Acute bronchitis Diagnosis and management Chest X-ray ACCP Q Do vital signs show a HR > 100 beats/min? Q Do vital signs show a respiratory rate > 24 breaths/min? Q Do vital signs show an oral body temperature > 38 C? Q Does chest examination show focal abnormalities? Yes to any Obtain a CXR to eliminate alternative causes for the patient's symptoms, such as pneumonia. No to all Avoid obtaining CXRs routinely in patients with acute cough and sputum production meeting all of the following criteria: HR 100 beats/min respiratory rate 24 breaths/min oral body temperature of 38 C normal chest examination. D Diagnostic criteria Diagnose acute bronchitis in patients with an acute respiratory infection manifested predominantly by cough, with or without sputum production, lasting 3 weeks, if there is no clinical or radiographic evidence of pneumonia, common cold, acute asthma, and COPD exacerbation. E Diagnostic criteria for acute bronchitis Symptoms of an acute respiratory infection (predominantly cough, with or without sputum production) Symptoms lasting < 3 weeks Pneumonia ruled out clinically and radiographically as the cause of cough Common cold, acute asthma or an exacerbation of COPD ruled out as the cause of cough Acute bronchitis is unlikely Antibiotic therapy Avoid initiating antibiotics routinely in patients with uncomplicated acute bronchitis. D Implement strategies to reduce antibiotic use, such as asking patients to call for or pick up an antibiotic, or to hold an antibiotic prescription for a set amount of time. A Symptomatic therapy Consider offering dextromethorphan, guaifenesin, or honey for the management of acute bronchitis symptoms. C Avoid using -2 agonists routinely in patients with acute bronchitis unless wheezing is present. D Do not use OTC cough medications containing antihistamines and antitussives in < 4 years old patients because of the high potential for harm. D