, ACP, and Cochrane say do NOT give antibiotics to healthy adults with sudden bronchitis.
·A chest X-ray is only needed when you think the patient has pneumonia (infection deep in the lung). Warning signs for pneumonia are fever over 38°C (100.4°F), heart rate over 100 beats per minute, breathing rate over 24 breaths per minute, oxygen below 90%, or crackling sounds in one spot when you listen. If the patient has simple bronchitis with normal vital signs and clear lungs, you do NOT need an X-ray.
·The cough from sudden bronchitis often lasts one to three weeks. Many patients still cough at two weeks. Tell the patient this right away so they do NOT come back worried or ask for antibiotics when the cough is still there on day ten. Setting the right time frame stops unnecessary visits and antibiotic pressure.
·Albuterol can help IF the patient has wheezing that does not go away after coughing or if they have a history of asthma or reactive airways. But if the lungs sound clear or the patient has no trouble breathing, routine albuterol is NOT recommended. The ACP and Cochrane say the evidence does NOT support giving it to everyone.
·Most coughs after a cold ARE viral bronchitis. But if the cough lasts more than three weeks, gets worse instead of better, or comes with fever, night sweats, weight loss, or coughing blood, you must think of other causes like pertussis (whooping cough), tuberculosis, asthma, acid reflux, or even lung cancer in smokers. Always give clear return-precautions.

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