What is the treatment for acute bronchitis with a painful cough?

Treatment for Acute Bronchitis with Painful Cough

For acute bronchitis with painful cough, central cough suppressants such as codeine and dextromethorphan are recommended for short-term symptomatic relief of coughing. 1

First-line Treatment Approach

Symptomatic Relief

• Antitussives:

  • Codeine or dextromethorphan for short-term relief of cough 1
  • These agents are particularly helpful for reducing the frequency and severity of cough, especially when it's painful

• Other symptomatic treatments to consider:

  • First-generation antihistamine/decongestant combinations for associated cold symptoms 1
  • Nonsteroidal anti-inflammatory drugs like naproxen for pain relief 1
  • Vaporized air treatments in low-humidity environments 1

Avoid Antibiotics

• Antibiotics should NOT be prescribed for uncomplicated acute bronchitis 1
• More than 90% of acute bronchitis cases are caused by viruses 1, 2
• Antibiotics provide minimal benefit (reducing cough by only about half a day) while risking adverse effects 2

Special Considerations

When to Consider Bronchodilators

• β-agonist bronchodilators (like albuterol) are generally NOT recommended for routine use in acute bronchitis 1
• Consider β-agonists ONLY in patients with:
  • Wheezing accompanying the cough 1
  • Evidence of bronchial hyperresponsiveness 1

Exception for Pertussis

• If pertussis (whooping cough) is suspected, macrolide antibiotics should be prescribed 1
• Suspect pertussis when:
  • Cough persists >2 weeks
  • Accompanied by paroxysmal cough, whooping, or post-tussive emesis 2
  • Patient requires isolation for 5 days from start of treatment 1

Patient Education

• Emphasize that cough from acute bronchitis typically lasts 2-3 weeks 2
• Explain that colored sputum (green or yellow) does NOT indicate bacterial infection and is due to inflammatory cells 1
• Address patient expectations about antibiotics directly, as many patients expect to receive them based on previous experiences 1

Common Pitfalls to Avoid

1. Prescribing antibiotics unnecessarily - 65-80% of patients with acute bronchitis receive antibiotics despite evidence they are ineffective 1

2. Misdiagnosing pneumonia - Rule out pneumonia if patient has tachycardia (>100 beats/min), tachypnea (>24 breaths/min), fever (>38°C), or abnormal chest examination findings 1

3. Using newer-generation antihistamines - These are ineffective for cough relief; first-generation antihistamines are preferred 1

4. Prolonged use of antitussives - These should be used only for short-term relief 1

5. Overlooking pertussis - This requires specific antibiotic treatment and isolation measures 1

By following this evidence-based approach, you can provide effective symptomatic relief for painful cough in acute bronchitis while avoiding unnecessary antibiotics and their associated risks.