ACUTE BRONCHITIS
Acute bronchitis is an acute inflammatory disorder of the tracheobronchial tree characterised mainly by cough, with or without sputum production. It is usually caused by a respiratory viral infection and is generally self-limiting. The condition mainly affects the conducting airways rather than the alveoli; therefore, uncomplicated acute bronchitis does not produce the pulmonary consolidation typical of pneumonia.
The condition frequently develops during or shortly after an upper respiratory tract infection. Although sputum may be produced, production of coloured sputum does not by itself confirm bacterial infection.
The thorax extends from the root of the neck to the diaphragm. It contains the lungs and mediastinum and is protected by the ribs, sternum and thoracic vertebral column. The respiratory structures within this region include the intrathoracic trachea, main bronchi, branching bronchial tree and lungs.
The lungs occupy most of the thoracic cavity. The right lung is divided into superior, middle and inferior lobes, while the left lung contains superior and inferior lobes and accommodates the position of the heart.
The lungs lie on either side of the mediastinum and are enclosed by the pleural membranes. The heart occupies the central mediastinum. Inferiorly, the diaphragm separates the thoracic cavity from the abdominal cavity and serves as the principal muscle of inspiration. Understanding these relationships is important when assessing a patient with cough, chest pain or respiratory difficulty because symptoms arising from respiratory and cardiovascular structures may overlap.
The trachea begins below the larynx and descends into the thorax, where it divides at the carina into the right and left main bronchi. Each main bronchus divides into lobar bronchi, segmental bronchi, smaller bronchi and eventually bronchioles. Beyond the terminal bronchioles are the respiratory bronchioles, alveolar ducts and alveoli.
Acute bronchitis primarily affects the tracheobronchial conducting airways. Pneumonia, in contrast, involves the distal lung parenchyma and alveolar spaces.
The larger bronchi are lined mainly by pseudostratified ciliated columnar epithelium containing mucus-producing goblet cells. The bronchial wall also contains smooth muscle, connective tissue, mucous glands and cartilage.
Mucus traps microorganisms and inhaled particles. Coordinated movement of respiratory cilia transports this mucus upwards towards the pharynx. This protective mechanism is known as mucociliary clearance.
During acute bronchitis, inflammation can temporarily damage the epithelium and reduce effective mucociliary clearance, contributing to retained secretions and prolonged coughing.
The majority of cases of acute bronchitis are caused by respiratory viruses. The illness may occur during the course of influenza, rhinovirus infection, respiratory syncytial virus infection, adenovirus infection, parainfluenza infection, coronavirus infection and other viral respiratory illnesses.
True bacterial acute bronchitis is much less common. Certain organisms such as Bordetella pertussis should be considered when the clinical history suggests a prolonged or characteristic cough syndrome.
Non-infectious airway irritation from tobacco smoke, fumes, dust and pollutants may aggravate bronchial inflammation and coughing.
Acute bronchitis can occur in otherwise healthy individuals, but several circumstances increase exposure to respiratory pathogens or increase airway susceptibility. These include close contact with people who have respiratory infections, tobacco-smoke exposure, second-hand smoke, occupational exposure to dust or fumes and underlying airway disorders such as asthma or chronic obstructive pulmonary disease.
Very young patients, older adults and people with significant underlying cardiopulmonary or immune problems require particularly careful assessment when presenting with acute respiratory symptoms.
Acute bronchitis usually begins when a respiratory pathogen reaches the bronchial mucosa and infects or irritates airway epithelial cells. Local immune responses are activated and inflammatory mediators are released.
The resulting inflammation causes vascular congestion, mucosal oedema and increased secretion of mucus. Ciliary function may become temporarily impaired. These changes stimulate sensory receptors in the airways and generate the characteristic cough.
Some patients develop transient airway hyperresponsiveness and bronchial narrowing. This explains why wheezing may accompany acute bronchitis even in a patient without established chronic obstructive lung disease.
