What is the treatment for bronchitis?

Treatment of Bronchitis

The most effective treatment for bronchitis depends on whether it is acute or chronic, with symptomatic treatment without antibiotics being the primary approach for acute bronchitis, while avoidance of respiratory irritants is the most effective intervention for chronic bronchitis. 1, 2

Acute Bronchitis Treatment

First-line Management

• Symptomatic treatment without antibiotics is the primary approach 1
• Antitussive agents for short-term symptomatic relief:
  • Dextromethorphan or codeine for cough suppression 1
  • Honey (one teaspoon) can effectively relieve cough 1

Bronchodilators

• Beta-2-agonists (e.g., albuterol) may be beneficial only in select patients with wheezing 1
• Not recommended for routine use in acute bronchitis 1

Antibiotics

• Antibiotics should NOT be prescribed routinely for acute bronchitis 1, 3
• No benefit and potential harm from antibiotics in most cases 1
• Exception: Consider antibiotics only for suspected pertussis (whooping cough), using macrolide antibiotics 1

Other Supportive Measures

• Consider symptomatic relief with:
  • Expectorants
  • First-generation antihistamines
  • Decongestants
  • Elimination of environmental cough triggers (dust, dander) 1

Chronic Bronchitis Treatment

First-line Management

• Avoidance of respiratory irritants is the most effective intervention 2
  • Smoking cessation results in resolution of cough in 90% of patients 2
  • Avoid passive smoke exposure and workplace hazards 2

Pharmacological Treatment for Stable Chronic Bronchitis

1. Short-acting bronchodilators:

   • Short-acting β-agonists to control bronchospasm, relieve dyspnea, and reduce cough 2
   • Ipratropium bromide (anticholinergic) to improve cough 2

2. Long-acting bronchodilators with inhaled corticosteroids:

   • Long-acting β-agonist combined with inhaled corticosteroid for chronic cough control 2
   • Inhaled corticosteroids for patients with FEV1 <50% predicted or frequent exacerbations 2

3. Theophylline:

   • Consider for controlling chronic cough with careful monitoring for complications 2
   • Not recommended during acute exacerbations 2

Treatment for Acute Exacerbations of Chronic Bronchitis

1. Bronchodilators:

   • Short-acting β-agonists or anticholinergic bronchodilators 2
   • If no prompt response, add the other agent at maximal dose 2

2. Antibiotics:

   • Recommended for acute exacerbations, especially for severe exacerbations and patients with severe airflow obstruction 2, 4
   • Reserve for patients with at least one key symptom (increased dyspnea, sputum production, or sputum purulence) and one risk factor (age ≥65 years, FEV1 <50% predicted, ≥4 exacerbations in 12 months, or comorbidities) 4
   • Antibiotic selection based on severity:
     • Moderate severity: newer macrolide, extended-spectrum cephalosporin, or doxycycline 4
     • Severe exacerbation: high-dose amoxicillin/clavulanate or respiratory fluoroquinolone 4

3. Corticosteroids:

   • Systemic corticosteroids beneficial for acute exacerbations 4

Not Recommended Treatments

• Long-term prophylactic antibiotics in stable chronic bronchitis 2
• Postural drainage and chest percussion (for both stable and acute exacerbation) 2
• Expectorants (no proven effectiveness) 2
• Theophylline during acute exacerbations 2

Patient Education

• For acute bronchitis, explain the viral nature and expected cough duration (10-14 days) 1
• Refer to the illness as a "chest cold" rather than "bronchitis" to reduce antibiotic expectations 1
• Re-evaluate if symptoms worsen or persist beyond 3 weeks 1

Special Considerations

• For patients with underlying conditions (asthma, COPD, cardiac failure, diabetes):
  • Consider temporarily adjusting chronic medication dosages
  • Assess hydration status and provide IV fluids if needed
  • Provide supplemental oxygen when SpO₂ falls below 90% 1

Common Pitfalls to Avoid

1. Overuse of antibiotics for acute bronchitis (65-80% of patients receive antibiotics despite evidence against their use) 1
2. Failure to distinguish between acute bronchitis and pneumonia, which requires different management
3. Not emphasizing smoking cessation as the most effective intervention for chronic bronchitis 2
4. Using theophylline during acute exacerbations of chronic bronchitis 2
5. Relying on sputum color to determine need for antibiotics (colored sputum does not reliably differentiate between bacterial and viral infections) 3