What is the management for a patient with bronchitis, as indicated by bilateral peribronchial thickening on CT (Computed Tomography) chest and spirometry results showing a Forced Expiratory Volume (FEV1)/Forced Vital Capacity (FVC) ratio of 81 percent, with a Forced Vital Capacity (FVC) of 89 percent and Peak Expiratory Flow (PEF) of 49 percent?

Management of Bronchitis Based on CT Findings and Spirometry Results

For a patient with bronchitis confirmed by bilateral peribronchial thickening on CT chest and relatively preserved spirometry (FEV1/FVC 81%, FVC 89%, FEV1 88%, but reduced PEF 49%), bronchodilator therapy with short-acting β-agonists should be the primary treatment to control bronchospasm, relieve dyspnea, and reduce cough.

Assessment of Findings

• The CT findings of bilateral peribronchial thickening without bronchiectasis, interstitial lung disease, or emphysema are consistent with bronchitis 1
• The spirometry results show preserved lung function (FEV1/FVC 81%, FVC 89%, FEV1 88%) but reduced peak expiratory flow (PEF 49%), suggesting airway inflammation without significant obstruction 1
• The absence of consolidation, pleural effusion, or lymphadenopathy on CT indicates uncomplicated bronchitis without pneumonia 1

Treatment Recommendations

First-Line Therapy

• Short-acting β-agonists should be used to control bronchospasm, relieve dyspnea, and may reduce chronic cough 1
• Ipratropium bromide (anticholinergic) should be offered to improve cough symptoms 1
• If the patient does not show prompt response to one bronchodilator, the other agent should be added after the first is administered at maximal dose 1

Additional Considerations

• For persistent symptoms, consider adding a long-acting β-agonist coupled with an inhaled corticosteroid (ICS) to control chronic cough 1
• If FEV1 were <50% predicted (not the case here) or if frequent exacerbations occur, inhaled corticosteroid therapy would be recommended 1
• Central cough suppressants such as codeine or dextromethorphan may be used for short-term symptomatic relief of troublesome cough 1

Therapies to Avoid

• Antibiotics are not recommended for uncomplicated bronchitis, regardless of cough duration 1
• Expectorants lack evidence of effectiveness and should not be used 1
• Long-term oral corticosteroids should be avoided as there is no evidence they improve cough or sputum production, and they carry significant risk of side effects 1
• Theophylline is not recommended for acute exacerbations of bronchitis 1
• Postural drainage and chest percussion have not been proven effective and are not recommended 1

Monitoring and Follow-up

• If symptoms persist or worsen, consider reassessment and targeted investigations 1
• Monitor for signs of exacerbation: increased dyspnea, increased sputum volume, and increased sputum purulence (Anthonisen triad) 2, 3
• If fever >38°C persists for more than 3 days or if respiratory symptoms significantly worsen, reevaluate for possible bacterial infection 2, 4
• Symptoms typically last about three weeks; patients should be informed of this expected timeline 5, 6

Important Considerations

• Avoidance of respiratory irritants, especially tobacco smoke, is essential for management 1
• The reduced PEF (49%) warrants close monitoring, as it may indicate more significant airway involvement than suggested by the preserved FEV1/FVC ratio 1
• Consider underlying asthma if symptoms persist beyond 3-4 weeks, as up to 65% of patients with recurrent episodes of bronchitis may have mild asthma 1, 7

Safety Netting Advice

• Patients should seek immediate medical attention if they experience persistent fever for more than 3 days, worsening shortness of breath, or severe respiratory distress 2
• Symptoms lasting longer than 3 weeks may indicate other conditions such as asthma, postinfectious cough, or pneumonia 2, 6