Clinical Features

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The hallmark of acute bronchitis is cough, usually productive, in patients without evidence of pneumonia, sinusitis, or chronic pulmonary disease. Patients may have rhinitis (nasal congestion and discharge), myalgias, and fever.1 Sputum may be clear or colored, and the presence of colored sputum does not necessarily indicate a bacterial infection. Patients may complain of dyspnea or wheezing; usually due to bronchospasm.

Acute bronchitis caused by influenza A and B usually includes the abrupt onset of fever, chills, headaches, and myalgias that subside over 3 to 4 days, followed by 1 to 2 weeks of nonproductive cough and malaise. Less commonly, patients present with pharyngitis or tracheobronchitis. One-quarter may have rales or wheezes. Outbreaks occur from October to April.

Bordatella pertussis as a cause of acute bronchitis in adults has been increasing since 1981 and has been implicated as a causative agent in adults with chronic cough.3 Protection owing to childhood immunization diminishes within 4 to 12 years. Cough is usually preceded by low-grade fever, rhinorrhea, and conjunctivitis, but adults usually lack the characteristic "whoop" heard in children. Commonly, available culture and direct fluorescence antibody test of nasopharyngeal swabs are uniformly negative.3

Mycoplasma pneumoniae affects mainly older children and young adults and may occur throughout the year, with epidemics occurring every 4 to 7 years. The incubation period is 16 to 30 days. Given the usual brevity of symptoms and relatively quick resolution of illness, diagnostic tests are usually not warranted unless pneumonia is suspected.

Chlamydia pneumoniae, which may cause wheezing associated with acute bronchitis and chronic asthma, has a 30-day incubation period and is found mainly in the elderly. Patients may be afebrile and produce minimal sputum, and laryngitis may be more common than with mycoplasmal or viral infections. Symptoms may persist even after adequate antibiotic therapy.

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Dealing With Bronchitis

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