ACUTE BRONCHITIS CLINICAL PATHWAY

CLINICAL DIAGNOSIS Cough for 1 week or more, productive of purulent sputum may suggest acute bronchitis Fever, chills, dyspnea easy fatigability and hoarseness may or may not be present

HOSPITAL ADMISSION Confinement is not usually needed

DIAGNOSTIC EXAMINATION No routine laboratory tests are needed for uncomplicated acute bronchitis. Chest xray may be done to rule out other causes

ACUTE BRONCHITIS CLINICAL PATHWAY Cough >1 week with purulent sputum ± fever, chest discomfort, dyspnea & hoarseness ± crackles/ronchi/wheezes Chest x-ray ABNORMAL Other diagnosis NORMAL Treat as Bronchitis Treatment options for Bronchitis (Alone or in combination) ANTITUSSIVES BRONCHODILATORS (if bronchospastic) (e.g. β2 agonist) ANTI-INFLAMMATORY (if with persistent cough) (e.g. oral or inhaled corticosteroids) MUCOLYTIC (e.g. Erdostein, Carbocisteine) ANTIBIOTICS (e.g. Macrolides) If with no improvement Do repeat CXR after 5-7 days of treatment especially if with fever, chest pain and pleurisy

Cough >1 week with purulent sputum ± fever, chest discomfort, dyspnea & hoarseness ± crackles/rhonchi/wheezes Chest x-ray ABNORMAL Other diagnosis NORMAL Treat as Bronchitis In a patient presenting with cough for more than a week, accompanied by symptoms such as fever, chest discomfort, and dyspnea. A chest Xray is warranted. If there are abnormal findings found on xray suggesting certain pathologies such as pneumonia or tuberculosis, the pathway for these diseases would be followed. If the chest xray turns out to be normal, the patient would be labeled as acute bronchitis.

Treatment options for Bronchitis (Alone or in combination) ANTITUSSIVES BRONCHODILATORS (if bronchospastic) (e.g. β2 agonist) ANTI-INFLAMMATORY (if with persistent cough) (e.g. oral or inhaled corticosteroids) MUCOLYTIC (e.g. Erdostein, Carbocisteine) ANTIBIOTICS (e.g. Macrolides) If with no improvement Do repeat CXR after 5-7 days of treatment especially if with fever, chest pain and pleurisy

MONITORING RESPONSE TO THERAPY Prognosis is good and special monitoring or referral for specialty care is not required

REFERENCES Philhealth HTA Committee, Proceedings Workshop on the Critical Appraisal of Clinical Practice Guidelines and Development of Policy Statements. Sept 19-21, 2005 Light, Mathay, Mathay; Chest Medicine, 1995