What is the management protocol for bronchitis?

Bronchitis Management Protocol

The management of bronchitis should focus on symptom relief and avoidance of unnecessary antibiotics, as most cases are viral in origin and self-limiting, typically resolving within 2-3 weeks. 1

Diagnosis and Differentiation

• Acute bronchitis: Acute cough with/without sputum production lasting up to 3 weeks
• Chronic bronchitis: Productive cough on most days for 3 months over 2 consecutive years

Key Assessment Points:

• Rule out pneumonia: Absence of fever, tachycardia, tachypnea, and focal chest findings suggests bronchitis rather than pneumonia 1
• Differentiate from asthma, COPD exacerbation, and common cold
• Chest radiography typically not indicated in healthy adults without vital sign abnormalities or asymmetrical lung sounds 2
• Consider chest radiography if cough persists >3 weeks 2

Management Protocol for Acute Bronchitis

1. Patient Education

   • Explain viral etiology and expected duration (2-3 weeks)
   • Use term "chest cold" rather than "bronchitis" to reduce antibiotic expectations 1
   • Emphasize that colored sputum does not indicate need for antibiotics 3

2. Symptomatic Treatment

   • Hydration and avoidance of respiratory irritants 1
   • Short-acting β-agonists for bronchospasm and dyspnea relief 2
   • Consider short-term codeine or dextromethorphan for cough relief 1
   • Avoid expectorants - no evidence of effectiveness 2

3. Antibiotic Use

   • Routine antibiotic treatment is NOT recommended 2, 1
   • Antibiotics only reduce cough duration by approximately 0.5 days while exposing patients to adverse effects 4

Management Protocol for Chronic Bronchitis

1. Stable Chronic Bronchitis

   • Smoking cessation - most effective intervention (90% cough resolution) 2
   • Short-acting β-agonists for bronchospasm and dyspnea 2
   • Ipratropium bromide to improve cough 2
   • Consider theophylline with careful monitoring 2
   • For patients with FEV1 <50% or frequent exacerbations, add inhaled corticosteroids 2
   • Avoid long-term prophylactic antibiotics - no benefit 2
   • Avoid long-term oral corticosteroids - high risk of side effects 2

2. Acute Exacerbation of Chronic Bronchitis (AECB)

   • Characterized by worsening airflow and symptoms
   • Treatment with short-acting β-agonists or anticholinergic bronchodilators 2
   • If no prompt response, add the other agent at maximal dose 2
   • Short course (10-15 days) of systemic corticosteroids 2
   • Antibiotics indicated when at least two Anthonisen criteria present (increased dyspnea, sputum volume, and purulence) 1, 5
   • Avoid theophylline during exacerbations 2

Antibiotic Selection (When Indicated for AECB)

• First-line: Amoxicillin 1
• Alternatives for beta-lactam allergy: Macrolides, doxycycline 1
• For severe exacerbations: Amoxicillin-clavulanate or respiratory fluoroquinolone 5
• Azithromycin (500mg daily for 3 days) has shown 85% clinical cure rate for AECB 6

Special Considerations

• Patients with underlying conditions (COPD, heart failure, immunosuppression) or elderly patients require closer monitoring 1
• If pertussis is suspected, perform diagnostic testing and initiate appropriate antimicrobial therapy 2
• Reevaluate if cough persists beyond 3 weeks or new symptoms develop 1

Common Pitfalls to Avoid

• Prescribing antibiotics for uncomplicated acute bronchitis
• Using expectorants which lack evidence of effectiveness
• Failing to distinguish between acute bronchitis and pneumonia
• Overlooking the importance of smoking cessation in chronic bronchitis
• Using theophylline during acute exacerbations of chronic bronchitis

Remember that patient satisfaction depends more on effective communication about the condition and expected recovery time than on receiving antibiotics 1.