DIAGNOSIS OF ACUTE BRONCHITIS IN ADULTS - A NATIONAL SURVEY OF FAMILYPHYSICIANS

BACKGROUND. The purpose of this study was to determine how family phys icians in the United States diagnose acute bronchitis in otherwise hea lthy adults. METHODS. A 33-item questionnaire on the diagnosis and tre atment of acute bronchitis was mailed to a random sample of 500 physic ians who are members of the American Board of Family Practice. RESULTS . Two hundred sixty-five physicians responded. Of those who did not re spond, 32 could not be located. Of those who did respond, 10 were eith er retired or were practicing in another specialty. The net response r ate was 56% (255/458). Responding physicians stated that character of cough and sputum production are the most important items used in diagn osing acute bronchitis. Fifty-eight percent indicated that the cough s hould be productive, and 60% stated that the sputum should be purulent . Seventy-two percent of respondents did not feel that wheezing or rho nchi need to be present. Younger physicians and those who selected ant ibiotics as their first treatment choice were more likely to define ac ute bronchitis as the presence of a productive cough with purulent spu tum (P<.05). Physicians from an academic setting were more likely to d efine acute bronchitis as a productive cough (P<.05). Thirty-six perce nt of physicians from practices serving populations with greater than or equal to 60% managed care patients included wheezing or rhonchi in the definition of acute bronchitis, compared with 26% of ail others (P <.05). CONCLUSIONS, Variations in the diagnosis of acute bronchitis in otherwise healthy adults can be attributed to physician age, treatmen t choice, and practice setting. A significant number of family physici ans did not require a productive cough as part of the diagnostic crite ria for acute bronchitis. This finding needs to be considered in studi es evaluating treatment. Additional qualitative studies are necessary to identify other factors involved in diagnosing acute bronchitis.