Snapshot A 23-year-old-male presents with a one week history of cough productive of whitish sputum. This was preceded one week prior by an URI. He denies chills, night sweats, shortness of breath or wheeze. Temperature is 99.9°F (37.7°C). Introduction Acute inflammation of the tracheobronchial tree generally self-limited and with eventual complete healing and return of function Acute infectious bronchitis most prevalent in winter and is generally part of an acute URI viruses that cause acute bronchitis include: adenovirus coronavirus influenza A and B viruses parainfluenza virus respiratory syncytial virus coxsackievirus A21 rhinovirus viruses that cause rubella and measles Mycoplasma pneumoniae, Bordetella pertussis, and Chlamydia pneumoniae also cause acute infectious bronchitis, often in young adults Malnutrition and exposure to air pollutants are predisposing or contributory factors Acute irritative bronchitis may be caused by: various mineral and vegetable dusts fumes from strong acids tobacco or other smoke. Cough-variant asthma/bronchitis degree of bronchoconstriction is not sufficient to produce overt wheezing may be caused by allergen inhalation in an atopic person management is similar to that of ordinary asthma Presentation Onset of a distressing cough usually signals onset of bronchitis. Cough features initially dry and nonproductive small amounts of viscid sputum are raised after a few hours or days sputum may be more abundant and mucoid or mucopurulent Symptoms of an upper respiratory infection Coryza, malaise, chilliness, slight fever, back and muscle pain, sore throat Frankly purulent sputum suggests superimposed bacterial infection Persistent fever suggests complicating pneumonia Evaluation Diagnosis is usually based on the symptoms and signs Chest radiograph to rule out other diseases or complications indicated if symptoms are severe or prolonged Gram stain and sputum culture should be performed to determine the causative organism in patients who do not respond to antibiotics or who have special clinical circumstances Treatment Rest until fever subsides Oral fluids (up to 3 or 4 L/day) are urged during the febrile course An antipyretic analgesic relieves malaise and reduces fever Antibiotics are indicated when there is concomitant COPD purulent sputum is present high fever persists and the patient is more than mildly ill High Yield Presentation patient with persistent cough > 5 days following an URTI with mild or no fever or constitutional symptoms Management initial test:do a radiograph to exclude pneumonia if: fever >100.4°F(38°C) signs of consolidation on exam definite therapy:rehydration and antipyretics