What is the treatment for bronchitis?

Treatment of Bronchitis

Antibiotics are not recommended for uncomplicated acute bronchitis as it is primarily a viral infection that resolves on its own within 2-3 weeks. 1 Instead, treatment should focus on symptomatic relief and patient education.

Types of Bronchitis and Treatment Approach

Acute Bronchitis

Acute bronchitis is a self-limiting condition typically lasting 2-3 weeks. Treatment should focus on:

1. Symptomatic therapy:

   • Bronchodilators: Albuterol has shown consistent benefit in reducing duration and severity of cough in randomized controlled trials 2
   • Cough suppressants: Dextromethorphan or codeine can be prescribed for patients with dry, bothersome cough, especially at night 2, 3
   • Avoid unnecessary medications: Expectorants, mucolytics, antihistamines should not be prescribed as they lack evidence of benefit 2, 1

2. Patient education:

   • Provide realistic expectations about cough duration (typically 10-14 days after office visit) 2
   • Refer to the condition as a "chest cold" rather than bronchitis to reduce expectation for antibiotics 2
   • Explain the viral nature of the infection and why antibiotics are not beneficial 1

Chronic Bronchitis

For chronic bronchitis (defined as cough with sputum production for at least 3 months per year during 2 consecutive years), treatment options include:

1. Long-term maintenance therapy:

   • LAMA (Long-acting muscarinic antagonists): Tiotropium is preferred due to its once-daily dosing 3, 4
   • LABA/ICS combinations: Such as salmeterol/fluticasone for reducing inflammation and improving symptoms 3, 5
   • LABA/LAMA combinations: Provide superior efficacy for patients with inadequate response to monotherapy 3

2. Lifestyle modifications:

   • Smoking cessation: Strongly recommended as it significantly improves symptoms 3
   • Hydration: Helps thin secretions 3
   • Avoiding irritants: Such as smoke and pollutants 3
   • Vaccinations: Annual influenza and pneumococcal vaccinations 3

Management of Acute Exacerbations of Chronic Bronchitis

For acute exacerbations of chronic bronchitis (AECB), treatment includes:

1. Supportive care for all patients:

   • Bronchodilators
   • Oxygen if needed
   • Hydration
   • Systemic corticosteroids (short course of 10-15 days) 3, 6

2. Antibiotics only when indicated:

   • Reserve for patients with at least one key symptom (increased dyspnea, sputum production, or purulence) AND one risk factor (age ≥65, severe lung function impairment, ≥4 exacerbations/year, or comorbidities) 3, 6
   • Options include newer macrolides, extended-spectrum cephalosporins, or doxycycline for moderate exacerbations 6
   • For severe exacerbations, use high-dose amoxicillin/clavulanate or a respiratory fluoroquinolone 6

Common Pitfalls to Avoid

1. Unnecessary antibiotic use: Antibiotics provide minimal benefit (reducing cough by only about half a day) while exposing patients to adverse effects including allergic reactions, nausea, vomiting, and C. difficile infection 7, 1

2. Failure to differentiate from other conditions: Ensure bronchitis is differentiated from pneumonia, asthma, COPD exacerbation, and pertussis, which may require specific therapies 8, 7

3. Inadequate patient education: Not explaining the expected course of illness can lead to patient dissatisfaction and unnecessary return visits 2

4. Overuse of ineffective treatments: Many over-the-counter cough and cold preparations lack evidence of efficacy 8

By focusing on symptomatic relief, appropriate use of bronchodilators for cough, and patient education about the expected course of illness, most cases of bronchitis can be effectively managed without antibiotics, leading to better outcomes and reduced antibiotic resistance.