Treatment Approach for Acute Bronchitis

Acute bronchitis should be managed symptomatically without antibiotics in most cases, as it is typically viral in origin and self-limiting. 1, 2

Diagnosis and Assessment

Acute bronchitis is defined as an acute respiratory infection with cough (with or without phlegm) lasting up to 3 weeks with normal chest radiograph findings 2
Rule out pneumonia, asthma, COPD exacerbation, and common cold before diagnosing acute bronchitis 1, 3
Pneumonia is unlikely in the absence of:
- Tachycardia (heart rate >100 beats/min)
- Tachypnea (respiratory rate >24 breaths/min)
- Fever (oral temperature >38°C)
- Focal chest examination findings 3
Purulent sputum does not reliably indicate bacterial infection and should not be used as a criterion for antibiotic therapy 2, 3

Routine antibiotic treatment is not recommended for uncomplicated acute bronchitis 1, 2
Antibiotics provide minimal benefit (reducing cough by only about half a day) while exposing patients to adverse effects 2, 4
Consider antibiotics only if:
- Pertussis (whooping cough) is confirmed or suspected - use macrolide antibiotics 2
- The condition significantly worsens, suggesting bacterial superinfection 1, 3
- Patient is at high risk (e.g., elderly, immunocompromised) 1

Antitussive agents (codeine, dextromethorphan) may provide modest relief for severe cough 2, 5
β2-agonist bronchodilators are not recommended for routine use but may help select patients with wheezing 2, 3
Guaifenesin may help loosen phlegm and thin bronchial secretions to make coughs more productive 6, 5
Low-cost interventions like elimination of environmental cough triggers and vaporized air treatments are reasonable options 2
NSAIDs at anti-inflammatory doses or systemic corticosteroids are not justified 1

Inform patients that cough typically lasts 10-14 days after the office visit 1, 2
Refer to the condition as a "chest cold" rather than bronchitis to reduce antibiotic expectations 1, 2
Explain that patient satisfaction depends more on physician-patient communication than whether an antibiotic is prescribed 1, 2, 7
Discuss the risks of unnecessary antibiotic use, including side effects and contribution to antibiotic resistance 1, 4

If symptoms persist or worsen, consider reassessment and targeted investigations 1, 3
Potential investigations include chest x-ray, sputum culture, peak flow measurements, complete blood count, and inflammatory markers 3
Be aware that approximately 65% of patients with recurrent episodes of acute bronchitis may have underlying mild asthma 3

For confirmed pertussis, patients should be isolated for 5 days from the start of treatment 1, 2
For influenza-related bronchitis, antiviral agents may be considered if within 48 hours of symptom onset 1
Patients with comorbidities like COPD, heart failure, or immunosuppression may require different management approaches 1