Does acute bronchitis really exist?

This new model of conceptualizing respiratory infections implies that assigning an anatomic-specific diagnosis to the condition is irrelevant beyond being a determinant for which symptomatic care should be the highest priority (eg, decongestants for predominantly sinus symptoms or bronchodilators for wheezing or rhonchi). Also, although acute respiratory infection is a very common reason for visits to primary care physicians, only some patients consult a clinician for their problem. Care-seeking for acute respiratory infection is likely determined by a combination of forces that include severity of the infection (patients with more severe viral illnesses would be more likely to seek care), anatomic localization (infections with more specifically localized symptoms would be more likely to seek care), and personal psychosocial issues (including the perceived importance of existing or possible disruption of daily activities, personal coping skills and resources, and the need for empathy and affirmation from someone else that they are sick). Rather than focusing research in this area on identifying how certain subsets of patients with what is predominantly a viral illness respond to antibiotics that do not treat what they have, future research in acute respiratory infections might be better directed at why some patients seek care or self-medicate inappropriately²⁴ and how clinicians can best serve this population.

Conclusions

Our study shows a great deal of overlap in the signs and symptoms of acute bronchitis and URIs. Very little of the variation in the diagnoses could be explained by clinical factors. These results are similar to earlier work suggesting considerable clinical overlap in sinusitis. This leads us to hypothesize that these conditions all represent the same clinical entity and that a reconceptualization of acute viral respiratory infections as a single problem, rather than anatomically distinct disorders, is warranted.