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Mar 23

Acute Bronchitis

Happy Monday, and welcome to Medical Mondays! This topic was actually fairly unplanned and will be less “technical” today, but we’re gonna go with it because…I think it’s what I’ve been trying to battle out for the past several weeks!

As some of you might know, I’ve had a pretty terrible cough since the end of my peds rotation. Initially, I thought it was a parting gift of RSV from one of the kids or that my body was doing a protest on psych, but it’s been lasting way too long for that. ._. (It’s actually past the norm even for acute bronchitis, but there really isn’t much else in my differential.)

On the plus side, I’m not coughing up blood, and I’m not really coughing to the point of retching throughout the night, so…at least there’s that?! I’d like to believe I’m on the mend, although I’d really love it if I could recover before my voice gets ruined forever. I miss being able to sing, and I’m worried that my patients think I’m contagious and/or dying, but enough about me, let’s talk about…

Acute Bronchitis

armedwithcoughmeds

I’ve since added guaifenesin (Mucinex) to the mess.

 

Cough is the most common symptom that brings a patient to the primary care physician’s office, and acute bronchitis tends to be the diagnosis. Symptoms usually last 2-3 weeks.

The most common infectious etiologies of acute bronchitis are listed below:

  • Adenovirus
  • Coronavirus
  • Influenza A + B
  • Metapneumovirus
  • Parainfluenza virus
  • Respiratory syncytial virus
  • Rhinovirus
  • Bordetella pertussis
  • Chlamydia pneumonia
  • Mycoplasma pneumonia

Please note that all but the last three in that are viruses. Viruses are responsible for over 90% of acute bronchitis infections, so antibiotics are generally not indicated for the treatment of bronchitis, unless pertussis is suspected, or if the patient is at increased risk of developing pneumonia.

Despite the fact that 90% of bronchitis infections are caused by viruses, ~2/3 patients are treated with antibiotics.

(Warning: This is where I get on one of my soapboxes.)

I’ve seen this happen in many a clinic/hospital and each time, I’ve asked my preceptors about antibiotic resistance, and whether or not the antibiotic is really necessary if the cause is usually viral.

The answer I always get is…no, the antibiotic is not necessary, and “once upon a time, they were young and stupid” and tried to explain that the antibiotic wouldn’t help because it was a viral infection…but patients have come to expect that prescription, so complaints increase, patient satisfaction rates decrease, and they get reprimanded by the hospital for said decrease in satisfaction rates.

My family med preceptor went with the delayed “pocket” prescription/”wait-and-see” prescription, where she’d put an order in and ask her patients to fill the prescription only if they felt that they really needed it after a couple days (if it was a URI) or a couple weeks (if it was likely to be acute bronchitis).

Because I am still young and stupid idealistic in my ways, and for the greater good of us all, however, I’d like to share the following:

  • Symptom duration for acute bronchitis tends to be about 3 weeks.
  • Antibiotics do not significantly reduce the duration of symptoms, and may cause adverse effects + lead to antibiotic resistance.
  • Antibiotics are used to treat bacteria, not viruses.

Depending on the severity, symptomatic treatment options include:

  • Antitussives (e.g. dextromethorphan, codeine, hydrocodone) in patients > 6yo
  • Beta-agonist inhalers in patients with wheezing
  • High-dose episodic inhaled corticosteroids
  • Echinacea or pelargonium (few studies have shown a modest positive effect)
  • Dark honey in children

Avoid using:

  • Routine use of antibiotics
  • Expectorants (commonly used/suggested by physicians, although they’ve been shown to be ineffective)
  • Beta-agonist inhalers in patients without wheezing
  • Antitussives in children < 6yo

Medical Mondays
Disclaimer: The information in this post was gleaned from an AAFP article on the diagnosis + treatment of acute bronchitis, UpToDate, and other med school resources. This is where I reiterate that I am merely a medical student struggling through the world that is her clinical rotations. The statements made on this blog should not be taken as medical advice to treat, cure or prevent any disease. Please contact your own physician or health care provider before starting a health or fitness/wellness program. (See full disclaimer here.)

