What is the difference in treatment between bronchitis and asthma?

Difference Between Bronchitis and Asthma: Treatment Approaches

The key difference in treatment between bronchitis and asthma is that bronchitis primarily requires symptomatic management without antibiotics (as it's usually viral), while asthma requires anti-inflammatory and bronchodilator therapy to control underlying airway inflammation and bronchoconstriction.

Diagnostic Distinctions

Acute Bronchitis

• Definition: An acute respiratory infection manifested by cough with/without phlegm production lasting up to 3 weeks 1
• Key features:
  • Self-limited respiratory disorder (typically resolves in 2-3 weeks)
  • Normal chest radiograph
  • Absence of pneumonia, asthma, or COPD exacerbation 2
  • Primarily viral etiology (>90% of cases) 2

Asthma

• Definition: Chronic inflammatory disorder of airways characterized by:
  • Variable airflow obstruction
  • Airway hyperresponsiveness
  • Eosinophilic airway inflammation 3
• Key features:
  • Persistent or recurrent symptoms
  • Wheezing, cough, shortness of breath
  • Symptoms worsen at night or with triggers (cold air, exercise)
  • Responds to bronchodilator treatment 1

Treatment Approaches

Acute Bronchitis Treatment

1. Antibiotics:

   • NOT recommended for uncomplicated acute bronchitis (Grade D recommendation) 2
   • Exception: Suspected pertussis requires macrolide antibiotics with 5-day isolation 2

2. Symptomatic relief:

   • Hydration
   • Avoidance of respiratory irritants
   • Short-term use of codeine or dextromethorphan for cough (Grade C recommendation) 2
   • Bronchodilators only if wheezing is present (not routine) 2

3. Patient education:

   • Explain typical cough duration (2-3 weeks)
   • Clarify viral nature of illness
   • Refer to condition as "chest cold" rather than "bronchitis" to reduce antibiotic expectations 2

Asthma Treatment

1. Anti-inflammatory therapy:

   • Inhaled corticosteroids - cornerstone of treatment for persistent asthma 3
   • Targets eosinophilic airway inflammation

2. Bronchodilators:

   • Short-acting beta-agonists for rescue/symptom relief
   • Long-acting beta-agonists for maintenance therapy (in combination with ICS)

3. Additional therapies for specific phenotypes:

   • Leukotriene modifiers
   • Theophylline
   • Biologics for severe asthma 4

4. Long-term management:

   • Regular monitoring
   • Step-up/step-down approach based on symptom control
   • Trigger avoidance

Special Considerations

Cough-Variant Asthma

• Presents with persistent cough (>2-3 weeks) without typical wheezing 1
• Diagnosis relies on:
  • Improvement with bronchodilator treatment
  • Positive methacholine challenge test 1
• Treatment: Similar to typical asthma with inhaled corticosteroids 3

Nonasthmatic Eosinophilic Bronchitis

• Shares eosinophilic airway inflammation with asthma
• Lacks airway hyperresponsiveness and variable airflow obstruction 3
• Treatment: Responds well to inhaled corticosteroids 3

Chronic Bronchitis with Exacerbations

• Antibiotics indicated only when at least two Anthonisen criteria present:
  • Increased dyspnea
  • Increased sputum volume
  • Increased sputum purulence 1
• Treatment options:
  • First-line: Amoxicillin for infrequent exacerbations
  • Second-line: Amoxicillin-clavulanate for frequent exacerbations 2

Common Pitfalls and Caveats

1. Misdiagnosis: Studies show acute asthma was misdiagnosed as acute bronchitis in approximately one-third of patients presenting with acute cough 1

2. Purulent sputum misconception: Many believe purulent sputum indicates bacterial infection requiring antibiotics, but purulence can result from either viral or bacterial infection 1

3. Recurrent "bronchitis": For patients with ≥2 similar doctor-diagnosed episodes of acute bronchitis in 5 years, 65% can be identified as having mild asthma 1

4. Persistent cough: When cough persists >3 weeks, consider other diagnoses including:

   • Postinfectious cough
   • Upper airway cough syndrome
   • Asthma
   • Gastroesophageal reflux disease 1

5. Antibiotic overuse: Despite evidence against it, acute bronchitis remains one of the most common reasons for inappropriate antibiotic prescriptions 5