What is the treatment for bronchitis?

Bronchitis Treatment

For acute bronchitis, antibiotics should not be prescribed as viruses are responsible for more than 90% of infections, while chronic bronchitis requires bronchodilators as first-line therapy with ipratropium bromide and short-acting β-agonists to improve cough and control bronchospasm. 1, 2

Acute Bronchitis Treatment

• Antibiotics should not be prescribed for uncomplicated acute bronchitis unless pneumonia is suspected 2
• Symptomatic treatment should focus on cough management:
  • Short-acting β-agonists like albuterol may reduce cough duration and severity in patients with evidence of bronchial hyperresponsiveness 1, 2
  • Ipratropium bromide may improve cough in some patients 2
  • Dextromethorphan or codeine are recommended for short-term symptomatic relief of bothersome cough 1, 2
• Patient education should include:
  • Realistic expectations for cough duration (typically 10-14 days) 2
  • Consider referring to the illness as a "chest cold" rather than bronchitis to reduce patient expectation for antibiotics 2

Chronic Bronchitis Treatment

• Short-acting β-agonists should be used to control bronchospasm and may reduce chronic cough (Grade A recommendation) 3, 1
• Ipratropium bromide should be offered to improve cough (Grade A recommendation) 3, 1
• Long-acting β-agonists combined with inhaled corticosteroids should be offered to control chronic cough, particularly for patients with COPD 1
• Inhaled corticosteroids should be offered to patients with chronic bronchitis and severe airflow obstruction (FEV1 <50% predicted) or those with frequent exacerbations 1, 2
• Theophylline may be considered to control chronic cough in stable patients, but requires careful monitoring for complications (Grade A recommendation) 3

Management of Acute Exacerbations of Chronic Bronchitis

• Short-acting β-agonists or anticholinergic bronchodilators should be administered during acute exacerbations (Grade A recommendation) 3, 1, 2
• 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 2
• Antibiotics are recommended for acute exacerbations of chronic bronchitis, particularly for patients with severe exacerbations and those with more severe airflow obstruction at baseline 1
• Theophylline should not be used for treatment of acute exacerbations (Grade D recommendation) 3

Treatments Not Recommended

• Expectorants are not recommended for either stable chronic bronchitis or acute bronchitis 1, 2
• Mucokinetic agents are not useful during an acute exacerbation of chronic bronchitis 3
• Long-term prophylactic antibiotic therapy is not recommended in stable chronic bronchitis patients 1

Common Pitfalls to Avoid

• Prescribing antibiotics based solely on presence of colored sputum (purulent sputum does not indicate bacterial infection) 2
• Failing to distinguish between acute bronchitis and pneumonia 2
• Overuse of expectorants, mucolytics, and antihistamines which lack evidence of benefit 2
• Using theophylline for acute exacerbations of chronic bronchitis 3, 1
• Not considering underlying conditions that may be exacerbated by bronchitis (asthma, COPD, cardiac failure, diabetes) 2

Special Considerations

• For patients with COPD, Wixela Inhub® 250/50 (fluticasone propionate/salmeterol) is indicated for the twice-daily maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease, including chronic bronchitis 4
• Azithromycin has shown efficacy in acute exacerbations of chronic bronchitis with clinical cure rates of 85% compared to 82% for clarithromycin in clinical trials 5
• Smoking cessation is a cornerstone of therapy for chronic bronchitis, with 90% of patients experiencing resolution of cough after smoking cessation 1