What is the management for acute bronchitis?

Management of Acute Bronchitis

Antibiotics are not recommended for routine treatment of acute bronchitis as they provide minimal benefit while exposing patients to adverse effects. 1

Diagnosis and Assessment

• Acute bronchitis is an acute respiratory infection with normal chest radiograph findings, manifested by cough with or without phlegm production lasting up to 3 weeks 1
• Respiratory viruses are the most common cause (89-95% of cases), with fewer than 10% of patients having bacterial infections 1, 2
• Rule out pneumonia, asthma, COPD exacerbation, and common cold before diagnosing acute bronchitis 1, 3
• Pneumonia is unlikely and chest radiography unnecessary if the following are absent: heart rate >100 beats/min, respiratory rate >24 breaths/min, oral temperature >38°C, and abnormal chest examination findings (rales, egophony, or tactile fremitus) 4, 3
• The presence of purulent sputum does not indicate bacterial infection and is not an indication for antibiotics 1, 5

Treatment Approach

Antibiotic Management

• Antibiotics should not be routinely prescribed as they reduce cough duration by only approximately 0.5 days while exposing patients to adverse effects 1, 2
• When patients expect antibiotics, explain the decision not to use these agents and discuss the potential harm of unnecessary antibiotic use 1, 4
• For confirmed or suspected pertussis (whooping cough), a macrolide antibiotic should be prescribed and patients should be isolated for 5 days from the start of treatment 1

Symptomatic Treatment

• Antitussive agents (codeine or dextromethorphan) may provide modest effects on severity and duration of cough in acute bronchitis 4, 1
• β2-agonist bronchodilators should not be routinely used but may be considered in select adult patients with wheezing accompanying the cough 1, 4
• First-generation antihistamine/decongestant combinations may be effective for symptom relief, while newer-generation nonsedating antihistamines should not be used 4
• Mucokinetic agents (expectorants, mucolytics) are not recommended due to lack of consistent favorable effects 4, 1
• Low-cost and low-risk actions such as elimination of environmental cough triggers and vaporized air treatments may be reasonable options 4, 1

Patient Education

• Inform patients that cough typically lasts 10-14 days after the office visit 4, 1
• Refer to the condition as a "chest cold" rather than bronchitis to reduce patient expectation for antibiotics 4, 1
• Patient satisfaction depends more on physician-patient communication than whether an antibiotic is prescribed 4, 1
• Provide realistic expectations about the self-limiting nature of the illness 2, 5

Special Considerations

• Consider reassessment if symptoms persist or worsen beyond the expected timeframe 3
• Approximately 65% of patients with recurrent episodes of acute bronchitis may have underlying mild asthma 3
• Consider other diagnoses such as cough-variant asthma, COPD, or bronchiectasis in patients with recurrent symptoms 3
• Patients with comorbidities like COPD, heart failure, or immunosuppression may require different management approaches 3

Common Pitfalls to Avoid

• Overdiagnosing acute bronchitis, which leads to unnecessary antibiotic prescriptions 4, 5
• Using antibiotics based on sputum color or purulence, which does not reliably indicate bacterial infection 1, 5
• Failing to recognize that patient satisfaction is tied to communication quality rather than receiving antibiotics 4, 1
• Underutilizing symptomatic treatments that may provide relief while the condition resolves naturally 4, 6
• Not providing clear expectations about illness duration, leading to unnecessary follow-up visits 4, 1