Permanent link to this article: http://www.fairyburger.com/acute-bronchitis/

71 comments

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  1. Kaylin @ Enticing Healthy Eating

    I applaud you for pointing out something that we, as consumers, should watch out for when it comes to prescribed pills from doctors and whether or not they are really worth it. I try to go as long as I can without getting a prescription (natural is the way to go for me!). I really wish more doctors were like you, by the way, Farrah!
    Kaylin @ Enticing Healthy Eating recently posted…Gone, but not ForgottenMy Profile

    1. Farrah

      Pretty much all medications have some sort of potential side effect, so unless I really do need it, I like to avoid using it, hehe.

      Thanks so much, Kaylin! I hope I will be awesome in the future! :D!!

  2. Channing

    I’ve had some doctors in the past perscribe me antibiotics like they were candy. I’ve always been hesitant when it comes to taking them because I’ve heard they could cause resistance.
    Channing recently posted…Vet visit FROM HELL!My Profile

    1. Farrah

      When used unnecessarily, it does contribute to causing resistance, and there haven’t been any new antibiotics made in a while, so I avoid using them too when I don’t feel that they’re necessary!

  3. Annmarie

    BOOO to bronchitis! I try not to use antibiotics unless I really really need them. My hubby was seriously ill several years ago and was on antibiotics for over 6 months including IV antibiotics and it messed him up! So scary!
    Annmarie recently posted…About Time Silver Dollar Chocolate Chip Protein PancakesMy Profile

    1. Farrah

      Aww, I’m so sorry your husband was so sick! I don’t know the whole story, but there are definitely cases where antibiotics are definitely indicated. I really hope he’s okay now!!

  4. Jess @hellotofit

    Thanks for touching on the correct use for antibiotics! Do you think as a whole, doctors are getting better about not prescribing antibiotics for every little thing?
    Jess @hellotofit recently posted…Monday motivation – your running startMy Profile

    1. Farrah

      Hard to say! :/ I think it’s really dependent on the physician (and also the patient population). Some have given up the fight, and others just have very awesomely compliant patients who actually listen (yay!). I’m going to be super-idealistic and hope that if I build super-awesome rapport with my patients, they’ll listen to me. <3

  5. Nicole

    I’ve been battling a terrible cough and congestion for about a week but I’m hopeful I’m hearing into the home stretch and getting better!
    Nicole recently posted…Coca-Cola NCAA® Final Four CupcakesMy Profile

    1. Farrah

      I hope you’re heading into that home stretch as well + that you feel better soon! <3

  6. Susie @ SuzLyfe

    Please don’t die….
    Susie @ SuzLyfe recently posted…Taking Life Back and Chicago Good Food FestivalMy Profile

    1. Farrah

      I’ll try not to! I’m virtually symptomless aside from the cough!

  7. Courtney @ Eat Pray Run DC

    interesting. Hope you feel better soon.
    Courtney @ Eat Pray Run DC recently posted…Cherry Blossom Ten Miler Training Recap Week 3My Profile

    1. Farrah

      Thank you! I hope so too!

  8. Leslie

    Interesting! Your picture looks like what I picked up yesterday. I’m battling this horrible cold & yesterday I started coughing so hopefully it’s breaking up. I hope you feel better! I don’t like taking meds when I think they won’t work, this kind of thing doesn’t surprise me. What a great post!
    Leslie recently posted…What Do I Do?My Profile

    1. Farrah

      Thank you! I hope you feel better too! I feel ya on the cough, but hopefully we’re both on the mend! Hooray for not having to spend extra money on unnecessary meds? 😛 (At least the cough drops are kinda like candy!)

  9. jess meddows

    Gosh it sounds like you’ve been through the wars, Farrah. I really hope your bronchitis clears up soon, and that your psych rotation is soon a distant memory – hahaha. 😉

    For some reason trying to explain antibiotics don’t work for viruses always reminds me of my old bosses in law firms. They’d all say “did you get medicine for that?” and I’d try to explain viruses didn’t work that way. It was like they thought antibiotics would have me back in the office quicker, no matter what the cause was!
    jess meddows recently posted…uTalk iPhone and iPad Application – Learn 113 Languages!My Profile

    1. Farrah

      Thank you! I really hope so too!

