What are the treatments for bronchitis (inflammation of the bronchial tubes)?

Bronchitis Treatment: Description and Management

For bronchitis treatment, short-acting β-agonists should be used to control bronchospasm and relieve dyspnea, while ipratropium bromide should be offered to improve cough. 1, 2

Types of Bronchitis

• Acute Bronchitis: Self-limited inflammation of large airways with cough lasting up to 6 weeks, often accompanied by mild constitutional symptoms 3
• Chronic Bronchitis: Cough with sputum production occurring on most days for at least 3 months of the year and for at least 2 consecutive years 3
• Chronic Bronchitis Classifications:
  • Simple chronic bronchitis: Daily expectoration for at least 3 consecutive months during at least 2 consecutive years; FEV1 > 80% 1
  • Obstructive chronic bronchitis: Exertional dyspnea and/or FEV1 between 35% and 80% 1
  • Obstructive chronic bronchitis with chronic respiratory insufficiency: Dyspnea at rest and/or FEV1 < 35% and hypoxemia at rest 1

Treatment of Acute Bronchitis

• Antibiotics: Not recommended for uncomplicated acute bronchitis as viruses are responsible for more than 90% of infections 2, 4, 5
• Bronchodilators:
  • Short-acting β-agonists (e.g., albuterol) may reduce cough duration and severity in patients with bronchial hyperresponsiveness 2, 3
  • Ipratropium bromide may improve cough in some patients 2, 3
• Cough suppressants: Dextromethorphan or codeine for short-term symptomatic relief of bothersome cough 2, 3
• Patient education: Provide realistic expectations for cough duration (typically 10-14 days after office visit) and consider referring to the illness as a "chest cold" rather than bronchitis to reduce patient expectation for antibiotics 3

Treatment of Chronic Bronchitis

• Bronchodilators:
  • Short-acting β-agonists should be used to control bronchospasm and may reduce chronic cough 1, 2
  • Ipratropium bromide should be offered to improve cough 1, 2
  • Long-acting β-agonists combined with inhaled corticosteroids should be offered to control chronic cough 1, 2
• Corticosteroids:
  • Inhaled corticosteroids should be offered to patients with chronic bronchitis and FEV1 < 50% predicted or those with frequent exacerbations 1, 2
• Theophylline:
  • May be considered to control chronic cough in stable patients with careful monitoring for complications 1
  • Not recommended for acute exacerbations 1, 2
• Expectorants: Not recommended as there is no evidence of effectiveness 1, 2
• Postural drainage and chest percussion: Not proven to be clinically beneficial and not recommended 1

Treatment of Acute Exacerbations of Chronic Bronchitis

• Bronchodilators:
  • Short-acting β-agonists or anticholinergic bronchodilators should be administered during acute exacerbations 1, 2
  • If the patient does not show a prompt response, the other agent should be added after the first is administered at the maximal dose 1
• Antibiotics:
  • For simple chronic bronchitis: Not recommended immediately, even with fever; only recommended if fever persists for more than 3 days 1
  • For obstructive chronic bronchitis: Recommended if at least two of the three Anthonisen criteria are present (increased sputum volume, increased sputum purulence, increased dyspnea) 1
  • For obstructive chronic bronchitis with chronic respiratory insufficiency: Immediate antibiotic therapy is recommended 1
• First-line antibiotics (for infrequent exacerbations in subjects with FEV1 ≥ 35%):
  • Amoxicillin (reference compound)
  • First-generation cephalosporins as an alternative
  • Macrolides, pristinamycin, or doxycycline as alternatives, particularly with beta-lactam allergies 1
• Second-line antibiotics (for treatment failures or frequent exacerbations or FEV1 < 35%):
  • Amoxicillin-clavulanate (reference antibiotic)
  • Second or third-generation oral cephalosporins
  • Fluoroquinolones active on pneumococci 1
• Corticosteroids: A short course (10-15 days) of systemic corticosteroids is effective for acute exacerbations 2, 3

Common Pitfalls to Avoid

• Prescribing antibiotics based solely on presence of colored sputum, as purulent sputum does not necessarily indicate bacterial infection 3
• Failing to distinguish between acute bronchitis and pneumonia 3
• Overuse of expectorants and mucolytics which lack evidence of benefit 3
• Using theophylline for acute exacerbations of chronic bronchitis 1, 2
• Not considering underlying conditions that may be exacerbated by bronchitis (asthma, COPD, cardiac failure) 3