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Bronchial epithelial irritation
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Inflammatory response
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Mucosal oedema
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Increased bronchial secretions
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Reduced mucociliary clearance
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Airway receptor stimulation
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COUGH ± SPUTUM ± WHEEZE
Cough is the principal clinical manifestation. It may initially be dry and irritating and later become productive. The cough often persists after associated upper respiratory symptoms have improved.
Sputum may be clear, white, yellow or green. The appearance of purulent-looking sputum does not alone establish a bacterial cause, because inflammatory cells can alter the colour of respiratory secretions.
Other features may include sore throat, nasal congestion, rhinorrhoea, malaise, fatigue, mild headache, muscle aches, low-grade fever, wheezing and retrosternal or chest-wall discomfort caused by frequent coughing.
Physical examination may be normal or may reveal nonspecific respiratory findings. The patient may cough frequently during the assessment. Auscultation may reveal scattered rhonchi or wheezing. Airway sounds caused by secretions may change or clear after coughing.
The nurse and clinician should assess respiratory rate, work of breathing, temperature, pulse and overall appearance. Oxygen saturation should be assessed when respiratory compromise is suspected or when clinically indicated.
Diagnosis of uncomplicated acute bronchitis is mainly clinical. A careful history and respiratory examination are used to recognise the typical acute cough syndrome while excluding pneumonia and other important causes of cough.
History
The history should establish when the cough began, how it has progressed, whether it is dry or productive and whether there is fever, breathlessness, wheezing, haemoptysis or chest pain. The clinician should also ask about upper respiratory symptoms, recent contact with respiratory illness, smoking, environmental exposures, asthma, COPD, cardiac disease and current medications.
Physical Examination
The patient should be observed for general appearance, level of consciousness, respiratory pattern, use of accessory muscles and ability to speak comfortably. The chest should be examined and auscultated systematically.
Pulse Oximetry
Peripheral oxygen saturation can be useful when there is respiratory difficulty, abnormal respiratory examination, significant underlying disease or concern about impaired oxygenation.
Microbiological Testing
Routine sputum bacterial culture is generally unnecessary in an ordinary uncomplicated case. Targeted viral or bacterial testing may be appropriate when a specific diagnosis would alter clinical management or infection-control measures.
Chest X-ray is not routinely required in every patient with acute bronchitis. It becomes useful when the clinical picture raises concern about pneumonia or another pulmonary disorder.
The most important alternative diagnosis is pneumonia. Other possibilities include asthma, COPD exacerbation, pertussis, influenza, other viral respiratory illnesses, upper airway cough syndrome, gastro-oesophageal reflux and other cardiopulmonary disorders.
Recurrent attacks labelled as “bronchitis,” particularly when associated with episodic wheeze or breathlessness, should raise consideration of underlying asthma or another chronic airway condition.
Uncomplicated acute bronchitis is usually self-limiting and has an excellent prognosis. The patient should nevertheless be advised that the cough can persist for several weeks, often lasting longer than the initial sore throat, rhinorrhoea, malaise or fever.
Persistent cough during otherwise steady recovery does not by itself mean that bacterial infection has developed. However, clinical deterioration or development of new concerning symptoms warrants reassessment.
Treatment is primarily supportive because most uncomplicated cases are caused by respiratory viruses. The goals are to relieve symptoms, maintain adequate hydration and comfort, monitor respiratory status, prevent avoidable complications and identify patients whose symptoms indicate another diagnosis.
Rest and Activity
Adequate rest should be encouraged during the acute symptomatic phase. Normal activity may be resumed gradually as malaise, fatigue and respiratory symptoms improve.
Hydration
Appropriate oral fluid intake should be encouraged unless medically contraindicated. This supports hydration and is especially important when fever, poor appetite or reduced oral intake is present.
Fever and Pain Relief
Appropriate prescribed or recommended analgesic and antipyretic therapy may be used for fever, headache, general discomfort or musculoskeletal pain caused by repeated coughing.
Cough Management
The cough is a protective reflex and treatment should be individualised. Complete suppression is not always desirable when respiratory secretions need to be cleared. The patient's age, symptoms, associated illness and prescribed treatment should guide symptom management.
