MDM - Acute Bronchitis

[##]-year-old [male/female] with history and exam consistent with acute bronchitis of likely [viral/bacterial] etiology.

Initial consideration in this patient included bronchitis, pneumonia, influenza, allergic rhinitis, upper respiratory infections (URI), pulmonary embolism (PE), and reactive airway diseases (asthma, chronic bronchitis) among others. 

Patient presented with cough [productive of sputum] and [reported/evidence of] wheezing consistent with bronchitis.  Patient’s lung sounds were [notable for expiratory wheezing/noted to be normal].  Patient noted to [have/have no] evidence of fever or other systemic infectious symptoms.  A chest x-ray [was/was not] obtained [and noted to have no evidence of consolidations suggestive of pneumonia or other acute abnormality/due to absence of abnormal lung sounds or other evidence suggestive of pneumonia or other acute intrathoracic pathology].  The patient [reported/denied] a history of obstructive lung disease (asthma or COPD).  Patient [reported/denied] a history of tobacco use [and we discussed smoking cessation prior to discharge with the patient noted to be pre-contemplative/contemplative/expressing desire to quit at this time].  Patient noted to have [mild/some/significant] improvement after treatment with [specify] in the ED prior to discharge.

We discussed return precautions, specifically for evidence of worsening difficulty breathing, treatment with [bronchodilators/steroids], and follow up with primary care doctor within [2-3 days/1 week] for further evaluation, and the patient demonstrated understanding and agreement with this plan.

Discharge instructions - Bronchitis

As discussed in the Emergency Department prior to discharge, you have been diagnosed with bronchitis.  Bronchitis is an infection that causes a cough.  It happens when the tubes that carry air into the lungs, called the "bronchi," get infected.  Usually, bronchitis happens after a person gets a cold or the flu.  The viruses that cause the cold or flu infect the bronchi and irritate them.

People often wonder if taking antibiotics will help with their bronchitis.  But the answer is no, because it is usually caused by a virus.  Antibiotics kill bacteria, not viruses.

Bronchitis can also happen when a person gets an infection called "whooping cough," but this is much less common.  Whooping cough is caused by bacteria that can infect the bronchi.  Most people get vaccines that prevent whooping cough, but the vaccine doesn't always work.  Your doctor will be able to tell if you have whooping cough by doing an exam and listening to way your cough sounds.

The most common symptoms of bronchitis are a nagging cough that can last up to a few weeks, coughing up mucus that is clear, yellow, or green, and normal cold or flu symptoms, like a stuffy nose, sore throat, or headache.  People with bronchitis do not usually get a fever.

Bronchitis almost always goes away on its own, although it can take a few weeks.  To feel better, you can treat your cold and flu symptoms.  Different treatments you can try include getting lots of rest and drinking plenty of liquids, drinking hot tea, sucking on cough drops or hard candy, taking over-the-counter cough and cold medicines, breathing in warm, moist air, such as in the shower, over a kettle, or from a humidifier, and taking a pain-relieving medicine if you have cold or flu symptoms like headache, muscle aches, or joint pain.

You may also have been prescribed an inhaler containing a medication called Albuterol.  To use the inhaler, breathe out, put your lips on the inhaler and then breathe in gradually and fully as you press the button on the inhaler.

It's also important to avoid smoking or being around others who smoke. This can make your cough worse.

Return to the Emergency Department for difficulty breathing, persistent or worsening wheezing or cough, new or worsening fever (≥38.0 °C or 100.4 °F), worsening chest tightness, or any new or concerning symptoms.