From the Guidelines
For acute bronchitis, treatment should focus on symptom relief without routine antibiotic therapy, as most cases are caused by viruses and resolve within 1-2 weeks 1. The diagnosis of acute bronchitis is clinical, with the importance of initial assessment being the exclusion of pertinent differential diagnoses such as pneumonia, the common cold, acute asthma, or an exacerbation of COPD 1.
Key Considerations
- The presentation with cough due to suspected acute bronchitis warrants a detailed review and exploration of preexisting health conditions, exposure history, and consideration of such differential diagnoses 1.
- Routine investigations such as chest x-rays, sputum cultures, measurement of serum inflammatory markers, or other laboratory tests are not recommended at initial presentation 1.
- Targeted investigations may be considered if the acute bronchitis persists or worsens, and may include chest x-ray, sputum for microbial culture, peak expiratory flow rate recording(s), complete blood count, and inflammatory markers such as CRP 1.
Treatment Approach
- Over-the-counter medications like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can help reduce fever and discomfort 1.
- A humidifier or steam from a hot shower can loosen mucus and ease breathing.
- Drinking plenty of fluids helps thin secretions.
- Antibiotics like azithromycin or amoxicillin may be prescribed if bacterial infection is suspected, particularly if symptoms persist beyond 3 weeks, worsen suddenly, or include high fever, severe shortness of breath, or bloody mucus 1.
Important Reminders
- Differential diagnoses, such as exacerbations of chronic airways diseases (COPD, asthma, bronchiectasis), should be considered if the acute bronchitis worsens 1.
- Quitting smoking is essential for recovery, as continued smoking irritates the bronchial tubes and prolongs healing time.
From the Research
Diagnosis of Acute Bronchitis
- Acute bronchitis is a clinical diagnosis characterized by cough due to acute inflammation of the trachea and large airways without evidence of pneumonia 2
- The presence or absence of colored sputum does not reliably differentiate between bacterial and viral lower respiratory tract infections 3
- Pneumonia should be suspected in patients with tachypnea, tachycardia, dyspnea, or lung findings suggestive of pneumonia, and radiography is warranted 2
- Pertussis should be suspected in patients with cough persisting for more than two weeks that is accompanied by symptoms such as paroxysmal cough, whooping cough, and post-tussive emesis, or recent pertussis exposure 2
Treatment of Acute Bronchitis
- Viruses are responsible for more than 90 percent of acute bronchitis infections, and antibiotics are generally not indicated for bronchitis 3
- Antibiotics should be used only if pertussis is suspected to reduce transmission or if the patient is at increased risk of developing pneumonia (e.g., patients 65 years or older) 3
- The typical therapies for managing acute bronchitis symptoms have been shown to be ineffective, and the U.S. Food and Drug Administration recommends against using cough and cold preparations in children younger than six years 3
- The supplement pelargonium may help reduce symptom severity in adults 3
- Symptomatic treatment with protussives, antitussives, or bronchodilators is appropriate for acute bronchitis 4
- Broad spectrum antibiotics are appropriate in selected patients, such as those with an exacerbation of underlying chronic bronchitis 5