What is the management approach for acute bronchitis?

Management of Acute Bronchitis

Acute bronchitis should be managed primarily with symptomatic therapy and patient education, while antibiotics should not be prescribed as they provide minimal benefit and increase risk of adverse effects. 1

Diagnosis and Clinical Considerations

• Acute bronchitis is a self-limiting respiratory disorder characterized by cough lasting up to 3 weeks with or without sputum production
• Over 90% of cases are viral in origin 2
• Rule out other conditions before diagnosing acute bronchitis:
  • Pneumonia (consider if tachycardia, tachypnea, fever, or abnormal lung findings present)
  • Asthma exacerbation
  • COPD exacerbation
  • Common cold (primarily nasal symptoms)
  • Influenza
  • Pertussis (if cough >2 weeks with paroxysmal cough, whooping, or post-tussive emesis)

Treatment Algorithm

First-Line Approach:

1. Patient Education

   • Explain the viral nature of the illness 1
   • Set realistic expectations about cough duration (typically 10-14 days) 1
   • Refer to the condition as a "chest cold" rather than "bronchitis" to reduce antibiotic expectations 1

2. Symptomatic Relief for Cough

   • Bronchodilators: Albuterol via metered-dose inhaler shows consistent benefit in reducing cough duration and severity 1, 3
     • Approximately 50% fewer patients report cough after 7 days of treatment
     • Consider particularly for patients with wheezing or bothersome cough

3. Antitussive Agents (for dry, bothersome cough, especially at night)

   • Dextromethorphan or codeine for short-term symptomatic relief 1
   • These agents have modest effects on severity and duration of cough 1

4. Environmental Modifications

   • Eliminate environmental cough triggers (dust, dander) 1
   • Consider vaporized air treatments, particularly in low-humidity environments 1

What NOT to Use:

• Antibiotics: Not indicated for uncomplicated acute bronchitis 1

  • Provide minimal benefit (reduce cough by only ~0.5 days) 4
  • Increase risk of adverse effects including allergic reactions, GI symptoms, and C. difficile infection

• Expectorants, mucolytics, antihistamines: Not recommended due to lack of evidence for benefit 1

• Theophylline: Should not be used for treatment 1

Special Considerations

For Elderly Patients (>75 years) or High-Risk Groups:

• Consider antibiotics only if the patient has:
  • Age >75 years with fever
  • Cardiac failure
  • Insulin-dependent diabetes
  • Serious neurological disorder 1

For Patients with Underlying Chronic Conditions:

• Consider temporarily adjusting dosages of chronic medications for patients with asthma, COPD, cardiac failure, or diabetes 1

Common Pitfalls to Avoid

1. Overdiagnosis of bacterial infection: Purulent (green or yellow) sputum does not indicate bacterial infection 2

2. Unnecessary antibiotic prescribing: Antibiotics are prescribed in 65-80% of cases despite lack of benefit 1

3. Inadequate patient communication: Patient satisfaction depends more on the quality of communication than receiving antibiotics 1

4. Failure to set realistic expectations: Not informing patients about the typical 2-3 week duration of cough 1

By following this evidence-based approach, clinicians can effectively manage acute bronchitis while reducing unnecessary antibiotic use and focusing on symptomatic relief that actually benefits patients.