What is the treatment for bronchitis?

Treatment of Bronchitis

For bronchitis treatment, antibiotics should NOT be prescribed for uncomplicated acute bronchitis as viruses are responsible for more than 90% of infections, while treatment for chronic bronchitis should focus on bronchodilators, with short-acting β-agonists and ipratropium bromide as first-line options. 1, 2

Acute Bronchitis Treatment

• Acute bronchitis is self-limiting, with symptoms typically lasting 2-3 weeks; patient education about expected cough duration is essential 3
• Antibiotics should not be prescribed unless pneumonia is suspected, as they only decrease cough duration by approximately 0.5 days while exposing patients to adverse effects 1, 3
• Short-acting β-agonists like albuterol may be beneficial in reducing cough duration and severity 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 provide short-term symptomatic relief of bothersome cough 1, 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) 4, 1
• Ipratropium bromide should be offered to improve cough (Grade A recommendation) 4, 1
• Theophylline may be considered to control chronic cough in stable patients, but requires careful monitoring for complications (Grade A recommendation) 4
• Long-acting β-agonists combined with inhaled corticosteroids should be offered to control chronic cough, particularly in patients with severe airflow obstruction (FEV1 <50% predicted) or frequent exacerbations 1, 2
• Avoidance of respiratory irritants, especially smoking cessation, is the cornerstone of therapy for chronic bronchitis 1

Acute Exacerbations of Chronic Bronchitis (AECB)

• Short-acting β-agonists or anticholinergic bronchodilators should be administered during acute exacerbations (Grade A recommendation) 4, 1, 2
• If the patient does not show prompt response to one agent, the other should be added after the first is administered at the maximal dose 4
• A short course (10-15 days) of systemic corticosteroids is effective for acute exacerbations 2
• Antibiotics are recommended for AECB, particularly for patients with severe exacerbations and those with more severe airflow obstruction at baseline 1, 5
• Antibiotics should be reserved 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 AECBs in 12 months, or comorbidities) 5

Treatments Not Recommended

• Theophylline should not be used for treatment of acute exacerbations of chronic bronchitis (Grade D recommendation) 4, 1
• Expectorants and mucokinetic agents are not recommended for either stable chronic bronchitis or acute bronchitis 4, 2
• Long-term prophylactic antibiotic therapy is not recommended in stable chronic bronchitis patients 1
• Colored sputum (e.g., green) does not reliably differentiate between bacterial and viral infections and should not be used as the sole criterion for antibiotic prescription 2, 6

Common Pitfalls to Avoid

• Prescribing antibiotics based solely on presence of colored sputum 2
• Failing to distinguish between acute bronchitis and pneumonia; assess for tachycardia, tachypnea, fever, and abnormal chest examination findings 2
• Using theophylline for acute exacerbations of chronic bronchitis instead of recommended bronchodilators 4, 1
• Not considering underlying conditions that may be exacerbated by bronchitis (asthma, COPD, cardiac failure, diabetes) 2, 7
• Overuse of expectorants, mucolytics, and antihistamines which lack evidence of benefit 2