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 rest, increased fluid intake, and over-the-counter medications like acetaminophen or ibuprofen for fever and discomfort, and antibiotics are generally not recommended unless there's evidence of a bacterial infection. For acute bronchitis, which is usually viral, treatment focuses on relieving symptoms, such as:

• Using a humidifier or steam from a hot shower to loosen mucus
• Over-the-counter cough suppressants containing dextromethorphan (such as Robitussin DM) for severe coughing, especially at night
• Expectorants with guaifenesin to help thin mucus According to the most recent clinical guidelines for management of acute uncomplicated bronchitis, routine antibiotic treatment is not recommended in the absence of pneumonia 1, 2, 3. For chronic bronchitis, treatment may include:
• Bronchodilators like albuterol (2 puffs every 4-6 hours as needed) to control bronchospasm and relieve dyspnea
• Inhaled corticosteroids to reduce inflammation
• Possibly antibiotics during flare-ups, as they have been shown to shorten the course of the illness, especially in patients with purulent sputum and more severe airflow obstruction at baseline 4, 5 Smoking cessation is crucial for recovery, as continued smoking worsens bronchitis and delays healing. Patients should seek medical attention if symptoms worsen, if fever exceeds 100.4°F (38°C), if there's shortness of breath, or if symptoms persist beyond three weeks, as these could indicate pneumonia or another serious condition. It's essential to note that the presence of purulent sputum or a change in its color does not signify bacterial infection; purulence is due to the presence of inflammatory cells or sloughed mucosal epithelial cells 1. The most effective way to reduce or eliminate cough in patients with chronic bronchitis and persistent exposure to respiratory irritants is avoidance, and therapy with a short-acting inhaled β-agonist, inhaled ipratropium bromide, and oral theophylline may improve cough in patients with chronic bronchitis 6. In patients with an acute exacerbation of chronic bronchitis, therapy with short-acting β-agonists or anticholinergic bronchodilators should be administered during the acute exacerbation, and oral antibiotics and oral corticosteroids (or in severe cases IV corticosteroids) may be useful, but their effects on cough have not been systematically evaluated 4, 5. Central cough suppressants such as codeine and dextromethorphan are recommended for short-term symptomatic relief of coughing 6, 7. The choice of antibiotic is based on respiratory status and frequency of exacerbations, and other bronchial pathology (asthma, bronchiectasis) should be identified and not mistaken for chronic bronchitis 8. The presence of at least two of the three Anthonisen triad criteria is suggestive of bacterial origin, and antibiotic therapy is usually limited to patients suffering from an obstructive syndrome 8.

From the FDA Drug Label

Theophylline is indicated for the treatment of the symptoms and reversible airflow obstruction associated with chronic asthma and other chronic lung diseases, e.g., emphysema and chronic bronchitis. The treatment for bronchitis includes the use of theophylline to manage symptoms and reversible airflow obstruction associated with chronic bronchitis 9.

• Theophylline is a relatively weak bronchodilator and is less effective than an inhaled beta-2 selective agonist.
• For acute bronchodilatation, an inhaled beta-2 selective agonist, alone or in combination with a systemically administered corticosteroid, is the most effective treatment.
• Azithromycin is used to treat acute bacterial exacerbations of chronic bronchitis (AECB), with a clinical cure rate of 85% at Day 21 to 24 10.
• The most common side effects of azithromycin are diarrhea, nausea, and abdominal pain.

From the Research

Treatment for Bronchitis

The treatment for bronchitis varies depending on the type and severity of the condition.

• For acute bronchitis, symptomatic treatment with protussives, antitussives, or bronchodilators is appropriate, as it is often caused by a viral infection 11.
• Antibiotics are generally not recommended for acute bronchitis, as they have been shown to be ineffective and can contribute to antibiotic resistance 11, 12.
• For chronic bronchitis, supportive care such as removal of irritants, use of a bronchodilator, oxygen, hydration, and chest physical therapy may be provided 13.
• Antibacterial treatment may be reserved for patients with chronic bronchitis who have at least one key symptom and one risk factor, such as increased dyspnea, sputum production, or purulence, and risk factors like age over 65 or forced expiratory volume in one second less than 50% of the predicted value 13.
• Mucoregulators may be prescribed by general practitioners for patients with acute bronchitis or acute exacerbations of chronic bronchitis, as they are believed to be effective and well-tolerated 12.
• Evidence-based therapy for acute bronchitis includes symptomatic treatment of cough, with options such as antitussive agents, protussive agents, and beta-2-agonists 14.