Bronchodilators
Bronchodilators are not routinely necessary for every patient. They may be considered when clinically significant wheezing, bronchospasm or underlying reversible airflow obstruction is present.
Antibiotics
Routine antibiotics are not indicated for uncomplicated acute bronchitis. Most cases are viral, so antibacterial medicines usually provide no meaningful benefit for the underlying cause.
Antibiotic therapy may be appropriate when a specific bacterial infection or another bacterial respiratory condition is diagnosed or sufficiently suspected according to clinical assessment and applicable treatment guidelines.
Medical management begins by assessing whether the presentation is consistent with uncomplicated bronchitis and determining whether pneumonia, asthma, COPD exacerbation or another important disorder is present.
Once serious alternative diagnoses have been reasonably excluded, management is largely symptom directed. Treatment may include appropriate hydration, rest, fever and pain management and selected therapy for wheezing when indicated. Specific antiviral or antibacterial treatment is directed at a confirmed or strongly suspected specific infection rather than prescribed routinely for the diagnosis of uncomplicated bronchitis itself.
Patients with asthma, COPD or other established cardiopulmonary disease require additional assessment because an acute respiratory infection may trigger deterioration of their underlying disease.
Nursing assessment should be systematic and should evaluate both the respiratory illness and the patient's overall physiological condition.
Assessment of Cough
Determine the onset, duration, severity and frequency of coughing. Establish whether it is dry or productive and ask whether coughing interferes with sleep, eating, conversation or usual activity.
Assessment of Sputum
When sputum is present, assess its approximate amount and relevant characteristics. Haemoptysis is an important finding and should be reported and investigated appropriately.
Respiratory Assessment
Assess respiratory rate, rhythm and depth. Observe for nasal flaring, accessory muscle use, difficulty completing sentences, cyanosis or other signs of increasing respiratory effort. Auscultate breath sounds and document wheezes, rhonchi or other abnormalities.
Vital Signs
Monitor temperature, pulse, respiratory rate and blood pressure according to the clinical situation. Assess oxygen saturation when indicated.
Hydration and General Condition
Assess oral intake, mucous membranes, urine output when relevant, fatigue, sleep disturbance and the patient's ability to perform normal activities.
Relevant History
Ask about smoking, exposure to second-hand smoke, occupational irritants, allergies, previous respiratory disease, medication use and previous episodes of similar illness.
Maintain and Monitor Airway Patency
Assess the airway and respiratory pattern regularly. Listen to the chest for changes in breath sounds and observe whether the patient can clear secretions effectively. Any evidence of increasing airway obstruction or respiratory distress should be reported promptly.
Promote Effective Coughing
When bronchial secretions are present, encourage an effective cough rather than repeated shallow coughing. Effective coughing supports clearance of secretions from the larger airways.
Maintain Adequate Hydration
Encourage appropriate oral fluid intake unless contraindicated. Monitor patients who are unable to maintain adequate intake and report evidence of dehydration.
Promote Rest and Comfort
Provide periods of rest and reduce unnecessary exertion during the acute phase. Comfortable positioning can reduce the sensation of breathlessness and support more efficient ventilation.
Administer Prescribed Medication
Administer prescribed medications according to professional standards. Observe therapeutic effects and adverse reactions and document the patient's response.
Monitor Oxygenation
Assess oxygen saturation where clinically indicated and observe for signs of impaired oxygenation. Unexpected abnormalities require prompt reassessment.
Monitor Temperature
Record temperature as appropriate and observe the overall pattern rather than focusing on a single value. Increasing fever accompanied by worsening respiratory signs may indicate a change in the clinical condition.
Reduce Exposure to Respiratory Irritants
Advise the patient to avoid tobacco smoke, second-hand smoke and other substances that aggravate airway irritation.
The nurse has an important clinical, therapeutic, educational and preventive role in the care of a patient with acute bronchitis.
Assessment Role
The nurse collects an accurate respiratory history, assesses cough and sputum, monitors vital signs, evaluates respiratory effort, auscultates the lungs and assesses oxygenation when clinically indicated. This information helps distinguish uncomplicated illness from deterioration requiring further medical evaluation.
