What are the best treatments for relief of a common cough due to acute bronchitis?

Best Treatments for Relief of Common Cough Due to Acute Bronchitis

Antitussive agents are the most effective option for short-term symptomatic relief of coughing in acute bronchitis and should be offered when symptom relief is needed. 1

First-Line Treatment Options

Antitussives

• Antitussives provide symptomatic relief for the bothersome cough of acute bronchitis
• Options include:
  • Dextromethorphan: Temporarily relieves cough due to minor throat and bronchial irritation and helps suppress the cough reflex to improve sleep 2
  • Codeine: Can provide relief for cough due to bronchial irritation, though evidence shows mixed results 1, 3

Treatment Algorithm

1. Initial approach: Patient education about the self-limiting nature of acute bronchitis (typically resolves in 2-3 weeks) 4
2. For bothersome cough: Offer short-term antitussive therapy with dextromethorphan or codeine 1
3. For patients with wheezing: Consider β2-agonist bronchodilators 1

Second-Line/Alternative Options

Bronchodilators

• Not recommended for routine use in uncomplicated acute bronchitis 1
• May be beneficial in select patients with wheezing accompanying the cough 1
• A Cochrane review showed no significant overall benefit for β2-agonists on daily cough scores 1

Expectorants/Mucokinetic Agents

• Not recommended for acute bronchitis 1
• Guaifenesin (an expectorant) helps loosen phlegm and thin bronchial secretions 5, but clinical trials show inconsistent results 1, 6
• The ACCP guidelines specifically state: "because there is no consistent favorable effect of mucokinetic agents on cough, they are not recommended" 1

Treatments to Avoid

Antibiotics

• Not recommended for routine treatment of acute bronchitis 1
• Do not contribute to overall improvement and only decrease cough duration by approximately 0.5 days 4
• Exception: Confirmed or suspected pertussis infection requires macrolide antibiotics 1

Other Ineffective Treatments

• Antihistamines: No more effective than placebo in relieving cough symptoms 6, 7
• Oral corticosteroids: Not supported by evidence 4
• Inhaled corticosteroids: Not supported by evidence for acute bronchitis 4

Important Clinical Considerations

Diagnostic Approach

• Ensure the diagnosis is truly acute bronchitis by ruling out:
  • Pneumonia (absence of: heart rate >100, respiratory rate >24, fever >38°C, focal consolidation) 1
  • Asthma exacerbation
  • COPD exacerbation
  • Common cold 1

Common Pitfalls

1. Inappropriate antibiotic use: Despite patient expectations, antibiotics should be avoided unless pertussis is suspected 1
2. Overreliance on expectorants: Despite widespread use, mucokinetic agents have not shown consistent benefits 1
3. Failure to set appropriate expectations: Patients should understand that cough may persist for 2-3 weeks 4

Special Populations

• Children: Limited evidence for effectiveness of OTC cough medicines, with potential for harm from antihistamines and centrally active antitussives 7
• Patients with wheezing: May benefit from bronchodilator therapy 1

Remember that acute bronchitis is primarily self-limiting, and treatment should focus on symptom relief while the condition resolves naturally. Patient education about the expected course of illness is as important as medication therapy.