What is the treatment for bronchitis?

Treatment for Bronchitis

For acute bronchitis, antibiotics are not recommended as they provide minimal benefit while carrying risks of side effects. Instead, focus on symptomatic relief measures including hydration, avoidance of respiratory irritants, and consideration of bronchodilators for patients with wheezing. 1

Types of Bronchitis and Treatment Approaches

Acute Bronchitis

Acute bronchitis is a self-limiting condition typically lasting about 3 weeks, characterized by acute cough with or without phlegm production.

First-line Management:

• Symptomatic relief measures:
  • Adequate hydration
  • Avoidance of respiratory irritants
  • Rest

Medication Options:

• Short-acting β-agonists - For bronchospasm and dyspnea relief 1
• Short-term cough suppressants - Codeine or dextromethorphan may provide symptomatic relief 1
• NOT recommended:
  • Antibiotics (unless pertussis is suspected) 1, 2
  • Expectorants (lack evidence of effectiveness) 1
  • Antitussives, honey, antihistamines, anticholinergics, NSAIDs, or corticosteroids (insufficient evidence) 3

Patient Education:

• Inform patients about typical cough duration (2-3 weeks)
• Explain the viral nature of most cases
• Discuss risks of unnecessary antibiotic use
• Refer to the condition as a "chest cold" rather than "bronchitis" to reduce antibiotic expectations 1

Chronic Bronchitis

Chronic bronchitis is defined as cough and sputum expectoration occurring on most days for at least 3 months of the year and for at least 2 consecutive years.

First-line Management:

• Smoking cessation - Most effective intervention, resulting in 90% cough resolution 4
• Avoidance of respiratory irritants - Including passive smoke exposure and workplace hazards 4

Medication Options for Stable Chronic Bronchitis:

• Short-acting β-agonists - For bronchospasm, dyspnea relief, and may reduce chronic cough 4
• Ipratropium bromide - Improves cough 4
• Theophylline - May control chronic cough (requires careful monitoring for complications) 4
• Long-acting β-agonist with inhaled corticosteroid - For cough control 4
• Inhaled corticosteroids - For patients with FEV1 <50% or frequent exacerbations 4
• NOT recommended:
  • Long-term prophylactic antibiotics 4
  • Oral corticosteroids 4
  • Expectorants 4
  • Postural drainage and chest percussion 4

Acute Exacerbation of Chronic Bronchitis (AECB)

Characterized by sudden clinical deterioration with increased sputum volume, purulence, and/or worsening shortness of breath.

Treatment:

• Short-acting β-agonists or anticholinergic bronchodilators - First-line treatment 4
• Antibiotics - Recommended for patients with:
  • At least one key symptom (increased dyspnea, sputum production, sputum purulence) AND
  • At least one risk factor (age ≥65 years, FEV1 <50% predicted, ≥4 AECBs in 12 months, or comorbidities) 5
• Antibiotic selection:
  • Moderate severity: Newer macrolide, extended-spectrum cephalosporin, or doxycycline
  • Severe exacerbation: High-dose amoxicillin/clavulanate or respiratory fluoroquinolone 5
• Oral corticosteroids - For severe exacerbations or when airflow obstruction is moderately severe 6
• NOT recommended:
  • Theophylline 4
  • Postural drainage and chest percussion 4

Common Pitfalls and Caveats

1. Misdiagnosis: Ensure bronchitis is differentiated from pneumonia, asthma, COPD exacerbation, and common cold based on symptoms and examination findings 1

2. Unnecessary antibiotic use: Colored sputum (e.g., green) does not reliably differentiate between bacterial and viral infections 2

3. Overlooking underlying conditions: Consider heart failure as a cause of progressive shortness of breath, cough, and increasing sputum production, especially in patients with known heart disease 6

4. Inadequate assessment of airflow obstruction: Routine pulmonary function testing is important in smoking patients, as physical examination alone may underestimate obstruction 6

5. Overuse of antibiotics for AECB: Antibiotics should be reserved for patients with at least two of the three cardinal symptoms (increased dyspnea, increased sputum production, increased purulent sputum) 6

By following these evidence-based recommendations, clinicians can provide effective management for both acute and chronic bronchitis while avoiding unnecessary treatments that may cause harm.