Therapeutic Role
The nurse promotes rest and adequate hydration, supports airway clearance where secretions are present, administers prescribed medication and implements measures that improve the patient's comfort.
Monitoring Role
The nurse observes the patient's response to treatment and watches for worsening breathlessness, altered respiratory rate, abnormal oxygenation, persistent fever, haemoptysis, confusion or other concerning changes.
Educational Role
Patient education includes explaining the usual viral nature of the condition, expected duration of coughing, correct use of prescribed medications, appropriate hydration and rest, avoidance of tobacco smoke and signs that require medical reassessment.
Infection-Prevention Role
The nurse reinforces appropriate hand hygiene, cough etiquette and other respiratory infection-prevention measures and encourages recommended vaccination according to applicable guidance.
Advocacy Role
The nurse promotes patient-centred care by ensuring that concerns are communicated, the patient's understanding is checked and appropriate referral or reassessment occurs whenever the clinical condition changes.
The nursing care plan is developed from the patient's individual assessment findings. The following diagnoses illustrate common nursing priorities in a patient with symptomatic acute bronchitis.
Possible relationship: increased bronchial secretions, mucosal inflammation and temporarily reduced mucociliary clearance.
Expected outcome. The patient will maintain a patent airway, demonstrate an effective cough and show improvement or stability in respiratory findings.
Nursing interventions. Assess respiratory rate, depth and pattern and auscultate breath sounds regularly. Assess the effectiveness of coughing and determine whether secretions are being cleared. Encourage appropriate fluid intake when not contraindicated. Assist the patient to adopt a comfortable position that promotes ventilation. Encourage effective coughing when secretions are present. Administer prescribed therapy and reassess the respiratory response.
Rationale. Regular respiratory assessment allows early recognition of changes in airway status. Adequate hydration supports normal respiratory secretions, while effective coughing helps move secretions out of the conducting airways. Reassessment determines whether treatment has improved airway clearance.
Evaluation. The airway remains patent, the patient clears secretions effectively, breath sounds and respiratory effort remain stable or improve and no evidence of acute respiratory deterioration is present.
Possible relationship: airway irritation, bronchospasm, respiratory discomfort or fatigue.
Expected outcome. The patient will maintain an effective breathing pattern without progressive respiratory distress.
Nursing interventions. Observe respiratory rate, depth and rhythm. Assess use of accessory muscles and ability to speak comfortably. Assess oxygen saturation when indicated. Position the patient appropriately and minimise unnecessary exertion during symptomatic periods. Administer prescribed treatment and evaluate its effect.
Rationale. Changes in respiratory pattern can indicate increasing airway obstruction, fatigue or development of another respiratory problem. Positioning and reduction of unnecessary activity can reduce respiratory demand.
Evaluation. The patient demonstrates a comfortable respiratory pattern without increasing effort or other signs of respiratory compromise.
Possible relationship: persistent coughing, irritation of the respiratory tract and strain of chest-wall muscles.
Expected outcome. The patient will report improved comfort and obtain adequate rest.
Nursing interventions. Assess the site, nature and severity of discomfort. Determine whether pain is directly related to coughing or whether it possesses features requiring further assessment. Encourage adequate rest and comfortable positioning. Administer prescribed pain-relieving treatment and evaluate its effectiveness.
Rationale. Repeated coughing can cause muscular and chest-wall discomfort. Pain assessment is important because not every episode of chest pain in a patient with cough should automatically be attributed to bronchitis.
Evaluation. The patient reports reduced discomfort and demonstrates improved ability to rest and participate in appropriate activity.
Possible relationship: fatigue, malaise, sleep disturbance and acute respiratory illness.
Expected outcome. The patient will progressively resume normal activities without excessive fatigue or worsening respiratory symptoms.
Nursing interventions. Assess response to normal activity and determine whether symptoms increase with exertion. Schedule periods of rest, assist with activities where necessary and encourage gradual return to activity as the patient recovers.
