What is the treatment for chronic bronchitis?

Treatment of Chronic Bronchitis

The most effective treatment for chronic bronchitis is avoidance of respiratory irritants, particularly smoking cessation, which results in resolution of cough in 90% of patients. 1, 2

Definition and Diagnosis

• Chronic bronchitis is defined as cough and sputum production occurring on most days for at least 3 months of the year and for at least 2 consecutive years when other respiratory or cardiac causes for chronic productive cough are excluded 1, 3
• Morning cough with brown sputum is particularly characteristic of chronic bronchitis 3

First-Line Management

Environmental Modifications

• Smoking cessation is the cornerstone of therapy and should always be recommended as the most effective intervention 1, 2
• Avoidance of all respiratory irritants including passive smoke exposure and workplace hazards is essential 1
• Ninety percent of patients who stop smoking report resolution of cough, with benefits occurring within the first year of cessation 1, 3

Pharmacological Treatment for Stable Chronic Bronchitis

• Inhaled anticholinergics (ipratropium bromide) should be used as first-line therapy to reduce cough frequency, severity, and sputum volume 3, 2
• Short-acting β-agonists can be added to control bronchospasm and may help reduce chronic cough 2
• For patients with severe airflow obstruction or frequent exacerbations, a combination of long-acting β-agonist and inhaled corticosteroid is recommended 3, 2, 4
• Central cough suppressants such as codeine or dextromethorphan should be used only for short-term symptomatic relief of severe cough 1, 3

Treatment of Acute Exacerbations

• Acute exacerbations are characterized by increased cough, increased sputum volume, increased dyspnea, and/or sputum purulence 5
• Management includes:
  • Short-acting bronchodilators (β-agonists or anticholinergics) 2
  • Antibiotics, particularly for patients with purulent sputum and all three cardinal symptoms (increased cough, increased sputum volume, increased dyspnea) 1, 2, 5
  • Short course (10-15 days) of systemic corticosteroids 2

Treatments Not Recommended

• Long-term prophylactic antibiotic therapy in stable chronic bronchitis patients 1, 2
• Theophylline for acute exacerbations of chronic bronchitis 2
• Expectorants for either stable chronic bronchitis or acute exacerbations 2
• Routine use of mucolytics, positive end expiratory pressure, or other non-pharmacologic treatments 1

Special Considerations

• Patients with more severe degrees of airflow obstruction may have persistent cough despite avoidance of respiratory irritants 1
• For patients with COPD including chronic bronchitis, maintenance treatment with tiotropium or a combination of fluticasone propionate/salmeterol is indicated for airflow obstruction and reduction of exacerbations 4, 6, 4
• Patients with frequent exacerbations may benefit from more aggressive therapy with combination inhalers 3, 2

Monitoring and Follow-up

• Assess improvement in cough frequency and severity after initiating therapy 3
• Monitor for changes in sputum color or volume that might indicate an acute exacerbation 3
• If symptoms worsen acutely with increased sputum volume or purulence, consider treatment for an acute exacerbation 3