What are the treatment options for bronchitis?

Treatment Options for Bronchitis

The most effective treatment for bronchitis depends on whether it is acute or chronic, with smoking cessation being the single most important intervention for chronic bronchitis, resulting in resolution of cough in 90% of patients. 1

Acute Bronchitis Treatment

First-Line Approach

• Symptomatic management only - Acute bronchitis is primarily viral and self-limiting, typically lasting 2-3 weeks 2
• Antibiotics are NOT recommended for uncomplicated acute bronchitis as they do not significantly improve outcomes and expose patients to adverse effects 1, 2
• Patient education about the expected duration of cough (2-3 weeks) is crucial for management 1

Symptom Relief for Acute Bronchitis

• Short-acting bronchodilators (albuterol) can reduce duration and severity of cough 1
• Dextromethorphan or codeine may provide modest effect on cough severity and duration 1
• Avoid environmental cough triggers (dust, dander) and consider vaporized air treatments in low-humidity environments 1

Chronic Bronchitis Treatment

First-Line Interventions

• Smoking cessation - Most effective intervention with 90% of patients experiencing cough resolution 1
• Short-acting β-agonists (Grade A recommendation) to control bronchospasm and relieve dyspnea 1
• Ipratropium bromide (Grade A recommendation) to improve cough 1

Additional Pharmacological Options

• Combined therapy with long-acting β-agonist and inhaled corticosteroid for stable chronic bronchitis (Grade A recommendation) 1, 3
• Inhaled corticosteroids for patients with FEV₁ <50% predicted or frequent exacerbations 1, 3
• Theophylline may be considered for chronic cough control with careful monitoring for complications 1
• Roflumilast (PDE4 inhibitor) for reducing exacerbations in severe COPD with chronic bronchitis 4

Management of Acute Exacerbations of Chronic Bronchitis

Diagnostic Criteria for Exacerbation

• Presence of at least one key symptom (increased dyspnea, sputum production, or purulence) AND
• One risk factor (age ≥65, FEV₁ <50% predicted, ≥4 exacerbations/year, or comorbidities) 5

Treatment for Exacerbations

1. Short-acting bronchodilators (β-agonists or anticholinergics) - first-line therapy 1, 3

   • If no prompt response, add the other agent at maximal dose 1

2. Systemic corticosteroids for acute exacerbations 3, 5

   • Short course of 10-15 days

3. Antibiotics for patients with purulent sputum 1, 3, 5

   • Newer macrolides, extended-spectrum cephalosporins, or doxycycline for moderate exacerbations
   • High-dose amoxicillin/clavulanate or respiratory fluoroquinolones for severe exacerbations
   • Azithromycin (500 mg once daily for 3 days) has shown 85% clinical cure rate for acute exacerbations 6

4. Avoid theophylline during acute exacerbations (Grade D recommendation) 1

What NOT to Use

• Expectorants - Not effective for chronic bronchitis (Grade I recommendation) 1, 3
• Mucokinetic agents - Not recommended due to lack of evidence 3
• Postural drainage and chest percussion - Benefits not proven for stable or exacerbated chronic bronchitis 1
• Long-term prophylactic antibiotics - Not recommended for stable chronic bronchitis 1

Preventive Measures

• Annual influenza vaccination and pneumococcal vaccinations 3, 7
• Pulmonary rehabilitation to improve exercise tolerance and quality of life 3
• Oxygen therapy for patients with significant hypoxemia 3
• Environmental exposure avoidance to reduce irritating inhalants 3

Common Pitfalls to Avoid

1. Overuse of antibiotics for acute bronchitis - most cases are viral and self-limiting 1, 2
2. Failure to distinguish between acute bronchitis, pneumonia, and exacerbation of chronic conditions 8
3. Missing heart failure as a cause of worsening symptoms in chronic bronchitis patients 7
4. Inadequate assessment of airflow obstruction - pulmonary function testing is important 7
5. Using theophylline during acute exacerbations - can worsen outcomes 1

Remember that patient communication is crucial - referring to acute bronchitis as a "chest cold" rather than "bronchitis" can reduce patient expectations for antibiotics 1, 2.