Rationale. Acute illness increases fatigue and can temporarily reduce activity tolerance. Balancing rest and activity reduces unnecessary energy expenditure while preventing prolonged inactivity.
Evaluation. The patient completes appropriate activities with improving tolerance and without clinically significant worsening of symptoms.
Possible relationship: inadequate information about the disease process, expected duration, medication and prevention.
Expected outcome. The patient will correctly explain the nature of the illness, prescribed treatment, home-care measures and warning signs before discharge or completion of consultation.
Nursing interventions. Explain that most uncomplicated cases are caused by viruses. Discuss the expected duration of coughing and explain that coloured sputum does not necessarily mean a bacterial infection. Explain prescribed medications and why unnecessary antibiotics are avoided. Teach appropriate hydration, rest, respiratory hygiene, avoidance of smoke and indications for reassessment.
Rationale. Accurate knowledge improves self-care, supports adherence to appropriate treatment and reduces unnecessary antibiotic use. Understanding warning signs also promotes timely access to further care if the illness worsens.
Evaluation. The patient correctly describes the illness, treatment plan, preventive measures and symptoms requiring reassessment.
Prevention focuses on reducing exposure to respiratory infections and protecting normal airway function.
Frequent hand hygiene reduces transmission of many respiratory pathogens. Appropriate cough and sneeze etiquette should be practised, particularly during respiratory infections.
Avoidance of tobacco smoking and second-hand smoke is particularly important because smoke irritates the bronchial mucosa and impairs normal respiratory defence mechanisms.
Exposure to occupational or environmental dust, smoke and chemical fumes should be reduced where possible. Appropriate respiratory vaccinations should be encouraged according to current recommendations and individual risk.
Explain that uncomplicated acute bronchitis usually improves spontaneously but that the cough may continue after the patient otherwise feels better.
The patient should understand the importance of adequate rest, appropriate hydration and avoidance of respiratory irritants. Prescribed medicines should be taken correctly, and medicines prescribed for another person should not be used.
The nurse should specifically educate the patient about unnecessary antibiotic use. Leftover antibiotics should not be taken for a new episode of cough without appropriate assessment.
Respiratory hygiene and regular handwashing should be reinforced to reduce spread of infectious respiratory illness.
Serious complications are uncommon in otherwise uncomplicated acute bronchitis. Possible problems include prolonged post-infectious cough and worsening of pre-existing asthma or COPD.
A patient whose symptoms worsen rather than gradually improve should be reassessed because pneumonia or another condition may have developed or may have been present from the beginning.
Before discharge or completion of outpatient care, ensure that the patient understands the diagnosis and treatment plan. Review medication instructions, recommended activity and hydration, avoidance of smoke and expected duration of symptoms.
The patient should also understand when further medical assessment is necessary. Worsening respiratory difficulty, significant haemoptysis, cyanosis, altered mental status, severe systemic illness or other evidence of respiratory deterioration requires prompt professional evaluation.
Acute bronchitis is an acute inflammatory disorder of the bronchial airways and is usually viral. Cough is the most important symptom and may occur with or without sputum. Sputum colour alone does not establish bacterial infection.
The disease primarily affects the conducting airways rather than the alveoli. Diagnosis is mainly clinical, and the principal diagnostic challenge is to recognise patients who may instead have pneumonia or another significant cardiopulmonary disorder.
Management is predominantly supportive. Routine antibiotics are not indicated for uncomplicated acute bronchitis. Nursing care centres on respiratory assessment, monitoring, promotion of effective airway clearance where required, hydration, rest, comfort, medication administration, health education and recognition of deterioration.
Main symptom: cough.
Usual cause: viral respiratory infection.
Main pathology: bronchial mucosal inflammation, oedema and increased secretions.
Main diagnostic concern: exclude pneumonia.
Main treatment: supportive care.
Routine antibiotics: not indicated in uncomplicated disease.
Major nursing responsibility: assess respiratory status, promote comfort and airway clearance, educate the patient and detect deterioration early.
Educational note: This chapter is intended for nursing and medical education. Individual diagnosis and treatment should be guided by clinical assessment and applicable professional guidelines.