Does acute bronchitis really exist? A reconceptualization of acute viral respiratory infections

BACKGROUND Considerable overlap exists in patient presentations and physica l findings in viral upper respiratory tract infections (URIs) and acute bro nchitis, 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 b een given a diagnosis of acute bronchitis and a random sample of 409 patien ts with URIs over a 2.5-year period. Patient and provider characteristics, patient symptoms, and physical findings were compared with bivariate analys es 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 sho wed that the strongest independent predictors of acute bronchitis were coug h (adjusted odds ratio [AOR]=21.12; 95% confidence interval [CI], 6.01-74.2 6), 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 o verlap 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 al l variations of the same clinical condition (acute respiratory infection) a nd should be conceptualized as a single clinical entity, with primary sympt oms related to different anatomic areas rather than as different conditions .