      Psych is still driving me nuts even though the rotation is (thankfully) long over. I just got my grades back and I am absolutely furious over them. ._.

      It’s definitely a problem! They probably just didn’t want you to take too many sick days and found another way to work that in without actually saying it(?). (Sigh.) Hopefully more people will start to understand though!

  10. Julie @ Running in a Skirt

    Oh no!!! Bronchitis was the vein of my existence for a few years there. That is what started all of my voice issues. Hope you are on the mends soon.
    Julie @ Running in a Skirt recently posted…Easter Decorations & TablescapeMy Profile

    1. Farrah

      Nooo! I’m so sorry! I’m really scared that it’s gonna ruin my voice. :[[ I want to still be able to sing!

  11. Deborah @ Confessions of a Mother Runner

    My dad (retired MD) has been talking about this for years. Antibiotics are def over used. Nice post
    Deborah @ Confessions of a Mother Runner recently posted…Smokey Mac n Cheese Stuffed Peppers w BBQ TofuMy Profile

    1. Farrah

      Thank you! It’s unfortunately still a huge problem! :[

  12. Elle

    I have been treated with antibiotics and not, for seemingly similar conditions in the past. It depends on the doctor, in my opinon. Good to be armed with some information for ourselves for sure.
    Elle recently posted…Spring it On!My Profile

    1. Farrah

      I think there’s definitely a time and a place for it, but for common colds and bronchitis (with no suspicion for pertussis) in an otherwise healthy person, there’s no reason for it!

  13. Gloria

    Thank you for sharing this! I fully approve of you getting on a soapbox – I think in most industries there is this mentality that the customer is always right and at least half of the time, that simply is not true. I just don’t understand why the hospital would be upset with doctors for not prescribing something that isn’t needed! Happy Monday, Farrah!
    Gloria recently posted…Jazzercise College Area ReviewMy Profile

    1. Farrah

      Happy Monday to you as well! <3 I have a lot of soapboxes that I think I'll be getting on this year, haha. I think the basis behind is is that if patient satisfaction rates are down, hospital revenue also decreases, so they've taken to deducting a portion of physician salaries too based on said satisfaction rates. I'm all for helping out patients when possible, but feel that that is an extremely misguided concept when it comes to drug seekers. :[

  14. Sandra Laflamme

    I hate taking antibiotics and am glad doctors are limiting their use. I have several antibiotic allergies and don’t want the same thing to happen to my kids. Bronchitis is the worst. Hope you feel better soon!
    Sandra Laflamme recently posted…Let’s Lift Each Other Up. Ten tips for supporting each other.My Profile

    1. Farrah

      Thank you; I really hope so too! Here’s to hoping that trend continues, because there hasn’t been a new antibiotic developed in quite some time! :[

  15. Nicole @ Fitful Focus

    Great info here! When I was studying abroad in London, I got a terrible ear infection. I went to a clinic expecting to just get an antibiotic, but when I walked in there were signs all over the waiting room about how antibiotics are bad and we shouldn’t use them. I thought I’d be screwed for medication, but they ended up giving me some ear drops that did the trick. I am definitely not against antibiotics, but agree they are over used and prescribed. If we use them too often, our bodies will build up a tolerance and they’ll become useless.

    1. Farrah

      I’m definitely not against them either; there’s a time and a place for them, but with lots of illnesses (e.g. upper respiratory infection/common cold, bronchitis if there’s no suspicion for pertussis), it just isn’t the answer! I worry sometimes about the supersuperbug all this unnecessary antibiotic use is creating. :[

  16. Margo

    So sorry you are sick! I try to avoid antibiotics unless absolutely necessary. I hope you feel better soon!
    Margo recently posted…Brooklyn Fit Chick News & Notes: SCUBA Dive Tips, The Amazing Ashley Judd, “Bricolage” in Brooklyn & More!My Profile

