Acute Cough Due to Acute Bronchitis in Immunocompetent Adult Outpatients CHEST Expert Panel Report Maeve P. Smith, MD; Mark Lown, PhD; Sonal Singh, MD; Belinda Ireland, MD; Adam T. Hill, MD; Jeffrey A. Linder, MD, MPH; and Richard S. Irwin, MD; on behalf of the CHEST Expert Cough Panel * BACKGROUND: Evidence for the diagnosis and management of cough due to acute bronchitis in immunocompetent adult outpatients was reviewed as an update to the 2006 “Chronic Cough Due to Acute Bronchitis: American College of Chest Physicians (ACCP) Evidence- Based Clinical Practice Guidelines.” METHODS: Acute bronchitis was defined as an acute lower respiratory tract infection man- ifested predominantly by cough with or without sputum production, lasting no more than 3 weeks with no clinical or any recent radiographic evidence to suggest an alternative explanation. Two clinical population, intervention, comparison, outcome questions were addressed by systematic review in July 2017: (1) the role of investigations beyond the clinical assessment of patients presenting with suspected acute bronchitis, and (2) the efficacy and safety of pre- scribing medication for cough in acute bronchitis. An updated search was undertaken in May 2018. RESULTS: No eligible studies relevant to the first question were identified. For the second question, only one relevant study met eligibility criteria. This study found no difference in number of days with cough between patients treated with an antibiotic or an oral nonsteroidal antiinflammatory agent compared with placebo. Clinical suggestions and research recom- mendations were made based on the consensus opinion of the CHEST Expert Cough Panel. CONCLUSIONS: The panelists suggested that no routine investigations be ordered and no routine medications be prescribed in immunocompetent adult outpatients first presenting with cough due to suspected acute bronchitis, until such investigations and treatments have been shown to be safe and effective at making cough less severe or resolve sooner. If the cough due to suspected acute bronchitis persists or worsens, a reassessment and consider- ation of targeted investigations should be considered. CHEST 2020; 157(5):1256-1265 KEY WORDS: bronchitis; cough; guidelines; infection ABBREVIATIONS: CRP = C-reactive protein; NSAID = nonsteroidal antiinflammatory drug; PCR = polymerase chain reaction; PICO = population, intervention, comparison, outcome AFFILIATIONS: From the Division of Pulmonary Medicine (Dr Smith), University of Alberta, Edmonton, AB, Canada; Primary Care and Population Science (Dr Lown), University of Southampton, Southampton, England; the UMass Medical School (Dr Singh), Family Medicine & Community Health & Meyers Primary Care Institute, Worcester, MA; TheEvidenceDoc (Dr Ireland), Pacific, MO; the Department of Respiratory Medicine (Dr Hill), Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, Scotland; the Division of General Internal Medicine and Geriatrics (Dr Linder), Northwestern University Feinberg School of Medicine, Chicago, IL; and the UMass Memorial Medical Center (Dr Irwin), Worcester, MA. FUNDING/SUPPORT: Dr Linder is supported by grants from the Na- tional Institute on Aging [R21AG057400, R21AG057396, R33AG057383], National Institute on Drug Abuse [R33AG057395], Agency for Healthcare Research and Quality [R01HS024930, R01HS026506], The Peterson Center on Healthcare, and a contract [ Education and Clinical Practice Guidelines and Consensus Statements ] 1256 Guidelines and Consensus Statements [ 157#5 CHEST MAY 2020 ]
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