What are the treatment options for bronchitis?

Treatment Options for Bronchitis

Antibiotics are not recommended for uncomplicated acute bronchitis as they provide minimal benefit that does not outweigh potential harms. 1

Acute Bronchitis Treatment

Definition and Diagnosis

• Acute bronchitis is a self-limiting respiratory infection lasting up to 3 weeks
• Characterized by cough with or without phlegm production
• Normal chest radiograph (distinguishing it from pneumonia)
• Primarily caused by respiratory viruses (>90% of cases) 1, 2

First-Line Treatment Approach

1. Symptomatic relief and patient education

   • Inform patients that cough typically lasts 10-14 days after the office visit 1
   • Refer to the condition as a "chest cold" rather than bronchitis to reduce antibiotic expectations 1
   • Explain that antibiotics do not significantly improve outcomes 2

2. Bronchodilators

   • Albuterol has demonstrated consistent benefit in randomized controlled trials for reducing cough duration and severity 1
   • Approximately 50% fewer patients report cough after 7 days of treatment 1

3. Antitussives for bothersome cough

   • Dextromethorphan or codeine can be prescribed for dry, bothersome cough, especially at night 1
   • These agents have modest effects on severity and duration of cough 1

4. Environmental modifications

   • Elimination of environmental cough triggers (dust, dander)
   • Vaporized air treatments in low-humidity environments 1
   • Adequate hydration

What NOT to Use

• Antibiotics - not justified for uncomplicated acute bronchitis 1, 2
• Expectorants, mucolytics, antihistamines - lack consistent evidence for beneficial effects 1
• Inhaled bronchodilators - not shown to have relevant beneficial effects in uncomplicated acute cough 1

Chronic Bronchitis Treatment

When Antibiotics Are Indicated

Antibiotics should be reserved for patients with:

1. At least one key symptom:

   • Increased dyspnea
   • Increased sputum production
   • Sputum purulence

2. AND at least one risk factor:

   • Age ≥65 years
   • FEV₁ <50% predicted
   • ≥4 exacerbations per year
   • Significant comorbidities 1, 3

Antibiotic Selection for Exacerbations

• Moderate exacerbation: Newer macrolide (e.g., azithromycin), extended-spectrum cephalosporin, or doxycycline 3
• Severe exacerbation: High-dose amoxicillin/clavulanate or respiratory fluoroquinolone 3

Long-Term Management for Chronic Bronchitis

1. Bronchodilator therapy

   • Anticholinergic agents (e.g., ipratropium bromide) as first-line treatment 4
   • Short-acting β2-agonists (e.g., albuterol) for bronchospasm control 4

2. Combination therapy

   • Long-acting beta-agonist with inhaled corticosteroid for patients with:
     • FEV₁ <50% predicted
     • Frequent exacerbations 4

3. Non-pharmacological interventions

   • Smoking cessation (highest priority) - 90% of patients will have resolution of cough after smoking cessation 1, 4
   • Annual influenza and pneumococcal vaccinations 4
   • Avoidance of environmental irritants 4

Special Considerations

Acute Exacerbations of Chronic Bronchitis

• Short course of systemic corticosteroids 4
• Increased frequency of bronchodilators 4
• Antibiotics if purulent sputum is present 4

Common Pitfalls to Avoid

1. Prescribing antibiotics for uncomplicated acute bronchitis
2. Failing to distinguish between acute bronchitis, pneumonia, and exacerbation of chronic conditions
3. Not providing adequate patient education about expected duration of symptoms
4. Using ineffective treatments like expectorants or mucolytics
5. Not addressing smoking cessation in patients with chronic bronchitis

Remember that acute bronchitis is self-limiting, and patient satisfaction depends more on the quality of communication than on receiving antibiotics 1. Explaining the expected course of illness and providing effective symptomatic relief are key to successful management.