    1. Farrah

      Thank you! I hope so too! I’m so sick of this cough! :[

  17. Ange @ Cowgirl Runs

    The only time I get frustrated about not receiving antibiotics is when I have a virual sore throat. But that’s only because I’m the queen of strep so I usually hope it is strep since it goes away quick than the viral infection.
    Ange @ Cowgirl Runs recently posted…Marathon Monday 3/23 & Run L’Arche Half Marathon RecapMy Profile

    1. Farrah

      Aww, I’m sorry about the strep! But yeah, I can definitely understand how it’d be so much more satisfying to just be able to take care of an illness/feel better with medication vs. just to ride it out!

  18. Sam @ PancakeWarriors

    This is such an interesting article. And it’s why I don’t go to the doctor unless I’m dying LOL. I don’t think that antibiotics are the answer, and I like to give my body the chance to work through the sickness on it’s own before I ever get meds. I do however think that most people think they need to leave the doctor with a prescription and it should be antibiotics. This is so sad for me. I’m so sorry you have to deal with this craziness, but I do think that most people would complain if you didn’t send them home with a script (unfortunately).
    Sam @ PancakeWarriors recently posted…Balsamic Eggplant SteaksMy Profile

    1. Farrah

      haha, same here! (Or unless it’s my annual physical, haha.) I’ve been giving my immune system all the chances in the world to fight this thing, but it’s taking its sweet time! I guess it doesn’t help that I hang out in a hospital all day, haha.

      They really do! :[ It’s hard to argue with some of them, because they refuse to believe that taking a medication is not always the answer–maybe it has to do with the fact that they have this thought that if they go to their doctor, it’s his/her job to “fix” their illness? :/ I really don’t know!

  19. Shashi at RunninSrilankan

    Farrah – awesome post! I am with you – unless something is totally necessary and there is no other alternate then meds would be ok – but, not otherwise. My 16 yr old daughter has been having headaches recently and I took her in to get her checked out – doc had an xray of her neck done and when everything looked good, she said the headaches sounded like tension headaches and pulled out her prescription booklet to write my daughter a prescription painkiller for her headaches – of course, I graciously said no – but I couldn’t believe how easily and quickly the doc was willing to dole out prescription meds!!!

    1. Farrah

      There are definitely some physicians out there that are super prescription-happy. I had a preceptor who had a bunch of patients who came to him after their physician passed away, and every single one of them (regardless of age, gender, medical illnesses) was on some kind of a prescription painkiller. :[ I think more recently, they’ve gotten way stricter about it, but it’s still a huge problem! :[

  20. Kristy @Runaway Bridal Planner

    I am so glad you pointed out the difference here!
    So I have bad lungs, ever since I was a child I had a really bad hospitalized case of Pneumonia that hurt my lungs and for some reason ever since if I get sick there is a great chance my common cold if not taken care of will go to my lungs and I get Bronchitis or bronchial (I am sure I spelled that wrong) Pneumonia.
    I never take anti-biotics for it, I just let it run it’s course 2-4 weeks whatever it takes. (Unless it turns into Peumonia) But I work with so many people that get bronchitis, and pretty much make their Dr’s give them anti-biotics which I tell them is pointless, but they never listen.
    Sometimes I don’t know what is more annoying a Dr who just gives it to them to shut them up, or the patient who refuses to realize that anti-biotics won’t cure all.
    Great post!!!
    Kristy @Runaway Bridal Planner recently posted…Current Events and Random FactsMy Profile

    1. Farrah

      Aww, I’m sorry about your lungs! :[ That definitely doesn’t sound fun as all, but good on you for not trying to get antibiotics for it every time! I guess I’m somewhat biased on the doctor’s side because I’ve seen so many continue to try (to no avail) to convince some of their patients that antibiotics really aren’t the answer, but it falls to deaf ears, and their patients just keep complaining to them about the same thing. :[ My favorite is when they regularly smoke like chimneys and blame their inability to recover on the fact that they don’t have antibiotics. :[

  21. AJ @ NutriFitMama

    We try to avoid any medicines if we can, and only use if necessary. Unfortunately I feel we have used way too many this year because someone was CONSTANTLY sick (and not with viral stuff either! :/ )- I think it’s great that you are pointing this out, because you are right, so many people have come to expect that prescription.
    AJ @ NutriFitMama recently posted…Chattanooga Raccoon Mountain Half Marathon | A MUST DO race in TNMy Profile

    1. Farrah

      Aww, darn! I hope everyone feels/gets better soon! Being sick definitely isn’t fun. :[

      The expectation is what does us in! I think part of why they feel better is really just the placebo effect!

