Created: January 2003

Revised: 1/2005, 1/2007, 1/2009,

1/2011
Last Revision: February 2013

Acute Bronchitis/Cough Illness Guidelines

This clinical guideline provides assistance in interpreting medical coverage provided under HPN
and SHL commercial, Medicaid and Medicare benefit plans. When making coverage
determinations, the enrollee specific document must be referenced.
The terms of an enrollee's document (e.g., Evidence or Certificate of Coverage (EOC/COC),
Attachment A, Benefit Schedules and any attached Endorsements and Riders) may differ greatly.
In the event of a conflict, the enrollee's specific benefit document(s) supersedes this clinical practice
guideline.
All reviewers must first identify enrollee eligibility, any federal or state regulatory requirements
and the plan benefit coverage as outlined in the enrollees specific benefit document prior to use of
this clinical practice guideline. Other Policies and Coverage Determination Guidelines may apply.
HPN/SHL reserves the right, in its sole discretion, to modify its Protocols, Policies and Guidelines
as necessary. This clinical practice guideline is provided for informational purposes. It does not
constitute medical advice.

DESCRIPTION:

Bronchitis is the inflammation of the mucous membrane within the bronchial

tubes. The cough produced in earlier stages is hacking and irritating; in later
stages, the cough becomes looser and easier. Chest pain, wheezing and
shortness of breath can also be present.

OVERVIEW OF
ACUTE
BRONCHITIS
AND COUGH
ILLNESS

Greater than 90% of cases of acute cough illness are non-bacterial.

Acute bronchitis is often caused by the same viruses that cause the flu and
the common cold.
Acute bronchitis may be present for a few days or last up to ten days; The
cough could linger for many weeks after the infection is gone.
Risks factors for acute bronchitis include:
o Dust or other air pollution
o Fumes or vapors
o Tobacco smoke, including second hand smoke
o Co-morbid lung disease
o Elderly, children and infants

DIAGNOSIS

Perform a clinical assessment including history of the following:

o Presenting symptoms (most common symptom is persistent a cough
which may last 10-20 days).
o Use of over the counter or self medications
o Previous medical history including relevant co-morbidities
o Exposure to smoke, air pollutions, dust or fumes
Perform a limited physical exam including:
o Lung sounds
o Inspection of mucus (optional)
o Oxygen saturation (optional)
Consider chest x-ray for patients with symptoms lasting more than 3 weeks.

ACUTE
BRONCHITIS VS.
COUGH
ILLNESS

Acute Bronchitis
Individual presents with the following:
Chilliness
Malaise
Soreness and constriction behind
sternum
Coughing
Slight fever of 100 to 102 degrees
fahrenheit
Cough at first dry and painful
Later mucopurulent expectoration that
becomes free as inflammation
subsides
Shortness of breath
Wheezing
Body aches
This diagnosis does not require
antibiotics.

Cough Illness
Individual presents with the
following:
Cough for more than 10 days
Pertussis
Pneumonia
Chronic pulmonary disease

TREATMENT
FOR
BRONCHITIS/
COUGH
ILLNESS

General Treatment:

Encourage patient to remain on bed-rest.

Instruct patient to drink plenty of fluids.

Recommend appropriate analgesics and antipyretics. (Expectorants and

non-steroidal anti-inflammatory medicines may help ease some
symptoms).

Breathing in warm, moist air, such as in the shower, over a kettle or

from a humidifier

Antibiotic Treatment:
Do not prescribe antibiotics for uncomplicated acute bronchitis/cough
illness. Acute bronchitis almost always gets better on its own.
Consider antibiotics for a prolonged cough that lasts more than 10 days.
o Mycoplasma pneumoniae infection may cause pneumonia and
prolonged cough, usually in children older than 5 years of age. A
macrolide agent (or tetracycline in children 8 years of age or older)
may be used for treatment.
o Children with underlying chronic pulmonary disease (not including
asthma) may occasionally benefit from antibiotic therapy for acute
exacerbations.
o Pertussis should be treated according to established clinical
recommendations.
FOLLOW-UP

The following measures may be considered if symptoms persist:

Recurrent wheezing evaluate for asthma

Persistent fever evaluate for other infection such as pneumonia or

pertussis.

