What is the treatment for bronchitis (bronchitis tx)?

Treatment of Bronchitis

For bronchitis treatment, the most effective approach depends on whether the condition is acute or chronic, with avoidance of respiratory irritants being the cornerstone of therapy for chronic bronchitis, while most cases of acute bronchitis should not receive antibiotics as they are primarily viral in origin. 1

Acute Bronchitis Treatment

First-line Management

• Antibiotics should not be prescribed for uncomplicated acute bronchitis unless pneumonia is suspected, as viruses are responsible for more than 90% of acute bronchitis infections 1, 2
• Short-acting β-agonists like albuterol may be beneficial in reducing cough duration and severity in patients with evidence of bronchial hyperresponsiveness 1
• Ipratropium bromide may improve cough in some patients with acute bronchitis 1
• Dextromethorphan or codeine are recommended for short-term symptomatic relief of bothersome cough 1

Special Considerations

• Antibiotics may be considered only in specific high-risk populations, such as patients aged ≥75 years with fever 1
• Colored sputum (e.g., green) does not reliably indicate bacterial infection and should not be used as a criterion for antibiotic prescription 1, 2
• Patient satisfaction depends more on the quality of communication than on receiving antibiotics 1, 3

Chronic Bronchitis Treatment

First-line Management

• Avoidance of respiratory irritants (especially smoking cessation) is the most effective intervention for chronic bronchitis - 90% of patients will have resolution of cough after smoking cessation 4
• Short-acting β-agonists should be used to control bronchospasm and may reduce chronic cough 4
• Ipratropium bromide should be offered to improve cough 4

Additional Therapies

• Long-acting β-agonists combined with inhaled corticosteroids should be offered to control chronic cough 4
• Inhaled corticosteroids should be offered to patients with chronic bronchitis and FEV1 <50% predicted or those with frequent exacerbations 4
• Theophylline should be considered to control chronic cough, with careful monitoring for complications 4

Acute Exacerbations of Chronic Bronchitis

First-line Management

• Short-acting β-agonists or anticholinergic bronchodilators should be administered during acute exacerbations 4
• If the patient does not show a prompt response, the other agent should be added after the first is administered at the maximal dose 4
• Antibiotics are recommended for acute exacerbations of chronic bronchitis; patients with severe exacerbations and those with more severe airflow obstruction at baseline are most likely to benefit 4, 5
• A short course (10-15 days) of systemic corticosteroids is effective for acute exacerbations 4

Antibiotic Selection for Exacerbations

• For moderate exacerbations: newer macrolides (like azithromycin), extended-spectrum cephalosporins, or doxycycline 5
• For severe exacerbations: high-dose amoxicillin/clavulanate or a respiratory fluoroquinolone 5
• Azithromycin has shown 85% clinical cure rates in acute exacerbations of chronic bronchitis 6

Treatments Not Recommended

• Long-term prophylactic antibiotic therapy in stable chronic bronchitis patients 4
• Theophylline for acute exacerbations of chronic bronchitis 4
• Expectorants for either stable chronic bronchitis or acute bronchitis 4, 1
• Postural drainage and chest percussion for either stable chronic bronchitis or acute exacerbations 4

Common Pitfalls to Avoid

• Prescribing antibiotics for acute bronchitis based solely on presence of colored sputum 1, 2
• Failing to distinguish between acute bronchitis and pneumonia - assess for tachycardia, tachypnea, fever, and abnormal chest examination findings 1
• Overuse of expectorants and mucolytics which lack evidence of benefit 1
• Not considering underlying conditions that may be exacerbated by bronchitis (asthma, COPD, cardiac failure) 1
• Not providing realistic expectations for cough duration (typically 10-14 days after the office visit) 1