  22. Alanna

    Very useful information! Antibiotic resistance always worries me and I agree that it should only be used if completely necessary. Feel better soon :) Thanks for the info and happy Monday!!
    Alanna recently posted…Sweet Potato Energy BitesMy Profile

    1. Farrah

      Happy Monday to you as well, and thank you! I hope my immune system decides to finally kick in soon. >_> I like avoiding the use of medications unless it’s absolutely necessary, hehe.

  23. Ivanna

    Farrah, what a great series. I am looking forward to seeing more of these posts. I am always looking up medical advice online before I take a medicine or anything like that. I was give antibiotics recently for cystic acne however I haven’t taken them yet. I’m trying the holistic route first as I always do. Thanks for sharing this.

  24. Ivanna

    Farrah, what a great series. I am looking forward to seeing more of these posts. I am always looking up medical advice online before I take a medicine or anything like that. I was give antibiotics recently for cystic acne however I haven’t taken them yet. I’m trying the holistic route first as I always do. Thanks for sharing this.
    Ivanna recently posted…Managing Anxiety and Panic (Techniques)My Profile

    1. Farrah

      Thanks, Ivanna! I’ll keep trying to come up with useful topics! :]

      I haven’t learned too much in the realms of dermatology, so I did a superrrr arbitrary search for holistic methods to treat cystic acne, and there’s been some anecdotal evidence supporting apple cider vinegar and/or turmeric!

  25. MCM Mama

    Great information! We avoid antibiotics as much as possible. I can’t remember the last time anyone here had one… Strep is our most frequent bacterial caller here, sigh.

    My grandfather used to totally abuse antibiotics (by saving drugs when symptoms were gone) and I’ve long wondered if that is why his lungs never truly healed.
    MCM Mama recently posted…Beer, cello, and runningMy Profile

    1. Farrah

      Aww, I had strep throat when I was around 8 and they gave me a course of amoxicillin that I absolutely detested. I pretended to take it and would go to the bathroom and spit it out. My mom eventually caught on and made me sit there and swallow it…and then I got hives. I guess little-me had some inkling of an idea that I was allergic! :O

      Aww, I’m really sorry to hear that. :[ That’s definitely another thing I need to write about–if a course of antibiotics really is needed, they gotta finish them even if the symptoms seem to have disappeared!

  26. Rebecca @ Strength and Sunshine

    Great info! I hope you feel better darling!
    Rebecca @ Strength and Sunshine recently posted…Recipe ReDux #17 Garlic Kale HummusMy Profile

    1. Farrah

      Thank you! I thought it was getting better, but had to excuse myself from a patient room today because that incessant tickle in my throat would not leave. ;_; Somedayy….

  27. Wendy@Taking the Long Way Home

    If I could hug you for this post, I would! Thank you! I’m a pediatric nurse practitioner, and I see kids with coughs all day long. I know they’re annoying but antibiotics are not the answer! Too bad so many providers give them to patients…so many people have an expectation that they need them. “It’s time for antibiotics” is the line I hear in my job. Nope, honey is just as effective as anything else…
    Wendy@Taking the Long Way Home recently posted…Recovery is a many splendored thing…My Profile

    1. Farrah

      Aww, thank you, Wendy! <3 I think this problem is especially bad in pediatric offices, because the parents just want something that will get their kids feeling better quick! I can understand the thought process behind that and I know they hate hearing that you just have to wait it out, but...it's the truth! ;_; Honey is wonderful. <3

  28. Kathryn @ Dancing to Running

    I try to go as long as I can without resorting to medicine. My mom, who is a nurse, has witnessed far too many people being overly medicated. Medicine comes with its own set of side effects, and sometimes its better to just ride out whatever has made you sick.
    Kathryn @ Dancing to Running recently posted…Shamrock Half Marathon Training Log – Week 18My Profile

    1. Farrah

      My mom’s a nurse too! She actually told me to go get antibiotics (sigh), but I think she was just worried about me and being a mom.

