What is the treatment for bronchitis?

Treatment for Bronchitis

For acute bronchitis, antibiotics are generally not recommended as it is typically viral in nature, while for chronic bronchitis, bronchodilator therapy with ipratropium bromide or short-acting β-agonists is the first-line treatment. 1, 2

Acute Bronchitis Treatment

First-Line Management

• Acute bronchitis is a self-limited respiratory infection lasting up to 3 weeks, with viruses responsible for more than 90% of cases 1, 3
• Antibiotics are not justified for routine treatment of uncomplicated acute bronchitis and should not be offered due to minimal benefit and risk of side effects 1, 4
• Patient education about the expected duration of cough (typically 10-14 days after the office visit) is essential for management 1

Symptomatic Relief

• Albuterol (short-acting β-agonist) has demonstrated benefit in randomized controlled trials for reducing duration and severity of cough in acute bronchitis 1
• Both dextromethorphan and codeine can be prescribed for patients with a dry and bothersome cough, particularly at night 1
• Expectorants, mucolytics, antihistamines should not be prescribed in acute lower respiratory tract infections as evidence for beneficial effects is lacking 1

Chronic Bronchitis Treatment

First-Line Bronchodilator Therapy

• Ipratropium bromide should be offered to improve cough in stable patients with chronic bronchitis (Grade A recommendation) 1, 2
• The standard dosing is ipratropium bromide 36 μg (2 inhalations) four times daily 2, 5
• Short-acting β-agonists should be used to control bronchospasm and relieve dyspnea; they may also reduce chronic cough in some patients (Grade A recommendation) 1

Management of Acute Exacerbations of Chronic Bronchitis

• Antibiotics are recommended for acute exacerbations of chronic bronchitis, particularly for patients with severe exacerbations and those with more severe airflow obstruction at baseline (Grade A recommendation) 1
• During acute exacerbations, both short-acting β-agonists and anticholinergic bronchodilators should be administered, with the addition of the other agent at maximal dose if prompt response is not observed 1
• A short course (10-15 days) of systemic corticosteroid therapy is beneficial for acute exacerbations of chronic bronchitis 1
• Theophylline should not be used during acute exacerbations of chronic bronchitis (Grade D recommendation) 1

Advanced Therapy Options

• For stable patients with chronic bronchitis and severe airflow obstruction (FEV1 < 50%) or frequent exacerbations, inhaled corticosteroid therapy should be offered 1
• Combined therapy with a long-acting β-agonist and an inhaled corticosteroid has been shown to reduce exacerbation rate and cough in long-term trials 1
• Theophylline may be considered to control chronic cough in stable patients, but careful monitoring for complications is necessary (Grade A recommendation) 1

Lifestyle Modifications

• In patients with chronic cough who have chronic exposure to respiratory irritants such as tobacco smoke, avoidance is the most effective means to improve or eliminate cough of chronic bronchitis 1
• Ninety percent of patients will have resolution of their cough after smoking cessation 1

Common Pitfalls and Caveats

• Postural drainage and chest percussion have not been proven beneficial for either stable patients with chronic bronchitis or during acute exacerbations 1
• Long-term prophylactic therapy with antibiotics is not recommended for stable patients with chronic bronchitis due to concerns about antibiotic resistance 1
• Expectorants have not been proven effective for the treatment of cough in patients with chronic bronchitis 1
• Mucokinetic agents are not useful during an acute exacerbation of chronic bronchitis 1
• Mistaking chronic bronchitis for acute bronchitis can lead to inappropriate treatment choices 6