CHEST Guidelines-Acute Cough Due to Acute Bronchitis in Immunocompetent Adult Outpatients

Acute Cough Due to Acute Bronchitis in Immunocompetent Adult Outpatients

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The CHEST Expert Cough Panel released updated guidelines for the diagnosis and management of acute cough due to acute bronchitis in immunocompetent adult outpatients. This updates the 2006 guidelines, focusing on whether additional investigations or medications improve outcomes. The panel defined acute bronchitis as an acute lower respiratory infection characterized by cough, lasting no more than three weeks, without alternative clinical or radiographic explanations.<br /><br />The systematic review addressed two questions: the necessity of investigations beyond clinical assessment, and the efficacy and safety of medications for cough relief. No studies met criteria for the first question regarding additional investigations. Only one study was relevant for the second question, comparing antibiotics, NSAIDs, and placebo for cough relief, finding no significant differences in cough duration.<br /><br />The panel advises against routine investigations like chest X-rays or laboratory tests and prescribing medications for acute bronchitis unless persistence or worsening of symptoms occurs, in which case reassessment and targeted investigations are suggested. Antibiotics should only be considered if a bacterial infection is likely.<br /><br />This guidance emphasizes a conservative approach, which limits unnecessary treatments and investigations unless necessary. Future research should focus on randomized controlled trials to better understand the efficacy of treatment options and further refine guidelines for patient care. The recommendations highlight the importance of antimicrobial stewardship and tailoring patient management based on clinical evaluation rather than routine testing and medication.

Keywords

acute cough

acute bronchitis

immunocompetent adults

diagnosis guidelines

management guidelines

systematic review

antibiotics

NSAIDs

antimicrobial stewardship

patient care