What is the diagnosis and treatment for acute bronchitis?

From the Guidelines

Bronchitis is typically caused by viral infections and resolves within 1-2 weeks without antibiotics, so treatment should focus on symptom relief rather than antibiotic therapy, unless there's evidence of bacterial infection 1. The primary symptoms of bronchitis include coughing with mucus, chest discomfort, fatigue, and mild fever.

• Most cases of acute bronchitis are self-limited and will improve on their own, with or without treatment.
• The evaluation of adults with an acute cough illness or a presumptive diagnosis of uncomplicated acute bronchitis should focus on clinically ruling out serious illness, particularly pneumonia 1.
• Routine antibiotic treatment of uncomplicated acute bronchitis is not recommended, regardless of the duration of cough, as it is usually caused by a viral illness 1.
• Patients can benefit from analgesics, antipyretics, and other supportive therapies to relieve symptoms, such as:
  • Rest and staying hydrated
  • Using over-the-counter medications like acetaminophen (325-650mg every 4-6 hours) or ibuprofen (400-600mg every 6-8 hours) for pain and fever
  • Honey for cough (1-2 teaspoons as needed for adults)
  • A humidifier to help loosen mucus
• Avoid smoking and secondhand smoke as they worsen symptoms and delay recovery.
• If symptoms persist beyond three weeks, worsen significantly, or include high fever, severe shortness of breath, or bloody mucus, seek medical attention as this could indicate chronic bronchitis or another condition requiring different treatment 1.
• Chronic bronchitis, often part of COPD, requires long-term management with bronchodilators and possibly inhaled steroids 1.

From the Research

Definition and Diagnosis of Bronchitis

• Bronchitis is a clinical diagnosis characterized by cough due to acute inflammation of the trachea and large airways without evidence of pneumonia 2.
• The presence or absence of colored sputum does not reliably differentiate between bacterial and viral lower respiratory tract infections 3.
• Acute bronchitis should be differentiated from other common diagnoses, such as pneumonia and asthma, because these conditions may need specific therapies not indicated for bronchitis 3.

Causes and Duration of Bronchitis

• Viruses are responsible for more than 90 percent of acute bronchitis infections 3.
• The cough associated with acute bronchitis typically lasts about two to three weeks 2.
• Symptoms of bronchitis typically last about three weeks 3.

Treatment and Management of Bronchitis

• Antibiotics are generally not indicated for bronchitis, and should be used only if pertussis is suspected to reduce transmission or if the patient is at increased risk of developing pneumonia 3.
• Antibiotics have been shown to provide only minimal benefit, reducing the cough or illness by about half a day, and have adverse effects, including allergic reactions, nausea and vomiting, and Clostridium difficile infection 2.
• Oral albuterol may be more effective than commonly used antibiotics in relieving the symptoms of acute bronchitis 4.
• The supplement pelargonium may help reduce symptom severity in adults 3.
• Symptomatic treatment of cough is primarily required for patients, though in most cases the condition is self-limiting 5.

Patient Education and Communication

• Evaluation and treatment of bronchitis include ruling out secondary causes for cough, such as pneumonia; educating patients about the natural course of the disease; and recommending symptomatic treatment and avoidance of unnecessary antibiotic use 2.
• Strategies to reduce inappropriate antibiotic use include delayed prescriptions, patient education, and calling the infection a chest cold 2.
• Effective communication strategies are necessary to provide the safest therapies available while maintaining patient satisfaction 3.