CHEST Guidelines-Acute-Cough-Due-to-Acute-Bronchitis-in-Immunocompe

Acute-Cough-Due-to-Acute-Bronchitis-in-Immunocompe

Pdf Summary

The report by the CHEST Expert Cough Panel addresses the diagnosis and management of acute cough due to acute bronchitis in immunocompetent adult outpatients. The update revisits the American College of Chest Physicians (ACCP) guidelines from 2006 by examining contemporary evidence concerning diagnostic and treatment strategies.<br /><br />Acute bronchitis is characterized as an acute lower respiratory tract infection lasting no more than three weeks, marked mainly by a cough, with no evidence of other possible causes. Systematic reviews were conducted to explore specific questions: first, the utility of diagnostic tests like chest x-rays and second, the efficacy and safety of various medications in managing bronchitis-related cough.<br /><br />In terms of diagnostics, no studies were found that suggested added predictive value by using routine tests (like chest x-rays) beyond a clinical assessment to rule out conditions such as pneumonia or asthma. Furthermore, there was only one relevant study regarding treatment, which concluded that neither antibiotics nor NSAIDs reduced the duration of cough compared to a placebo.<br /><br />Based on these findings, the expert panel offers several key suggestions:<br />1. Avoid routine investigations for immunocompetent adult outpatients with suspected acute bronchitis.<br />2. If symptoms persist or worsen, consider reassessment and targeted investigations such as chest x-rays.<br />3. Refrain from routine prescriptions of antibiotics or other therapies unless their efficacy and safety are proven.<br />4. In cases where bronchitis worsens, antibiotics may be considered if a bacterial infection is suspected.<br /><br />The report highlights a need for more rigorous randomized controlled trials to explore the effectiveness of both diagnostic tests and treatments for acute bronchitis. It concludes with a call for careful clinical evaluation, emphasizing antimicrobial stewardship and highlighting gaps in current knowledge that future research should address.

Keywords

acute bronchitis

immunocompetent adults

diagnosis

management

acute cough

antibiotics

NSAIDs

chest x-rays

antimicrobial stewardship

randomized controlled trials