What is the treatment for bronchitis?

Treatment for Bronchitis

The most effective treatment for bronchitis depends on whether it is acute or chronic, with avoidance of respiratory irritants being the cornerstone of treatment for chronic bronchitis, while most cases of acute bronchitis are viral and do not require antibiotics. 1, 2

Differentiating Acute vs. Chronic Bronchitis

Acute Bronchitis

• Defined as an acute respiratory infection with cough lasting up to 3 weeks
• Typically self-limited, resolving in 2-3 weeks
• Usually viral in origin (>90% of cases)
• Normal chest radiograph
• Absence of fever, tachycardia, tachypnea, or focal chest findings 2, 3

Chronic Bronchitis

• Defined as cough and sputum production occurring on most days for at least 3 months of the year and for at least 2 consecutive years
• Often associated with smoking or other respiratory irritants
• May progress to COPD with airflow limitation 1

Treatment for Acute Bronchitis

1. Antibiotics are generally NOT recommended

   • Most cases (>90%) are viral in origin
   • Antibiotics only decrease cough duration by approximately 0.5 days
   • Risks of antibiotics outweigh benefits for uncomplicated cases 2, 4, 3

2. Patient education

   • Inform patients about the typical cough duration (2-3 weeks)
   • Explain the viral nature of most cases
   • Refer to the condition as a "chest cold" rather than "bronchitis" to reduce antibiotic expectations 2

3. Symptomatic relief measures

   • Adequate hydration
   • Avoidance of respiratory irritants
   • Short-term use of codeine or dextromethorphan for cough relief 2, 5
   • Consider bronchodilators only if wheezing is present 2

Treatment for Chronic Bronchitis

1. Avoidance of respiratory irritants

   • Smoking cessation is the most effective intervention
   • 90% of patients will have resolution of cough after smoking cessation
   • Avoid passive smoke exposure and workplace hazards 1

2. Bronchodilator therapy

   • Short-acting β-agonists to control bronchospasm, relieve dyspnea, and reduce cough
   • Ipratropium bromide to improve cough
   • Consider theophylline to control chronic cough (with careful monitoring for complications) 1

3. Inhaled corticosteroids

   • Combined with long-acting β-agonists for cough control
   • Particularly indicated for patients with FEV1 <50% predicted or frequent exacerbations 1

4. Treatment of acute exacerbations

   • Short-acting β-agonists or anticholinergic bronchodilators
   • Add the other agent if no prompt response to the first
   • Antibiotics are recommended for exacerbations with increased dyspnea, sputum volume, and purulence 1, 6
   • Theophylline should NOT be used during acute exacerbations 1

Antibiotic Use in Bronchitis

When to use antibiotics:

• Acute bronchitis: Generally not indicated unless pertussis is suspected
• Chronic bronchitis exacerbation: Indicated when at least two Anthonisen criteria are present (increased dyspnea, sputum volume, and purulence) 1, 2, 6

Antibiotic options when indicated:

• Amoxicillin is the preferred first-line option
• Macrolides, doxycycline as alternatives for beta-lactam allergy
• For severe exacerbations: amoxicillin-clavulanate or respiratory fluoroquinolones 2, 6

What NOT to Use

1. For stable chronic bronchitis:

   • Long-term prophylactic antibiotics
   • Postural drainage and chest percussion
   • Expectorants 1

2. For acute exacerbations of chronic bronchitis:

   • Theophylline
   • Postural drainage and chest percussion 1

Special Considerations

• Patients with underlying conditions (COPD, heart failure, immunosuppression) or elderly patients require closer monitoring
• If cough persists beyond 3 weeks or new symptoms develop, further evaluation is necessary 2

Common Pitfalls to Avoid

1. Overuse of antibiotics for acute bronchitis, which contributes to antibiotic resistance
2. Mistaking other conditions (pneumonia, asthma, COPD exacerbation) for simple bronchitis
3. Focusing only on medications rather than addressing underlying causes like smoking
4. Failing to recognize when bronchitis is part of a more serious condition requiring different treatment

By following these evidence-based approaches, the treatment of bronchitis can be optimized to improve outcomes while avoiding unnecessary interventions.