  29. Katie @ Huff 'n Puff to Buff 'n Tough

    This article makes me think back to a few months ago when my little girl caught a form of this :( She was only 4 months at the time. Feel better girly!!
    Katie @ Huff ‘n Puff to Buff ‘n Tough recently posted…First 5K of the Year: Green Beer 5K 2015 Race RecapMy Profile

    1. Farrah

      Aww, I’m so sorry to hear that! :[[ I hope she’s feeling better!! (+ thank you! I hope to soon! :)

  30. Melanie

    Interesting info! I often wonder why antibiotics are prescribed for viruses. It always makes me leery to take unnecessary meds.
    Melanie recently posted…Weekly RundownMy Profile

    1. Farrah

      I think it’s a combination of doctors who just…prescribe it for the sake of prescribing a medication, or patients who insist on getting meds. :[ I don’t like taking unnecessary meds either!

  31. Patty @ Reach Your Peak

    Great post! Very informative. Most of my family lives in Paraguay, and in Paraguay they use antibiotics for everything…so bad! My mom and I have tried telling our family members to stop but idk, that’s the culture there I guess. Sigh.
    Patty @ Reach Your Peak recently posted…Questions About Training For a PRMy Profile

    1. Farrah

      Sometimes, it really feels like that’s the case here too! :[ Hopefully it’ll start to change!

  32. jill conyers

    Great information Farrah. Fingers crossed I can’t remember the last time I had to take antibiotics. Its been years.
    jill conyers recently posted…Quick and Easy Spring Veggie BowlMy Profile

    1. Farrah

      Thanks! I will keep my fingers crossed that you will continue to not need it! :]!

  33. Stephanie

    Such good info. Thank you for offering a real opinion and info in an age when many medical professionals can’t be bothered.
    Stephanie recently posted…Mayhem Monday: Pass the CoffeeMy Profile

    1. Farrah

      Thanks, Stephanie! That makes me so sad to hear that lots of medical professionals can’t be bothered to offer this information! :[

  34. Coco (@Got2Run4Me)

    since the placebo effect is real, there should be a way to write prescriptions for a placebo when you don’t think antibiotics are needed, but the patient wants them!
    Coco (@Got2Run4Me) recently posted…The Bicycling Big Book Of TrainingMy Profile

    1. Farrah

      Oh, if only! :[ I think it’d fall under that grey area of possibly-unethical practices though since we have to inform the patient of what we’re doing; this would probably give em’ more fuel for the fire if they wanted to sue. ._.

  35. Carmy

    I had a doc who used to give me anti botics all the time but NEVER explained to my mom that I had to finish every round no matter what. After learning about how the terrible it is, you can bet I stopped going to him.
    Carmy recently posted…Monday on the Run #19My Profile

    1. Farrah

      That’s horrible! :[ That makes me so sad to hear that. :[ I’m hoping that I’ll be awesome at promoting patient education in the future–it’s so important to explain what we’re doing + why!

  36. Sonali- The Foodie Physician

    I couldn’t have said it better! Working in the ER, especially during Urgent Care shifts, I see so many pt’s with coughs/URIs that expect/request abx. I’ve probably had the “it’s a virus” conversation a thousand times by now, but it really is all about pt education and not just handing out abx because it can be the path of least resistance.
    Sonali- The Foodie Physician recently posted…Dining with the Doc: Protein-Packed Vegetarian Burrito BowlsMy Profile

    1. Farrah

      Ohhhh man, I can definitely see how it gets like that in urgent care! ._. I’m hoping I won’t cave when I’m out in practice! Stay strong! <3

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