What is the treatment for bronchitis?

Treatment of Bronchitis

For bronchitis treatment, smoking cessation is the most effective intervention, resulting in 90% cough resolution in chronic bronchitis patients, and avoidance of all respiratory irritants should always be recommended. 1, 2

Differentiating Types of Bronchitis

Acute Bronchitis

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

Chronic Bronchitis

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

Treatment Approach for Acute Bronchitis

1. Supportive Care (First-line)

   • Avoidance of respiratory irritants
   • Adequate hydration
   • Rest
   • Symptom management

2. Pharmacological Management

   • Bronchodilators: Short-acting β-agonists (e.g., albuterol) for patients with wheezing or bronchospasm 2
   • Antitussives: May provide short-term symptomatic relief for troublesome cough 2
   • Antibiotics: Generally NOT recommended for routine treatment of acute bronchitis 2, 3

3. Patient Education

   • Inform about typical cough duration (2-3 weeks)
   • Explain viral nature of most cases
   • Discuss risks of unnecessary antibiotic use
   • Refer to condition as "chest cold" rather than "bronchitis" to reduce antibiotic expectations 2

Treatment Approach for Chronic Bronchitis

1. Non-Pharmacological Interventions

   • Smoking cessation: Most effective intervention (90% resolution of cough) 1, 2
   • Avoidance of respiratory irritants: Essential for improvement 1

2. Pharmacological Management

   • Short-acting bronchodilators: To control bronchospasm and relieve dyspnea 1

     • Short-acting β-agonists (Grade A recommendation) 1
     • Ipratropium bromide to improve cough (Grade A recommendation) 1

   • Long-acting bronchodilators with inhaled corticosteroids: For chronic cough control (Grade A recommendation) 1

   • Inhaled corticosteroids: For patients with FEV1 <50% predicted or frequent exacerbations 1

   • Mucolytics: May produce small reduction in exacerbations and modest improvement in quality of life 4, 5

     • Acetylcysteine is indicated as adjuvant therapy for abnormal, viscid mucous secretions in chronic bronchopulmonary disease 6

3. NOT Recommended

   • Long-term prophylactic antibiotics (Grade I recommendation) 1
   • Expectorants (Grade I recommendation) 1
   • Postural drainage and chest percussion (Grade I recommendation) 1
   • Theophylline for stable patients (not recommended due to side effects) 2

Management of Acute Exacerbations of Chronic Bronchitis

1. Bronchodilator Therapy

   • Short-acting β-agonists or anticholinergic bronchodilators (Grade A recommendation) 1
   • If no prompt response, add the other agent at maximal dose 1

2. Antibiotic Therapy

   • Recommended for acute exacerbations (Grade A recommendation) 1

   • Most beneficial for patients with:

     • Severe exacerbations
     • More severe airflow obstruction at baseline
     • At least one key symptom (increased dyspnea, sputum production, sputum purulence) and one risk factor (age ≥65 years, FEV1 <50% predicted, ≥4 exacerbations in 12 months, comorbidities) 7

   • Antibiotic options:

     • First-line: Amoxicillin 2
     • Alternatives: Macrolides (e.g., azithromycin), extended-spectrum cephalosporins, doxycycline for moderate exacerbations 2, 8, 7
     • For severe exacerbations: High-dose amoxicillin/clavulanate or respiratory fluoroquinolones 7

3. Corticosteroids

   • Short course of oral corticosteroids (10-15 days) may be beneficial for acute exacerbations 2, 7

4. NOT Recommended

   • Theophylline during acute exacerbations (Grade D recommendation) 1

Follow-up Recommendations

• Advise patients to seek reassessment if:

  • Cough persists beyond 3 weeks or worsens
  • New symptoms develop suggesting bacterial superinfection
  • Patient has underlying conditions increasing risk of complications 2

• Monitor for treatment response and adjust therapy as needed

Common Pitfalls to Avoid

1. Overuse of antibiotics for acute bronchitis (primarily viral)
2. Failure to emphasize smoking cessation as primary intervention
3. Inappropriate use of theophylline given its side effect profile
4. Neglecting to differentiate between acute bronchitis and pneumonia
5. Overlooking the importance of patient education about expected course and duration

By following these evidence-based recommendations, clinicians can effectively manage both acute and chronic bronchitis while minimizing unnecessary treatments and potential adverse effects.