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A systematic search of the medical literature was performed on November 15, 2007. The search included relevant articles from UpToDate®, Ovid, Guidelines from the Infectious Diseases Society of America (IDSA), the American Thoracic Society (ATS), and Centers for the Disease Control and Prevention (CDC).

Lower respiratory tract infections are a significant cause of morbidity and mortality in the United States and one of the major reasons for unscheduled physician office visits. In 1997, there were more than 10 million office visits by adults for acute bronchitis in the United States.1 Although bronchitis and pneumonia are often felt to be a spectrum of the same disease by patients and health care providers, they are in fact distinct, and require different treatment approaches. This chapter will discuss the epidemiology and evidence-based management of acute uncomplicated bronchitis and community-acquired pneumonia (CAP). Bronchitis occurring in patients with underlying lung disease, often termed acute exacerbations of chronic bronchitis, will not be addressed here.

Epidemiology and Microbiology

Acute uncomplicated bronchitis is a common inflammatory condition of the tracheobronchial tree that affects as many as 5% of adults each year.2 In contrast to more nonspecific respiratory syndromes, a majority of patients with bronchitis seek medical care from a physician. This is a result of the prevailing belief that bronchitis is a bacterial infection that requires antibiotic therapy to hasten resolution. In fact, literature supports the vast majority of cases of uncomplicated acute bronchitis that have a nonbacterial cause.2 Viruses, including influenza A and B, parainfluenza, respiratory syncytial virus (RSV), rhinoviruses, adenoviruses and coronaviruses are among the more common etiologic agents. RSV seems to be of concern especially in older adults, where a significant percentage of cases will be associated with pneumonia. The only nonviral causes that have been convincingly implicated in acute uncomplicated bronchitis are Bordetella pertussis, Mycoplasma pneumoniae and Chlamydophila pneumoniae, and are thought to account for 5% to 10% of cases of acute bronchitis.2B. pertussis may be a particularly common cause of prolonged cough, but antibiotic therapy is not of clinical benefit, unless begun early in the illness.3Pathogens common to other respiratory tract infections like otitis media and pneumonia, including Streptococcus pneumoniae, Haemophilus influenza and Moraxella catarrhalis have not been convincingly shown to be etiologic agents in acute bronchitis in patients without underlying lung disease.

Clinical Presentation and Diagnostic Evaluation

The hallmark of acute bronchitis is a cough, which may be purulent or nonpurulent, and is often prolonged in duration. Many patients begin with symptoms typical of a viral upper respiratory tract infection, but progress to persistent cough. Pulmonary function tests have been shown to be abnormal in nearly half of these patients. Bronchial hyperresponsiveness is typically evident for 2 to 3 weeks, although it may persist for up to 2 months.3 The main focus in the evaluation of patients ...

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