Diagnosis of acute bronchitis in adults: A national survey of family physicians

BACKGROUND. The purpose of this study was to determine, how family physicians in the United States diagnose acute bronchitis in otherwise healthy adults. METHODS. A 33-item questionnaire on the diagnosis and treatment of acute bronchitis was mailed to a random sample of 500 physicians who are members of the American Board of Family Practice. RESULTS. Two hundred sixty-five physicians responded. Of those who did not respond, 32 could not be located. Of those who did respond, 10 were either retired or were practicing in another specialty. The net response rate was 56% (255/458). Responding physicians stated that character of cough and sputum production are the most important items used in diagnosing acute bronchitis. Fifty-eight percent indicated that the cough should be productive, and 60% stated that the sputum should be purulent. Seventy-two percent of respondents did not feel that wheezing or rhonchi need to be present. Younger physicians and those who selected antibiotics as their first treatment choice were more likely to define acute bronchitis as the presence of a productive cough with purulent sputum (P<.05). Physicians from an academic setting were more likely to define acute bronchitis as a productive cough (P<.05). Thirty-six percent of physicians from practices serving populations with ≤60% managed care patients included wheezing or rhonchi in the definition of acute bronchitis, compared with 26% of all others (P<.05). CONCLUSIONS. Variations in the diagnosis of acute bronchitis in otherwise healthy adults can be attributed to physician age, treatment choice, and practice setting. A significant number of family physicians did not require a productive cough as part of the diagnostic criteria for acute bronchitis. This finding needs to be considered in studies evaluating treatment. Additional qualitative studies are necessary to identify other factors involved in diagnosing acute bronchitis.