What is the treatment for bronchitis?

From the Guidelines

Bronchitis treatment typically involves managing symptoms while the body fights the infection, with a focus on avoiding respiratory irritants and using pharmacologic therapy as needed, as recommended by the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines 1.

Key Recommendations

• For acute bronchitis, rest, increased fluid intake, and over-the-counter medications like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can help reduce fever and relieve pain.
• A humidifier or steam from a hot shower can loosen mucus, and over-the-counter expectorants containing guaifenesin (such as Mucinex) at 600-1200mg every 12 hours can help thin secretions.
• For cough relief, dextromethorphan (found in Robitussin DM) at 10-20mg every 4 hours or codeine-containing medications may be used short-term.
• Antibiotics are generally not recommended for acute bronchitis as it's usually viral, unless there's evidence of bacterial infection, as stated in the ACCP guidelines 1.

Chronic Bronchitis Treatment

• For chronic bronchitis, inhaled bronchodilators like albuterol (2 puffs every 4-6 hours as needed) and corticosteroids may be prescribed, as recommended by the ACCP guidelines 1.
• Severe cases might require oral steroids like prednisone (typically 40mg daily for 5 days).
• Smoking cessation is crucial for recovery as continued smoking irritates the bronchial tubes and prolongs healing time, with 90% of patients experiencing resolution of their cough after smoking cessation 1.

Additional Considerations

• Patient satisfaction with care for acute bronchitis depends most on physician–patient communication rather than whether an antibiotic is prescribed, as noted in the principles of appropriate antibiotic use for treatment of uncomplicated acute bronchitis 1.
• The use of pharmacologic therapy, such as short-acting β-agonists and anticholinergic bronchodilators, can help control bronchospasm and relieve dyspnea in patients with chronic bronchitis, as recommended by the ACCP guidelines 1.

From the FDA Drug Label

Tiotropium bromide inhalation powder is indicated for the long-term, once-daily, maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. Roflumilast tablet is a selective phosphodiesterase 4 inhibitor indicated as a treatment to reduce the risk of COPD exacerbations in patients with severe COPD associated with chronic bronchitis and a history of exacerbations. In a randomized, double-blind controlled clinical trial of acute exacerbation of chronic bronchitis (AECB), azithromycin (500 mg once daily for 3 days) was compared with clarithromycin (500 mg twice daily for 10 days).

The treatment for bronchitis may include:

• Tiotropium bromide for long-term maintenance treatment of bronchospasm associated with COPD, including chronic bronchitis 2
• Roflumilast to reduce the risk of COPD exacerbations in patients with severe COPD associated with chronic bronchitis and a history of exacerbations 3
• Azithromycin for acute bacterial exacerbations of chronic bronchitis (AECB) 4

From the Research

Treatment Options for Bronchitis

• Therapy for acute bronchitis is generally supportive 5
• Antimicrobial agents and vaccines may have both prophylactic and therapeutic roles in the management of chronic bronchitis 5
• Amoxicillin and clavulanic acid combination has been shown to be effective in treating pulmonary infections, including exacerbations of chronic bronchitis 6, 7
• Azithromycin has been compared to co-amoxiclav in the treatment of acute tracheobronchitis and acute infectious exacerbations of chronic bronchitis, with azithromycin producing a significantly higher cure rate 8
• Macrolides, quinolones, and amoxicillin/clavulanate may be considered equivalent for the treatment of patients with an acute bacterial exacerbation of chronic bronchitis in terms of short-term effectiveness 9

Antibiotic Treatment

• Amoxycillin/clavulanate has been shown to be effective in treating acute purulent exacerbations of chronic bronchitis associated with Haemophilus influenzae, Streptococcus pneumoniae, or beta-lactamase producing Branhamella catarrhalis 7
• Quinolones have been associated with better microbiological success and fewer recurrences of acute bacterial exacerbation of chronic bronchitis than macrolides 9
• Amoxicillin/clavulanate is associated with more adverse effects than quinolones, mainly diarrhoea 9

Comparison of Treatments

• Azithromycin has been shown to have a higher cure rate and fewer failures and relapses compared to co-amoxiclav in the treatment of acute tracheobronchitis and acute infectious exacerbations of chronic bronchitis 8
• Macrolides, quinolones, and amoxicillin/clavulanate have been compared in terms of treatment success, with no significant difference between the three 9