1. ACUTE BRONCHITIS CLINICAL PATHWAY

2. 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

3. HOSPITAL ADMISSION
Confinement is not usually needed

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

5. 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

6. 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.

7. 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

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

9. 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