Bronchitis

- Cough in absence of fever, tachypnea, and tachycardia suggests bronchitis rather than pneumonia.

- Bacterial bronchitis does NOT occur in children. Only occurs as a part of tracheobronchitis with viral infections.

- Green/yellow sputum production is indicative of inflammatory reaction and does not necessarily imply bacterial infection.

- Mycoplasma pneumoniae and Chlamydia pneumoniae have been implicated but not fully established as pathogens in acute bronchitis. Empiric therapy for these organisms is not recommended.

- Viral URTI can result in cough >14 days in 20% of children. Prolonged (> 10-14 days) cough may be evaluated for Mycoplasma pneumoniae, Bordetella pertussis, or asthma.

- In most patients the respiratory exam is normal (few patients may have wheezes). Chest x-ray is indicated if there is any suspicion of pneumonia on history or physical exam.

- Follow-up not recommended unless:

• symptoms worsen or new symptoms develop (dyspnea, persistent fever, vomiting)
• cough not improving at 14 days or cough lasting > 1 month
• symptoms recur (> 3 episodes/year).

- Corticosteroids (inhaled/oral) are not recommended as there is insufficient evidence to support their use.

- Expectorants are not recommended; good hydration more effective.

Viruses

No antibiotic therapy recommended

Management:

• increased humidity
• smoking cessation