From the Guidelines
For immunocompetent adult outpatients with cough due to acute bronchitis, no routine prescription of antibiotic therapy, antiviral therapy, antitussives, inhaled beta agonists, inhaled anticholinergics, inhaled corticosteroids, oral corticosteroids, oral NSAIDs or other therapies is suggested until such treatments have been shown to be safe and effective at making cough less severe or resolve sooner. This approach is based on the most recent and highest quality study available, which emphasizes a cautious use of medications unless absolutely necessary, as indicated by the study published in Chest in 2020 1.
Key Considerations for Treatment
- Rest, increased fluid intake, and over-the-counter medications like acetaminophen or ibuprofen can help manage symptoms.
- A humidifier or steam from a hot shower can loosen mucus, and over-the-counter cough suppressants containing dextromethorphan can be taken for severe coughing.
- Expectorants like guaifenesin help thin mucus, but their use should be guided by the severity of symptoms and the presence of any complicating factors.
- For chronic bronchitis, treatment may include bronchodilators like albuterol and inhaled steroids to reduce inflammation, along with pulmonary rehabilitation, oxygen therapy, and smoking cessation.
Antibiotic Use
The use of antibiotics is generally not recommended for acute bronchitis unless there is evidence of a bacterial infection, as suggested by the study 1. However, for patients with an acute exacerbation of chronic bronchitis, antibiotics may be considered, especially in those with purulent sputum or more severe illness, as indicated by older studies 1.
Management of Chronic Bronchitis
For stable patients with chronic bronchitis, treatment with a long-acting β-agonist coupled with an inhaled corticosteroid should be offered to control chronic cough, as recommended by the ACCP evidence-based clinical practice guidelines 1. Additionally, avoidance of respiratory irritants and therapy with short-acting inhaled β-agonists or anticholinergic bronchodilators can be beneficial during acute exacerbations 1.
Severe Cases
Severe cases of bronchitis might require oral steroids like prednisone, typically 40mg daily for 5 days, and it is crucial to complete any prescribed medication course fully and seek medical attention if symptoms worsen or include high fever, difficulty breathing, or coughing up blood. The management of severe cases should be guided by the most recent clinical guidelines and the patient's specific condition, considering the potential benefits and risks of each treatment option, as discussed in various studies 1.
From the Research
Treatment Options for Bronchitis
The treatment options for bronchitis can be divided into two main categories: acute bronchitis and chronic bronchitis.
- For acute bronchitis, the following treatment options are available:
- Symptom relief and patient education regarding the expected duration of cough (2-3 weeks) 2
- Strategies shown to decrease antibiotic prescribing include delayed antibiotic prescriptions and describing acute bronchitis as a chest cold 2
- The supplement pelargonium may help reduce symptom severity in adults 3
- For chronic bronchitis, the following treatment options are available:
- Supportive care, which might include removal of irritants, use of a bronchodilator, oxygen, hydration, use of a systemic corticosteroid, and chest physical therapy 4
- Antibacterial treatment should be reserved for patients with at least 1 key symptom (ie, increased dyspnea, sputum production, sputum purulence) and 1 risk factor (ie, age > or = 65 years, forced expiratory volume in 1 second < 50% of the predicted value, > or = 4 AECBs in 12 months, 1 or more comorbidities) 4
Antibiotic Treatment
Antibiotic treatment is not always necessary for bronchitis.
- Antibiotics may be modestly effective for a minority of patients with acute bronchitis, but it is not clear which patient subgroups might benefit 5
- Antibiotics do not contribute to the overall improvement of acute bronchitis, although they may decrease the duration of cough by approximately 0.5 days 2
- The use of antibiotics exposes patients to antibiotic-related adverse effects 2
Non-Antibiotic Treatment
Non-antibiotic treatment options are available for bronchitis.