What are the treatment options for acute bronchitis?

Treatment Options for Acute Bronchitis

For immunocompetent adult outpatients with acute bronchitis, no routine prescription of antibiotics, antivirals, antitussives, bronchodilators, corticosteroids, or NSAIDs is recommended as these treatments have not been shown to significantly improve outcomes. 1, 2

Diagnosis and Differentiation

Before initiating treatment, it's essential to differentiate acute bronchitis from other conditions:

• Acute bronchitis is characterized by:

  • Acute cough with or without phlegm lasting up to 3 weeks
  • Normal chest radiograph
  • Absence of fever, tachycardia, tachypnea, or focal chest findings 2

• Rule out pneumonia if patient has:

  • Heart rate >100 beats/min
  • Respiratory rate >24 breaths/min
  • Oral temperature >38°C
  • Focal chest examination findings 2

• Also differentiate from:

  • Asthma
  • COPD exacerbation
  • Common cold 2

Treatment Approach

First-line Management: Supportive Care

1. Patient Education:

   • Inform patients about the viral nature of the disease (>90% of cases) 3
   • Explain typical duration of cough (2-3 weeks) 2, 4
   • Discuss risks of unnecessary antibiotic use 2

2. Symptomatic Relief:

   • Hydration
   • Avoidance of respiratory irritants (including smoking cessation) 2
   • Honey (one teaspoon) for cough relief in adults and children >1 year 2

3. Over-the-counter Options:

   • Guaifenesin to loosen phlegm and thin bronchial secretions 5
   • Dextromethorphan for short-term symptomatic relief of cough 2

When to Consider Additional Treatments

1. Bronchodilators:

   • Consider only in patients with wheezing
   • Discontinue if no response is observed 2
   • Albuterol is indicated for relief of bronchospasm in patients with reversible obstructive airway disease 6

2. Antibiotics:

   • Not routinely recommended 1, 2, 3, 4
   • Consider only in specific cases:
     • Suspected or confirmed pertussis (macrolides such as erythromycin)
     • Patients with underlying pulmonary disease and frequent exacerbations
     • Patients ≥65 years at high risk for pneumonia 2
     • If acute bronchitis worsens and bacterial infection is suspected 1

Special Considerations

High-Risk Patients

• Patients with underlying conditions (COPD, heart failure, immunosuppression) may require adapted treatment 2
• Elderly patients (≥65 years) at high risk for pneumonia may need closer monitoring 2

Common Pitfalls to Avoid

1. Unnecessary Antibiotic Prescription:

   • Colored sputum (e.g., green) does not reliably differentiate between bacterial and viral infections 3
   • Antibiotics generally only decrease cough duration by approximately 0.5 days while exposing patients to adverse effects 4

2. Overreliance on Ineffective Treatments:

   • Most typical therapies for managing acute bronchitis symptoms have been shown to be ineffective 3
   • No consistent evidence supports the use of antitussives, antihistamines, anticholinergics, NSAIDs, or corticosteroids 4

3. Misdiagnosis:

   • Failing to consider exacerbations of underlying conditions like asthma or COPD that require different management approaches 2

When to Reassess

• If cough persists or worsens beyond expected duration (2-3 weeks)
• If new symptoms develop suggesting bacterial superinfection
• If patient has underlying conditions that increase risk of complications 1, 2

By focusing on supportive care and appropriate patient education, most cases of acute bronchitis will resolve without the need for prescription medications, while avoiding unnecessary antibiotic use and potential adverse effects.