What is the diagnosis and treatment for acute bronchitis?

From the Guidelines

For immunocompetent adult outpatients with cough due to suspected acute bronchitis, no routine investigation with chest x-ray, spirometry, peak flow measurement, sputum for microbial culture, respiratory tract samples for viral PCR, serum C-Reactive Protein (CRP) or procalcitonin is suggested, and no routine prescription of antibiotic therapy, antiviral therapy, antitussives, inhaled beta agonists, inhaled anticholinergics, inhaled corticosteroids, oral corticosteroids, oral NSAIDs or other therapies is recommended until such treatments have been shown to be safe and effective at making cough less severe or resolve sooner 1.

Diagnosis of Acute Bronchitis

The diagnosis of acute bronchitis is typically based on clinical presentation, and the absence of clinical or radiographic evidence of pneumonia and other conditions such as the common cold, acute asthma, or an exacerbation of COPD 1.

Treatment of Acute Bronchitis

Treatment for acute bronchitis typically focuses on symptom relief, with over-the-counter medications like acetaminophen or ibuprofen helping to reduce fever and relieve pain. For cough relief, dextromethorphan may be helpful, especially at night to improve sleep. Staying hydrated by drinking plenty of fluids helps thin mucus secretions, making them easier to clear.

Antibiotic Use

Most cases of acute bronchitis are viral and resolve within 1-2 weeks without antibiotics. However, if symptoms persist beyond 3 weeks, worsen significantly, or if you have underlying lung conditions like COPD, medical attention is necessary, and consideration for treatment with antibiotic therapy may be given if a complicating bacterial infection is thought likely 1.

Management of Chronic Bronchitis

For chronic bronchitis, which is often related to smoking or long-term exposure to irritants, quitting smoking is essential. Inhaled bronchodilators like albuterol or corticosteroids may be prescribed to reduce inflammation and improve breathing. Pulmonary rehabilitation programs can also help improve lung function and quality of life for those with chronic bronchitis.

Key Considerations

• The distinction between viral and bacterial causes is important, as antibiotics are only effective against bacterial infections and unnecessary antibiotic use contributes to antibiotic resistance.
• Patient satisfaction with care for acute bronchitis depends most on physician–patient communication rather than whether an antibiotic is prescribed 1.
• In patients with acute cough and sputum production suggestive of acute bronchitis, the absence of certain findings (such as heart rate > 100 beats/min, respiratory rate > 24 breaths/min, oral body temperature of > 38°C, and chest examination findings of focal consolidation, egophony, or fremitus) reduces the likelihood of pneumonia sufficiently to eliminate the need for a chest radiograph 1.

From the FDA Drug Label

Albuterol sulfate inhalation solution is indicated for the relief of bronchospasm in patients 2 years of age and older with reversible obstructive airway disease and acute attacks of bronchospasm. temporarily relieves • cough due to minor throat and bronchial irritation as may occur with the common cold or inhaled irritants

The diagnosis of acute bronchitis is not directly stated in the provided drug labels. The treatment for acute bronchitis may include:

• Bronchodilators like albuterol (INH) to relieve bronchospasm in patients with reversible obstructive airway disease 2
• Cough suppressants like dextromethorphan (PO) to temporarily relieve cough due to minor throat and bronchial irritation 3

From the Research

Diagnosis of Acute Bronchitis

• Acute bronchitis is a clinical diagnosis characterized by cough due to acute inflammation of the trachea and large airways without evidence of pneumonia 4
• The presence or absence of colored sputum does not reliably differentiate between bacterial and viral lower respiratory tract infections 5
• Pneumonia should be suspected in patients with tachypnea, tachycardia, dyspnea, or lung findings suggestive of pneumonia, and radiography is warranted 4
• Pertussis should be suspected in patients with cough persisting for more than two weeks that is accompanied by symptoms such as paroxysmal cough, whooping cough, and post-tussive emesis, or recent pertussis exposure 4

Treatment of Acute Bronchitis

• Viruses are responsible for more than 90 percent of acute bronchitis infections, and antibiotics are generally not indicated for bronchitis 5
• Antibiotics should be used only if pertussis is suspected to reduce transmission or if the patient is at increased risk of developing pneumonia (e.g., patients 65 years or older) 5
• The typical therapies for managing acute bronchitis symptoms have been shown to be ineffective, and the U.S. Food and Drug Administration recommends against using cough and cold preparations in children younger than six years 5
• The supplement pelargonium may help reduce symptom severity in adults 5
• Symptomatic treatment with protussives, antitussives, or bronchodilators is appropriate for acute bronchitis 6
• Inhaled bronchodilators are underused for symptomatic management 7

Management and Patient Education

• Evaluation and treatment of bronchitis include ruling out secondary causes for cough, such as pneumonia; educating patients about the natural course of the disease; and recommending symptomatic treatment and avoidance of unnecessary antibiotic use 4
• Strategies to reduce inappropriate antibiotic use include delayed prescriptions, patient education, and calling the infection a chest cold 4
• Patient satisfaction with the treatment of acute bronchitis is related to the quality of the physician-patient interaction rather than to prescription of an antibiotic 6, 7