Does acute bronchitis really exist? A reconceptualization of acute viral respiratory infections.
BACKGROUND
Considerable overlap exists in patient presentations and physical findings in viral upper respiratory tract infections (URIs) and acute bronchitis. Our goal was to determine whether there are any clinical cues that could help physicians differentiate between these 2 conditions.


METHODS
We performed a retrospective chart audit on 135 patients who had been given a diagnosis of acute bronchitis and a random sample of 409 patients with URIs over a 2.5-year period. Patient and provider characteristics, patient symptoms, and physical findings were compared with bivariate analyses and then entered into a logistic regression model.


RESULTS
In bivariate analyses, a number of demographic variables, symptoms, and signs were associated with acute bronchitis. Multivariate analysis showed that the strongest independent predictors of acute bronchitis were cough (adjusted odds ratio [AOR]=21.12; 95% confidence interval [CI], 6.01-74.26), and wheezing on examination (AOR=12.16; 95% CI, 5.39-27.42). Nausea was the strongest independent predictor that the diagnosis would not be acute bronchitis (AOR=0.01; 95% CI, 0.01-0.85). However, there was considerable overlap between the 2 conditions, and the logistic model explained only 37% of the variation between the diagnoses.


CONCLUSIONS
We hypothesize that sinusitis, URI, and acute bronchitis are all variations of the same clinical condition (acute respiratory infection) and should be conceptualized as a single clinical entity, with primary symptoms related to different anatomic areas rather than as different conditions.
Hueston
W J
WJ
Department of Family Medicine, Medical University of South Carolina, Charleston 29425, USA. huestowj@musc.edu
Mainous
A G
AG
Dacus
E N
EN
Hopper
J E
JE
D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001991:Bronchitis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D001993:Bronchodilator Agents / Q000627:therapeutic use; D003139:Common Cold / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D012141:Respiratory Tract Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D012189:Retrospective Studies; D013022:South Carolina; D014777:Virus Diseases / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy
D000900:Anti-Bacterial Agents; D001993:Bronchodilator Agents