What is the treatment for bronchitis?

Treatment for Bronchitis

For acute bronchitis, antibiotics are not recommended as treatment since over 90% of cases are viral in nature. Instead, focus on symptomatic relief with bronchodilators for wheezing, cough suppressants for bothersome cough, and patient education about the expected 2-3 week duration. 1

Acute Bronchitis Treatment

First-Line Management

• Avoid antibiotics for uncomplicated acute bronchitis (Grade D recommendation) 1
• Patient education about:
  • Expected cough duration (2-3 weeks)
  • Viral nature of most cases
  • Risks of unnecessary antibiotic use 1
  • Referring to the condition as a "chest cold" rather than "bronchitis" to reduce antibiotic expectations 1

Symptomatic Relief

• Hydration and avoidance of respiratory irritants 1
• Short-term use of codeine or dextromethorphan for cough relief (Grade C recommendation) 1
• Bronchodilators only if wheezing is present (not routinely recommended) 1

Special Circumstances

• For suspected pertussis: macrolide antibiotics (e.g., erythromycin) with 5-day isolation (Grade A recommendation) 1
• Closer monitoring for patients with underlying conditions (COPD, heart failure, immunosuppression) or elderly patients (≥65 years) 1

Chronic Bronchitis Treatment

First-Line Management

• Avoidance of respiratory irritants (especially smoking cessation) - most effective intervention with 90% of patients experiencing cough resolution after smoking cessation 2
• Short-acting β-agonists to control bronchospasm, relieve dyspnea, and potentially reduce chronic cough (Grade A recommendation) 2
• Ipratropium bromide to improve cough (Grade A recommendation) 2

Second-Line Options

• Theophylline for cough control in stable patients with careful monitoring for complications (Grade A recommendation) 2
• Combined long-acting β-agonist and inhaled corticosteroid therapy for patients with severe airflow obstruction (FEV1 <50%) or frequent exacerbations 2

For Acute Exacerbations of Chronic Bronchitis

• Short-acting β-agonists or anticholinergic bronchodilators (Grade A recommendation) 2
• Antibiotics when at least two of the Anthonisen criteria are present (increased dyspnea, increased sputum volume, increased sputum purulence) 1
• Oral corticosteroids for short-term use 2
• Avoid theophylline during acute exacerbations (Grade D recommendation) 2

Important Considerations

Differential Diagnosis

• Rule out pneumonia, asthma, COPD exacerbation, and common cold 1
• Consider further evaluation if cough persists beyond 3 weeks or new symptoms develop 1

Common Pitfalls to Avoid

1. Unnecessary antibiotic use for viral bronchitis, which doesn't improve outcomes but increases antibiotic resistance risk 1, 3
2. Overreliance on sputum color to determine bacterial infection - green sputum does not reliably indicate bacterial infection 4
3. Failure to recognize underlying conditions that may require different management approaches 1
4. Not providing adequate patient education about expected course and duration of symptoms 1

Monitoring

• If symptoms worsen or persist beyond expected duration (2-3 weeks), reevaluate for possible complications or alternative diagnoses 1
• For chronic bronchitis patients using bronchodilators, monitor for anticholinergic effects, especially in those with moderate to severe renal impairment 5

By following these evidence-based recommendations, clinicians can effectively manage both acute and chronic bronchitis while avoiding unnecessary antibiotic use and focusing on symptom relief and patient education.