From the Guidelines
Medical management of bronchitis should primarily focus on symptom relief, with the use of over-the-counter medications such as acetaminophen or ibuprofen for fever and pain, and a cough suppressant like dextromethorphan for severe cough, as recommended by the most recent guidelines 1.
Key Considerations
- For acute bronchitis, which is typically viral, antibiotics are generally not recommended unless there's clear evidence of bacterial infection 1.
- Bronchodilators such as albuterol may be beneficial in reducing the duration and severity of cough in patients with uncomplicated acute bronchitis, particularly those with bronchial hyperresponsiveness 1.
- Symptomatic therapy should be individualized, with consideration of the patient's most bothersome symptoms, such as cough, and the use of treatments like vaporized air and elimination of environmental cough triggers 1.
Treatment Options
- Over-the-counter medications:
- Acetaminophen (500-1000mg every 6 hours) or ibuprofen (400-600mg every 6-8 hours) for fever and pain.
- Dextromethorphan (15-30mg every 6-8 hours) for severe cough.
- Guaifenesin (200-400mg every 4 hours) to help thin mucus.
- Bronchodilators:
- Albuterol (2 puffs every 4-6 hours as needed) to help open airways.
- Inhaled corticosteroids:
- Fluticasone (1-2 puffs twice daily) to reduce inflammation in chronic bronchitis.
Important Notes
- Smoking cessation is crucial for recovery, as continued smoking worsens symptoms and delays healing.
- Pulmonary rehabilitation may benefit those with chronic bronchitis.
- The initial clinical evaluation is important in the longitudinal care of patients, and targeted investigations should be considered if the acute bronchitis persists or worsens 1.
From the Research
Medical Management of Bronchitis
- The medical management of bronchitis typically involves supportive therapy, as the condition is often caused by viruses 2, 3, 4, 5.
- For acute bronchitis, symptoms usually last about three weeks, and the presence or absence of colored sputum does not reliably differentiate between bacterial and viral lower respiratory tract infections 3.
- Antibiotics are generally not indicated for bronchitis, except in cases where pertussis is suspected or the patient is at increased risk of developing pneumonia, such as those 65 years or older 3, 4, 5.
- The use of antimicrobial agents and vaccines may have both prophylactic and therapeutic roles in the management of chronic bronchitis 2.
- For symptom management, evidence does not support the use of antitussives, honey, antihistamines, anticholinergics, oral nonsteroidal anti-inflammatory drugs, or inhaled or oral corticosteroids 4.
- Strategies shown to decrease antibiotic prescribing include delayed antibiotic prescriptions and describing acute bronchitis as a chest cold 4.
- Patient satisfaction with the treatment of acute bronchitis is related to the quality of the physician-patient interaction rather than to prescription of an antibiotic 5.
Treatment Options
- Symptomatic treatment with protussives, antitussives, or bronchodilators may be appropriate for acute bronchitis 5.
- The supplement pelargonium may help reduce symptom severity in adults 3.
- Expectants/mucolytics and beta2 agonists (inhaled) have been evaluated for their efficacy in treating acute bronchitis, but the evidence is limited 6.
Special Considerations
- Chronic bronchitis, characterized by prolonged sputum production, is most often caused by cigarette smoking, which decreases mucociliary transport velocity 2.
- Smoking cessation is essential for managing chronic bronchitis and preventing exacerbations 2.
- Patient education regarding the expected duration of cough (2-3 weeks) is recommended for the management of acute bronchitis 4.