Persistent cough lasting more than 4 to 8 weeks evaluate for other

condition such as; Gastro-esophageal reflux disease (GERD), asthma,
post nasal drip syndrome.

PATIENT
EDUCATION

Advise patient about the usual natural history of the illness and how
long it usually lasts.

Instruct patient on how to manage the illness (symptom relief).

Reassure the patient that antibiotics are not needed immediately because
they usually do not make a difference to the symptoms and may have
side effects like diarrhea, vomiting or rash.

Explain the risks of using antibiotics and provide educational materials

on antibiotic resistance.

Instruct patient when to contact provider. (If symptoms worsen or

become prolonged).

Education regarding prevention

o Practice good hand hygiene
o Avoid smoking
o Avoid exposure to second hand smoke and do not expose
children to second hand smoke
o Keep immunizations up to date of individual and children

This guideline is an educational tool to aid clinical decision making. It is not a standard of care.
The physician should adapt this guideline when clinical judgment so indicates.
REFERENCE PERSONS:
Bennett Mitchell MD, Adult Medicine, Southwest Medical Associates
REFERENCES:
Centers for Disease Control and Prevention. Careful Antibiotic Use, Academic Detailing Sheets
for Judicious Treatment: Summary for Otitis Media, Rhinitis, Sinusitis, Pharyngitis, Cough
Illness/Bronchitis.
Centers for Disease Control and Prevention. Adult Appropriate Antibiotic Use Summary:
Physician Information Sheet (Adults).
Centers for Disease Control and Prevention. Acute Cough Illness (Acute Bronchitis): Physician
Information Sheet (Adults).
Centers for Disease Control and Prevention. Appropriate Treatment Summary: Physician
Information Sheet (Pediatrics).
Centers for Disease Control and Prevention. Cough Illness/Bronchitis: Physician Information
Sheet (Pediatrics).
Snow V, Mottur-Pilson, C, Gonzales R. Principles of Appropriate Antibiotic Use for Treatment
of Acute Bronchitis in Adults. Annals of Internal Medicine, 2001:134: 518-520.
Gonzales R, Bartlett JG, Besser RE, Cooper RJ, Hickner JM, Hoffman JR, Sande MA.
Principles of Appropriate Antibiotic Use for Treatment of Uncomplicated Acute Bronchitis:
Background. Annals of Internal Medicine. March 20, 2001:134: 521-529.

Dowell SF, Marcy SM, Phillips WR, Gerber MA, Schwartz, B. Principles of Judicious Use of
Antimicrobial Agents for Pediatric Upper Respiratory Tract Infections. Pediatrics.
1998:101:163-165.
O'Brien KL, Dowell SF, Schwartz B, Marcy SM, Phillips WR, Gerber, MA. Cough
Illness/Bronchitis--Principles of Judicious Use of Antimicrobial Agents. Pediatrics. 1998:
101:178-181.
Institute for Clinical Systems Improvement (ICSI) Second Edition, January, 2008: Diagnosis
and Treatment of Respiratory Illness in Children and Adult.
National Institute for Health and Clinical Excellence: July, 2008: Respiratory Tract
Infections-antibiotic prescribing: NICE Clinical Guideline 69.
National Health Lung and Blood Institute: Diseases and Conditions Index: Bronchitis,
September, 2008.
The Centers for Disease Control and Prevention (CDC): Acute Cough Illness (Acute
Bronchitis) Fact Sheets.
AAFP Conditions A to Z (2010): Acute Bronchitis, American Academy of Family
Physicians created: May 2001, Updated February , 2010, posted 10/29/10.
2013 UpToDate, Inc at www.uptodate.com: Patient Information: Acute Bronchitis in Adults,
John G. Bartlett, MD.
ACP PIER & AHFS DI Essentials: Elements of Follow-up for Bronchitis: American
College of Physicians 2010, posted 1/11/2011 on http://online.statref.com.