What is the treatment for bronchitis?

Treatment of Bronchitis

For acute bronchitis, antibiotics should not be prescribed unless pneumonia is suspected, as viruses are responsible for more than 90% of infections. 1, 2

Acute Bronchitis Treatment

• Symptomatic management is the cornerstone of acute bronchitis treatment, as the condition is typically self-limiting and resolves within 1-3 weeks 2, 3
• Short-acting β-agonists like albuterol may be beneficial in reducing cough duration and severity, particularly in patients with evidence of bronchial hyperresponsiveness 4, 1
• Ipratropium bromide may improve cough in some patients with acute bronchitis 4, 1
• Dextromethorphan or codeine are recommended for short-term symptomatic relief of bothersome cough 4, 1
• Patient education should include realistic expectations for cough duration (typically 10-14 days) and explanation that colored sputum does not indicate bacterial infection 1, 2

Chronic Bronchitis Treatment

• Short-acting β-agonists should be used to control bronchospasm and may reduce chronic cough (Grade A recommendation) 5, 4
• Ipratropium bromide should be offered to improve cough (Grade A recommendation) 5, 4
• Long-acting β-agonists combined with inhaled corticosteroids should be offered to control chronic cough 4, 1
• Inhaled corticosteroids should be offered to patients with chronic bronchitis and severe airflow obstruction (FEV1 <50% predicted) or those with frequent exacerbations 4, 1
• Theophylline may be considered to control chronic cough in stable patients, but careful monitoring for complications is necessary (Grade A recommendation) 5
• Smoking cessation is essential, with 90% of patients experiencing resolution of cough after quitting 4

Acute Exacerbations of Chronic Bronchitis

• Short-acting β-agonists or anticholinergic bronchodilators should be administered during acute exacerbations (Grade A recommendation) 5, 4
• If the patient does not show a prompt response to one bronchodilator, the other agent should be added after the first is administered at the maximal dose 5
• A short course (10-15 days) of systemic corticosteroids is effective for acute exacerbations 4, 1
• Antibiotics are recommended for acute exacerbations of chronic bronchitis, particularly for patients with severe exacerbations and those with more severe airflow obstruction at baseline 4, 6
• Antibiotics should be reserved for patients with at least one key symptom (increased dyspnea, sputum production, or sputum purulence) and one risk factor (age ≥65 years, FEV1 <50% predicted, ≥4 exacerbations in 12 months, or comorbidities) 6
• Theophylline should not be used for treatment of acute exacerbations (Grade D recommendation) 5

Common Pitfalls to Avoid

• Prescribing antibiotics for uncomplicated acute bronchitis, which contributes to antibiotic resistance 1, 7
• Prescribing antibiotics based solely on the 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 5, 1
• Using theophylline for acute exacerbations of chronic bronchitis 5, 1
• Not considering underlying conditions that may be exacerbated by bronchitis (asthma, COPD, cardiac failure, diabetes) 1

Antibiotic Selection (When Indicated for Exacerbations)

• For moderate severity exacerbations: newer macrolide, extended-spectrum cephalosporin, or doxycycline 6
• For severe exacerbations: high-dose amoxicillin/clavulanate or a respiratory fluoroquinolone 6
• Azithromycin has shown clinical success rates of 85% for acute exacerbations of chronic bronchitis 8