Factsheet 2000/1

Acute Bronchitis

Public Health Sciences Dept., St George’s Hospital Medical School, Cranmer Terrace, London SW17 0RE laia@sghms.ac.uk http://www.sghms.ac.uk/depts/laia/laia.htm

Introduction Figure 1: Episodes of acute bronchitis in British general practice.

Acute bronchitis is an acute respiratory Mean weekly incidence by age group, 1979-1998
infection characterised by cough
0-4
productive of sputum which may be 450 5-14
accompanied by wheezing. Viral causes 15-44
400 45-64
include influenza, respiratory syncytial 65+
virus (RSV) and parainfluenza; bacterial 350

causes include Streptococcus pneumoniae, 300

Haemophilus influenzae, Mycoplasma 250
pneumoniae and Bordetella pertussis. 200

150
The majority of patients with acute
bronchitis who seek medical attention are 100

treated exclusively in primary care. New 50

episodes presenting in primary care are 0
79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98
estimated from the Weekly Returns Service
Year
(WRS) of the Royal College of General Source: WRS
Practitioners (see footnote).

Trends from year to year Figure 2: Episodes of asthma in British general practice.
Mean weekly incidence by age group, 1979-1998
Trends in rates of acute bronchitis and
asthma by age group for 1979-1998 are 180

presented in Figures 1 and 2. Rates of acute 160

0-4
bronchitis increased in all age groups, 140 5-14
reaching a peak in the early 1990s, 15-44
120 45-64
declining thereafter. Acute bronchitis is 65+
100
commonest in children aged 0-4 years;
followed by the elderly (aged 65 years and 80
over) and is least common in those aged 60
between 5 and 44 years. Between 1979 and 40
1993 the greatest increase occurred in the
20
elderly.
0
79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98
Comparison with asthma Year

Trends in the incidence of asthma attacks Source: WRS

are similar to those for acute bronchitis,
increasing until the early 1990s and
declining since, but the rise in new episode Figure 3: Mean weekly incidence of acute bronchitis in age
groups 0-4 and 65+ years old, 1989-1998
incidence rates in the 1980s was greater for
asthma than for acute bronchitis. 900

800
The frequency of new episodes of acute 700 0-4
bronchitis is much higher than that for 65+
600
asthma attacks for most age groups, except
for children aged 5-14 years. Therefore, in 500

most age groups, a relatively small 400

diagnostic shift away from acute bronchitis 300
to asthma could considerably affect rates 200
for the latter condition. However, the
100
increased frequency of both conditions in
the 1980s and early 1990s suggests that the 0
27 29 3133 35 37394143 4547 49 51 1 3 5 7 9 11 13 1517 1921 2325
increase in asthma was not due to a Week of the year
diagnostic shift away from acute Source: WRS
bronchitis.

Supported by: • British Lung Foundation • National Asthma Campaign • British Thoracic Society
020 7831 5831 020 7226 2260 020 7831 8778
Seasonal variations Figure 4: Weekly average for incidence of respiratory diseases
Acute bronchitis is commonest around the turn in ages 65+ and number of deaths from all causes in
of the year. In young children aged 0-4 years, England & Wales (all ages).
acute bronchitis peaks just before the end of the
year, but in persons aged 65 years and over the
peak is 2 weeks later, in the first week of the
year (Figure 3). This winter peak contrasts with
the early autumn peak in incidence of acute
asthma attacks (LAIA factsheet 93/4), but Rate of disease: ARD Bronchitis Influenza

coincides with the months of highest mortality Number of Deaths

rates, particularly among the elderly (Figure 4).
A similar seasonal pattern among elderly 18000
patients is evident for other acute upper and
lower respiratory diseases included in the
Weekly Returns Service. (Aggregated
15000
respiratory disease (ARD) represents the sum of
new episodes of all respiratory conditions
surveyed: acute bronchitis, common cold,
influenza, influenza-like illness, acute 12000

tonsillitis, acute sinusitis, laryngitis/tracheitis,

pneumonia/pneumonitis and pleurisy). It is
1400
striking how closely the seasonal variations in 9000
acute bronchitis and ARD among the elderly
1200
match those of deaths, regardless of cause. It is
likely that acute respiratory infections are a 6000
1000
common immediate cause of death for persons
with non-respiratory disease. 800
3000
600
Footnote
Since 1967, the Weekly Returns Service has 400
collected information on episodes of disease 0
presenting to general practitioners. Currently 72 200
practices with a registered population of 600,000 are
surveyed. Doctors record their working diagnoses, 0
89 90 91 92 93 94 95 96 97 98 99
specifying whether the patient is consulting about a
Year
new or an ongoing episode of disease. Results are
collated on a weekly basis by the Royal College of
General Practitioners Research Unit, Birmingham
and published as an Annual Report. Weekly data are
accessible on http://www.rcgp-bru.demon.co.uk Source:WRS,ONS

Summary

• New episode rates of acute bronchitis and asthma rose in the 1980s but have fallen since the early 1990s.
• Acute bronchitis is commonest in pre-school children and elderly persons.
• Acute bronchitis peaks just before the New Year in pre-school children, but just after in the elderly.
• There is a marked temporal association between respiratory infections, including acute bronchitis and
deaths from all causes.

We would like to thank Dr Andy Ross and Dr Douglas Fleming (Royal College of General Practitioners Research Unit,
Birmingham) for preparing this factsheet

The LAIA website address is http://www.sghms.ac.uk/depts/laia/laia.htm Back copies of factsheets and sets of the charts
from factsheets can be downloaded from the website in Adobe PDF format, or emailed on request from laia@sghms.ac.uk