What is the treatment for acute bronchitis?

Treatment of Acute Bronchitis

Acute bronchitis is a self-limiting condition that generally does not require antibiotics or other routine medications, as these have not been shown to significantly improve outcomes in terms of morbidity, mortality, or quality of life. 1

Definition and Diagnosis

• Acute bronchitis is an acute respiratory infection manifested by cough with or without phlegm production lasting up to 3 weeks with normal chest radiograph findings 1, 2
• Respiratory viruses are the most common cause (89-95% of cases), with fewer than 10% of patients having bacterial infections 1, 2
• Diagnosis should exclude pneumonia, common cold, acute asthma, or exacerbation of COPD 1

Initial Management Approach

• No routine investigations are recommended for immunocompetent adult outpatients with suspected acute bronchitis, including chest x-ray, spirometry, peak flow measurement, sputum cultures, viral PCR, or inflammatory markers 1
• No routine medications should be prescribed including antibiotics, antivirals, antitussives, inhaled beta agonists, inhaled anticholinergics, inhaled corticosteroids, oral corticosteroids, or NSAIDs 1
• Patient education is crucial - inform patients that cough typically lasts 10-14 days after the office visit 2, 3
• Referring to the condition as a "chest cold" rather than bronchitis may reduce patient expectation for antibiotics 2, 3

Antibiotic Use

• Antibiotics should not be routinely prescribed as they provide minimal benefit (reducing cough by only about half a day) while exposing patients to adverse effects 2, 3
• Purulent sputum or change in its color does not signify bacterial infection and is not an indication for antibiotics 2
• The only exception for antibiotic use is:
  • Confirmed or suspected pertussis (whooping cough), which should be treated with a macrolide antibiotic 1, 2
  • Cases where acute bronchitis significantly worsens and a complicating bacterial infection is thought likely 1

Symptomatic Treatment Options

• β2-agonist bronchodilators should not be routinely used but may be considered in select adult patients with wheezing accompanying the cough 2, 4
• Codeine or dextromethorphan may provide modest effects on severity and duration of cough, but evidence for significant benefit is limited 2, 4
• Low-cost and low-risk actions such as elimination of environmental cough triggers and vaporized air treatments may be reasonable options 2

Follow-up and Reassessment

• If acute bronchitis persists or worsens, patients should seek reassessment 1
• Targeted investigations may then be considered, including chest x-ray, sputum for microbial culture, peak expiratory flow measurements, complete blood count, and inflammatory markers 1
• Consider alternative diagnoses such as asthma, as studies show that up to 65% of patients with recurrent episodes of acute bronchitis may have mild asthma 1

Common Pitfalls to Avoid

• Prescribing antibiotics unnecessarily, which contributes to antibiotic resistance without providing meaningful clinical benefit 2, 3, 5
• Failing to distinguish acute bronchitis from other conditions like pneumonia, asthma, or COPD exacerbations 1
• Not adequately explaining to patients the expected duration of symptoms and self-limiting nature of the condition 2, 3
• Patient satisfaction depends more on physician-patient communication than whether an antibiotic is prescribed 2, 5