What is the treatment for bronchitis?

Treatment for Bronchitis

The treatment for bronchitis should focus on symptom management, with antibiotics reserved only for specific cases of acute exacerbations of chronic bronchitis with clear indicators of bacterial infection. 1, 2

Types of Bronchitis and Treatment Approaches

Acute Bronchitis

• First-line treatment: Supportive care only, as this is primarily a self-limiting viral condition 2

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

• Antibiotics: NOT recommended for routine use in acute bronchitis in otherwise healthy adults 2, 3, 4

  • Provide minimal benefit (may decrease cough duration by only 0.5 days)
  • Expose patients to unnecessary adverse effects
  • Contribute to antibiotic resistance

• For troublesome cough: Antitussives such as codeine or dextromethorphan may provide short-term symptomatic relief 2

• For patients with wheezing: Short-acting β-agonist bronchodilators (e.g., albuterol) are recommended 2

  • Assess response after 2-3 days
  • If wheezing persists, consider adding an inhaled corticosteroid

Chronic Bronchitis

• Most effective intervention: Avoidance of respiratory irritants, particularly smoking cessation (90% of patients will have resolution of cough after quitting smoking) 1, 2

• Bronchodilator therapy:

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

• Anti-inflammatory therapy:

  • Long-acting β-agonist combined with inhaled corticosteroid for chronic cough control 1
  • Inhaled corticosteroids for patients with FEV1 <50% predicted or frequent exacerbations 1

• NOT recommended for stable chronic bronchitis:

  • Long-term prophylactic antibiotics 1
  • Expectorants 1
  • Postural drainage and chest percussion 1
  • Oral corticosteroids for long-term use 1

Acute Exacerbation of Chronic Bronchitis (AECB)

• Criteria for antibiotic use: Patient should have at least one key symptom (increased dyspnea, sputum volume, or sputum purulence) AND one risk factor (age ≥65 years, FEV1 <50% predicted, ≥4 exacerbations in 12 months, or comorbidities) 1, 5

• Antibiotic selection:

  • Moderate severity: Newer macrolide, extended-spectrum cephalosporin, or doxycycline 5
  • Severe exacerbation: High-dose amoxicillin/clavulanate or a respiratory fluoroquinolone 5

• Bronchodilator therapy: Short-acting β-agonists or anticholinergic bronchodilators 1

  • If no prompt response, add the other agent at maximal dose

• Corticosteroids: Short course of systemic corticosteroids for exacerbations 1

• NOT recommended during exacerbations:

  • Theophylline 1
  • Mucokinetic agents 1
  • Postural drainage and chest percussion 1

Special Considerations

• Patient education:

  • Explain the typical cough duration (2-3 weeks for acute bronchitis)
  • Describe the condition as a "chest cold" rather than "bronchitis" to reduce antibiotic expectations 2
  • Advise on when to seek reassessment (cough persisting beyond 3 weeks, worsening symptoms, new symptoms suggesting bacterial infection) 2

• Roflumilast: Only indicated to reduce the risk of COPD exacerbations in patients with severe COPD associated with chronic bronchitis and a history of exacerbations; NOT indicated for acute bronchospasm relief 6

• Monitoring: For chronic bronchitis patients, regularly monitor weight as unexplained weight loss may occur and require evaluation 1

Common Pitfalls to Avoid

1. Prescribing antibiotics for acute bronchitis without clear indications
2. Failing to recommend smoking cessation as the primary intervention for chronic bronchitis
3. Using theophylline during acute exacerbations of chronic bronchitis
4. Relying on sputum color to differentiate between viral and bacterial infections 3
5. Using expectorants without evidence of benefit
6. Not distinguishing between acute bronchitis and other conditions like pneumonia, asthma, or COPD exacerbation 2, 3

By following these evidence-based recommendations, clinicians can effectively manage bronchitis while avoiding unnecessary treatments and potential complications.