What is the treatment for bronchitis?

Treatment of Bronchitis

For acute bronchitis, symptomatic management is recommended as first-line therapy, with antibiotics reserved only for specific cases of acute exacerbations of chronic bronchitis with clear bacterial infection indicators. 1

Acute Bronchitis Treatment

First-line Interventions

• Smoking cessation and avoidance of respiratory irritants - most effective intervention with 90% cough resolution 2, 1
• Symptomatic relief measures:
  • Adequate hydration
  • Rest
  • Humidification
  • Avoidance of irritants 1

Pharmacologic Management

1. Bronchodilators:

   • Short-acting β-agonists (e.g., albuterol) for patients with wheezing or bronchospasm 2, 1
   • Ipratropium bromide to improve cough 2

2. Antitussives:

   • Dextromethorphan or codeine for troublesome cough 1

3. Antibiotics:

   • NOT recommended for routine treatment of acute bronchitis 1, 3
   • Viruses cause >90% of acute bronchitis cases 3
   • Colored sputum (green/yellow) does not reliably indicate bacterial infection 3

Chronic Bronchitis Treatment

Stable Chronic Bronchitis

1. Bronchodilators:

   • Short-acting β-agonists for bronchospasm, dyspnea, and cough reduction 2
   • Ipratropium bromide to improve cough 2
   • Tiotropium bromide for long-term maintenance treatment 4

2. Anti-inflammatory therapy:

   • Long-acting β-agonist combined with inhaled corticosteroid for chronic cough control 2
   • Inhaled corticosteroids for patients with FEV1 <50% predicted or frequent exacerbations 2

3. Phosphodiesterase-4 inhibitors:

   • Roflumilast to reduce exacerbation risk in severe COPD with chronic bronchitis and history of exacerbations 5
   • Not for acute bronchospasm relief 5

4. Not recommended:

   • Long-term prophylactic antibiotics 2
   • Expectorants (no proven benefit) 2, 1
   • Postural drainage and chest percussion 2
   • Theophylline (side effects outweigh benefits) 2

Acute Exacerbation of Chronic Bronchitis

1. Bronchodilators:

   • Short-acting β-agonists or anticholinergic bronchodilators 2
   • Add second agent at maximal dose if no prompt response 2

2. Antibiotics:

   • Indicated when at least two Anthonisen criteria present (increased dyspnea, sputum volume, and purulence) 1, 6
   • First-line: Amoxicillin 1
   • Alternatives: Extended-spectrum cephalosporins, newer macrolides, or doxycycline for moderate exacerbations 6
   • For severe exacerbations: High-dose amoxicillin/clavulanate or respiratory fluoroquinolones 6
   • For beta-lactam allergy: Macrolides, pristinamycin, or doxycycline 1

3. Corticosteroids:

   • Short course of oral corticosteroids (10-15 days) for acute exacerbations 1

4. Not recommended:

   • Theophylline during acute exacerbations 2

Special Considerations

Risk Stratification for Antibiotic Use

• Antibiotics should be reserved for patients with:
  • At least one key symptom (increased dyspnea, sputum production, sputum purulence) AND
  • At least one risk factor (age ≥65 years, FEV1 <50% predicted, ≥4 exacerbations in 12 months, or comorbidities) 6

Patient Education

• Explain that acute bronchitis typically lasts 2-3 weeks 1
• Refer to condition as "chest cold" rather than "bronchitis" to reduce antibiotic expectations 1
• Advise patients to seek reassessment if:
  • Cough persists beyond 3 weeks
  • Symptoms worsen
  • New symptoms develop suggesting bacterial infection
  • Patient has underlying conditions increasing risk of complications 1

Common Pitfalls to Avoid

1. Unnecessary antibiotic use for acute bronchitis
2. Failure to distinguish between acute bronchitis, pneumonia, and COPD exacerbation
3. Overreliance on sputum color to diagnose bacterial infection
4. Neglecting smoking cessation as the most effective intervention
5. Using theophylline during acute exacerbations