What is the treatment for bronchitis?

From the Guidelines

Bronchitis treatment should focus on symptom relief and managing the underlying condition, with the most recent and highest quality study suggesting no routine prescription of antibiotic therapy, antiviral therapy, antitussives, inhaled beta agonists, inhaled anticholinergics, inhaled corticosteroids, oral corticosteroids, or oral NSAIDs for acute bronchitis in immunocompetent adult outpatients 1.

Key Considerations

• For acute bronchitis, treatment focuses on symptom relief with over-the-counter medications like acetaminophen or ibuprofen for pain and fever, and guaifenesin to thin mucus.
• Adults can take dextromethorphan for cough, typically 10-20 mg every 4 hours as needed.
• Staying hydrated, using a humidifier, and avoiding irritants like smoke are essential.
• Antibiotics are generally not recommended for acute bronchitis unless there's evidence of bacterial infection.

Chronic Bronchitis Management

• Treatment may include bronchodilators like albuterol (2 puffs every 4-6 hours), inhaled corticosteroids, and possibly oxygen therapy in severe cases.
• Pulmonary rehabilitation and smoking cessation are crucial for long-term management.
• According to the ACCP evidence-based clinical practice guidelines, therapy with short-acting β-agonists, ipratropium bromide, and theophylline may improve cough in patients with chronic bronchitis 1.

Important Notes

• Most acute bronchitis cases resolve within 1-3 weeks, but chronic bronchitis requires ongoing management.
• Seek medical attention if experiencing severe symptoms like high fever, difficulty breathing, or coughing up blood, as these may indicate a more serious condition requiring different treatment.
• The use of prophylactic antibiotics, oral corticosteroids, expectorants, postural drainage, or chest physiotherapy is not recommended for chronic bronchitis 1.

From the FDA Drug Label

For the 304 patients analyzed in the modified intent to treat analysis at the Day 21 to 24 visit, the clinical cure rate for 3 days of azithromycin was 85% (125/147) compared to 82% (129/157) for 10 days of clarithromycin 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. STIOLTO RESPIMAT is a combination of tiotropium bromide and olodaterol indicated for long-term, once-daily maintenance treatment of patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema

The treatment for bronchitis includes:

• Azithromycin: a 3-day course of azithromycin may be effective in treating acute bacterial exacerbations of chronic bronchitis, with a clinical cure rate of 85% 2
• Roflumilast: may be used to reduce the risk of COPD exacerbations in patients with severe COPD associated with chronic bronchitis and a history of exacerbations 3
• Tiotropium: as part of the combination therapy STIOLTO RESPIMAT, may be used for long-term, once-daily maintenance treatment of patients with COPD, including chronic bronchitis 4

From the Research

Treatment Options for Bronchitis

• The treatment for bronchitis depends on the causative pathogen and the presence or absence of underlying lung disease 5
• Simple bronchitis is best treated symptomatically, while an exacerbation of chronic bronchitis can be treated with antibiotics, such as broad spectrum antibiotics in selected patients 6
• Acute bronchitis is usually caused by a virus and is typically treated symptomatically, with a sore throat treated locally and a troublesome cough treated with antitussive agents for a limited period 7
• Management of chronic bronchitis consists primarily in the elimination of the causative noxae, such as cigarette smoking, and treatment with antibiotics only when there is a bacteriological infection of the upper or lower airways in an acute stage 7

Use of Antibiotics

• Antibiotics are generally not indicated for bronchitis, except in cases where pertussis is suspected or the patient is at increased risk of developing pneumonia, such as patients 65 years or older 8
• Broad spectrum antibiotics may be appropriate in selected patients with an exacerbation of chronic bronchitis 6
• Azithromycin may be used in the treatment of acute exacerbations of COPD, with a focus on short-term therapy, such as 3-day or single-day therapy 9

Symptomatic Treatment

• Symptoms of bronchitis typically last about three weeks and can be managed with symptomatic treatment, such as antitussive agents and secretolytic or mucolytic substances 7, 8
• The supplement pelargonium may help reduce symptom severity in adults with acute bronchitis 8