What is the treatment for bronchitis?

Treatment for Bronchitis

The treatment for bronchitis should be tailored based on whether it is acute or chronic, with antibiotics generally not indicated for acute bronchitis but recommended for specific cases of chronic bronchitis exacerbations that meet certain criteria.

Acute Bronchitis Treatment

Acute bronchitis is typically a self-limiting condition lasting 1-3 weeks, with viruses responsible for more than 90% of cases 1.

Non-Pharmacological Management

• Removal of environmental irritants (especially cigarette smoke)
• Adequate hydration
• Rest

Pharmacological Management

1. Bronchodilators:

   • Albuterol has shown consistent benefit in reducing duration and severity of cough 2
   • Approximately 50% fewer patients report cough after 7 days of treatment

2. Antitussives:

   • Dextromethorphan or codeine for short-term symptomatic relief of coughing 2
   • Most effective for bothersome cough that interferes with sleep

3. Antibiotics:

   • Generally NOT indicated for uncomplicated acute bronchitis 2, 1
   • Should only be used if pertussis is suspected (to reduce transmission) or in high-risk patients (e.g., ≥65 years) 1

Chronic Bronchitis Treatment

Chronic bronchitis is defined as cough and sputum production occurring on most days for at least 3 months of the year and for at least 2 consecutive years 2.

Baseline Management

• Smoking cessation (most critical intervention)
• Avoidance of respiratory irritants
• Vaccination (influenza and pneumococcal) 3

Pharmacological Management

1. Bronchodilators:

   • Short-acting β-agonists to control bronchospasm, relieve dyspnea, and potentially reduce chronic cough 2
   • Ipratropium bromide to improve cough 2
   • Theophylline may be considered to control chronic cough (with careful monitoring for side effects) 2

2. Mucolytics:

   • Acetylcysteine for patients with abnormal, viscid, or inspissated mucous secretions 4

3. Corticosteroids:

   • Combined regimen of inhaled long-acting β-agonist and inhaled corticosteroid may improve cough 2

Treatment for Acute Exacerbations of Chronic Bronchitis

Assessment Criteria

Antibiotic therapy should be reserved for patients with:

• At least one key symptom: increased dyspnea, increased sputum production, or increased sputum purulence 5
• AND at least one risk factor: age ≥65 years, FEV1 <50% predicted, ≥4 exacerbations in 12 months, or one or more comorbidities 5

Antibiotic Selection

1. Moderate Exacerbation:

   • Newer macrolide (e.g., azithromycin 500mg once daily for 3 days) 6, 5
   • Extended-spectrum cephalosporin
   • Doxycycline

2. Severe Exacerbation (especially with chronic respiratory insufficiency):

   • High-dose amoxicillin/clavulanate
   • Respiratory fluoroquinolone 5
   • Immediate antibiotic therapy is recommended for patients with chronic obstructive bronchitis with chronic respiratory insufficiency 2

Other Treatments for Exacerbations

• Inhaled bronchodilators 2
• Oral or IV corticosteroids for severe cases 2
• Oxygen therapy if hypoxemic
• NOT recommended: expectorants, postural drainage, chest physiotherapy 2

Common Pitfalls to Avoid

1. Prescribing antibiotics for uncomplicated acute bronchitis
2. Failing to distinguish between acute bronchitis, pneumonia, and asthma
3. Assuming colored sputum (e.g., green) indicates bacterial infection 1
4. Using cough and cold preparations in children under 6 years (FDA recommends against this) 1
5. Prescribing prophylactic antibiotics for stable chronic bronchitis patients 2

Remember that patient satisfaction with care for acute bronchitis depends more on physician-patient communication than whether an antibiotic is prescribed 2.