What is the treatment for bronchitis?

Treatment of Bronchitis

For bronchitis treatment, short-acting β-agonists and ipratropium bromide should be used as first-line therapy to control symptoms, with antibiotics reserved only for specific cases of acute exacerbations of chronic bronchitis with risk factors. 1, 2

Acute Bronchitis Treatment

• Acute bronchitis is primarily viral in origin (>90% of cases), so antibiotics should NOT be prescribed unless pneumonia is suspected 1, 2
• Short-acting β-agonists like albuterol are beneficial in reducing cough duration and severity, particularly in patients with evidence of bronchial hyperresponsiveness 1, 2
• Ipratropium bromide may improve cough in some patients with acute bronchitis 1, 2
• Dextromethorphan or codeine can be used for short-term symptomatic relief of bothersome cough 1, 2
• Patient education should include realistic expectations for cough duration (typically 10-14 days) 2

Chronic Bronchitis Treatment

• Short-acting β-agonists should be used to control bronchospasm and may reduce chronic cough 3, 1
• Ipratropium bromide should be offered to improve cough and decrease sputum volume 3, 1
• Long-acting β-agonists combined with inhaled corticosteroids should be offered to control chronic cough 1
• Inhaled corticosteroids are recommended for patients with severe airflow obstruction (FEV1 <50% predicted) or those with frequent exacerbations 3, 1
• Theophylline may be considered to control chronic cough in stable patients, but careful monitoring for complications is necessary 3

Acute Exacerbations of Chronic Bronchitis

• Short-acting β-agonists or anticholinergic bronchodilators should be administered during acute exacerbations 3, 1
• If the patient does not show a prompt response, the other agent should be added after the first is administered at the maximal dose 3
• A short course (10-15 days) of systemic corticosteroids is effective for acute exacerbations 1, 2
• Antibiotics should be considered only for patients with 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, or comorbidities) 4
• Theophylline should NOT be used for treatment of acute exacerbations of chronic bronchitis 3

Treatments Not Recommended

• Antibiotics for uncomplicated acute bronchitis (leads to more inappropriate prescribing than any other acute respiratory tract infection in adults) 2, 5
• Expectorants and mucolytics lack evidence of benefit in acute bronchitis 3, 2
• Long-term prophylactic antibiotic therapy in stable chronic bronchitis patients 1
• Theophylline for acute exacerbations of chronic bronchitis 3, 1

Common Pitfalls to Avoid

• Prescribing antibiotics based solely on presence of colored sputum (purulent sputum results from inflammatory cells or sloughed mucosal epithelial cells, not necessarily bacterial infection) 2
• Failing to distinguish between acute bronchitis and pneumonia (assess for tachycardia, tachypnea, fever, and abnormal chest examination findings) 2
• Overuse of expectorants and mucolytics which lack evidence of benefit 2
• Not considering underlying conditions that may be exacerbated by bronchitis (asthma, COPD, cardiac failure, diabetes) 2
• Using theophylline for acute exacerbations of chronic bronchitis 3, 2

Patient Communication Strategies

• Consider referring to the illness as a "chest cold" rather than bronchitis to reduce patient expectation for antibiotics 2
• Explain that patient satisfaction depends more on the quality of the clinical encounter than on receiving antibiotics 2
• Discuss the risks of unnecessary antibiotic use, including side effects and development of antibiotic resistance 2