What is the treatment for bronchitis?

Treatment of Bronchitis

The most effective treatment for bronchitis depends on whether it is acute or chronic, with avoidance of respiratory irritants being the cornerstone of therapy for chronic bronchitis.

Acute Bronchitis Treatment

Acute bronchitis is primarily a self-limiting viral condition that resolves without specific treatment in most cases.

First-Line Management:

• Symptomatic relief measures:

  • Adequate hydration
  • Avoidance of respiratory irritants
  • Patient education about expected cough duration (2-3 weeks) 1

• No routine antibiotics: Antibiotics are not recommended for routine use in acute bronchitis as they provide minimal benefit while carrying risks of side effects 1, 2

For Patients with Wheezing:

• Short-acting β-agonist bronchodilators (e.g., albuterol) as initial therapy 1
• Assess response after 2-3 days
• If wheezing persists despite bronchodilator therapy, consider adding an inhaled corticosteroid 1

For Troublesome Cough:

• Antitussives such as codeine or dextromethorphan may provide short-term symptomatic relief 1

Chronic Bronchitis Treatment

First-Line Interventions:

• Avoidance of respiratory irritants is the most effective treatment - smoking cessation results in 90% resolution of cough 3, 1
• No long-term prophylactic antibiotics in stable patients 3

Pharmacologic Management for Stable Chronic Bronchitis:

1. Short-acting bronchodilators:

   • Short-acting β-agonists for bronchospasm, dyspnea, and cough reduction 3
   • Ipratropium bromide to improve cough 3

2. Consider theophylline to control chronic cough (with careful monitoring for complications) 3

3. For patients with FEV1 <50% or frequent exacerbations:

   • Long-acting β-agonist combined with inhaled corticosteroid 3

For Acute Exacerbation of Chronic Bronchitis:

An acute exacerbation is characterized by:

• Increased sputum volume
• Increased sputum purulence
• Worsening shortness of breath 3, 4

Treatment includes:

1. Short-acting bronchodilators:

   • β-agonists or anticholinergic agents
   • If no prompt response, add the other agent at maximal dose 3

2. Antibiotics are recommended, particularly for:

   • Patients with severe exacerbations
   • Those with more severe baseline airflow obstruction 3, 4

3. Avoid theophylline during acute exacerbations 3

Important Considerations

Not Recommended:

• Expectorants (no proven benefit) 3
• Postural drainage and chest percussion (benefits not proven) 3
• Theophylline during acute exacerbations 3

Patient Education:

• Refer to acute bronchitis as a "chest cold" to reduce antibiotic expectations 1
• Explain the expected duration of symptoms (2-3 weeks) 1, 2
• Advise patients to seek reassessment if:
  • Cough persists beyond 3 weeks
  • Symptoms worsen
  • New symptoms develop suggesting bacterial infection 1

Special Populations:

• Patients with underlying conditions (COPD, heart failure, immunosuppression) or elderly patients require closer monitoring 1
• For patients with COPD, medications like tiotropium or salmeterol/fluticasone combinations are indicated for maintenance treatment, not for acute exacerbations 5, 6

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