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Acute Bronchitis Protocol (PAFP & MQIC)

Respiratory

1. Assessment & Diagnosis

Acute bronchitis is a self-limiting respiratory infection characterized by a cough lasting up to 3 weeks.

  • Key Symptoms: Cough (dry or productive) with or without sputum.
  • Rule Out Pneumonia: Suspect pneumonia if the patient has a high fever (>38°C), rapid heart rate (>100 bpm), or rapid breathing (>24 bpm).
  • Rule Out Chronic Conditions: Consider asthma or COPD exacerbation if there is a history of smoking or recurrent wheezing.
  • Diagnostic Tests: Chest X-ray is not indicated unless there are signs of pneumonia or the cough persists >3 weeks. Sputum analysis is generally not recommended.

    • 2. Management (Supportive Care)

    Since 90% of cases are viral, treatment focuses on symptom relief, not cure.

  • Antibiotics: NOT RECOMMENDED for uncomplicated cases. Antibiotics do not significantly shorten the duration of the cough and increase resistance risk.
  • Symptomatic Relief:
  • Cough: Antitussives (e.g., Dextromethorphan) or honey may provide relief.
  • Fever/Pain: Paracetamol or NSAIDs.
  • Wheezing: Inhaled beta-agonists (e.g., Salbutamol) are only indicated if there is evidence of airflow obstruction/wheezing.
  • Patient Education: Reassure the patient that the cough typically lasts 10-21 days and is self-limiting.

    • 3. Non-Pharmacologic Advice

  • Hydration: Increase fluid intake.
  • Lifestyle: Smoking cessation and avoidance of respiratory irritants (smoke, dust).
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    Warning Signs

    REFER TO HOSPITAL IF:

  • High Fever (>38°C / 100.4°F) persisting beyond a few days.
  • Bloody Mucus (Hemoptysis).
  • Shortness of Breath or trouble breathing.
  • Symptoms lasting > 3 weeks (Evaluate for TB or malignancy).
  • Confusion or signs of sepsis in elderly patients.

    • References

    1. Michigan Quality Improvement Consortium (MQIC) Medical Directors (2022). Management of Uncomplicated Acute Bronchitis in Adults.
    2. Noel L. Espallardo, MD, MSc and the PAFP QA Committee (Philippine Academy of Family Physicians) (2017). Clinical Pathways for the Management of Acute Bronchitis in Family and Community Practice.
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