What is the treatment for bronchitis?

Treatment of Bronchitis

The treatment of bronchitis should focus on symptomatic relief measures and avoidance of respiratory irritants, with antibiotics reserved only for acute exacerbations of chronic bronchitis when specific criteria are met. 1

Distinguishing Types of Bronchitis

Acute Bronchitis

• Defined as acute lower respiratory tract infection with cough lasting up to 3 weeks
• Normal chest radiograph with absence of fever, tachycardia, tachypnea, or focal chest findings
• Primarily viral in origin (>90% of cases) 2, 3

Chronic Bronchitis

• Productive cough on most days for 3 months over 2 consecutive years
• Often associated with irreversible reduction in airflow 4

First-Line Interventions

For All Bronchitis Patients

• Smoking cessation is the most effective intervention, resulting in 90% cough resolution 5, 1
• Avoidance of all respiratory irritants 5, 1
• Adequate hydration 1

Symptomatic Relief

• Short-acting β-agonists (e.g., albuterol) for patients with wheezing or bronchospasm 5, 1
• Antitussives (codeine or dextromethorphan) may provide short-term relief for troublesome cough 1

Management of Acute Bronchitis

1. Antibiotics are generally NOT indicated 1, 2, 3

   • May only decrease cough duration by approximately 0.5 days 2
   • Exposes patients to unnecessary antibiotic-related adverse effects

2. Patient education is crucial:

   • Explain expected cough duration (2-3 weeks) 1, 2
   • Refer to the condition as a "chest cold" rather than "bronchitis" to reduce antibiotic expectations 1
   • Emphasize the viral nature of most cases 1, 2

3. Not recommended therapies:

   • Expectorants have no proven benefit 5
   • Postural drainage and chest percussion have not shown clinical benefits 5

Management of Chronic Bronchitis

Stable Chronic Bronchitis

1. Bronchodilator therapy:

   • Short-acting β-agonists to control bronchospasm and relieve dyspnea 5
   • Ipratropium bromide to improve cough 5
   • Theophylline may be considered to control chronic cough (with careful monitoring for complications) 5

2. Inhaled corticosteroids:

   • Recommended for patients with FEV1 <50% predicted 5
   • Also indicated for patients with frequent exacerbations 5
   • Long-acting β-agonist coupled with inhaled corticosteroid for cough control 5

3. Not recommended:

   • Long-term prophylactic antibiotics 5
   • Currently available expectorants 5

Acute Exacerbations of Chronic Bronchitis (AECB)

1. Criteria for antibiotic use (at least one key symptom and one risk factor):

   • Key symptoms: increased dyspnea, increased sputum production, increased sputum purulence 4
   • Risk factors: age ≥65 years, FEV1 <50% predicted, ≥4 AECBs in 12 months, or comorbidities 4

2. Antibiotic selection:

   • Moderate exacerbation: newer macrolide, extended-spectrum cephalosporin, or doxycycline 4
   • Severe exacerbation: high-dose amoxicillin/clavulanate or respiratory fluoroquinolone 4
   • Azithromycin (500 mg once daily for 3 days) has shown 85% clinical cure rate for AECB 6

3. Additional treatments:

   • Short-acting β-agonists or anticholinergic bronchodilators 5
   • Systemic corticosteroids (10-15 days) 1
   • Theophylline should NOT be used during acute exacerbations 5

Common Pitfalls to Avoid

1. Overuse of antibiotics for acute bronchitis

   • Leads to antibiotic resistance
   • Exposes patients to unnecessary side effects

2. Misdiagnosis - ensure bronchitis is differentiated from:

   • Pneumonia (check for fever, tachycardia, tachypnea, focal chest findings)
   • Asthma (persistent wheezing, response to bronchodilators)
   • COPD exacerbation (history of COPD, severity of symptoms)
   • Heart failure (especially in patients with known heart disease) 7

3. Failure to address smoking - the most effective intervention for chronic bronchitis

4. Inappropriate use of expectorants - no proven benefit

5. Using theophylline during acute exacerbations - not recommended 5

Follow-up Recommendations

Patients should seek reassessment if:

• Cough persists beyond 3 weeks or worsens
• New symptoms develop suggesting bacterial superinfection
• Patient has underlying conditions that increase risk of complications 1