What is the treatment approach for bronchitis symptoms?

Treatment Approach for Bronchitis Symptoms

For acute bronchitis, antibiotics are not recommended as routine treatment since most cases are viral in origin and antibiotics provide minimal benefit while risking adverse effects. 1, 2, 3

Differentiating Types of Bronchitis

Acute Bronchitis

• Typically lasts less than 3 weeks and is usually viral in origin (>90% of cases) 2, 3
• Characterized by cough with or without sputum production 1
• Ruling out pneumonia is essential - consider chest radiography if tachypnea, tachycardia, dyspnea, or abnormal lung findings are present 3

Chronic Bronchitis

• Defined as daily expectoration for at least 3 consecutive months during at least 2 consecutive years 1
• May be classified as simple chronic bronchitis or obstructive chronic bronchitis based on symptoms and airflow limitation 1

Treatment for Acute Bronchitis

First-line approach

• Patient education about the typical course (2-3 weeks of cough) to set appropriate expectations 3
• Symptomatic relief for cough:
  • For dry, bothersome cough: Dextromethorphan can be prescribed (evidence of effectiveness for acute cough) 1
  • For cough associated with common cold: First-generation antihistamine plus decongestant may decrease cough severity 1

What to avoid

• Antibiotics should not be prescribed unless pertussis is suspected or the patient is at high risk for pneumonia (e.g., age ≥65 years) 2, 3
• Expectorants, mucolytics, antihistamines, and bronchodilators should not be routinely prescribed for uncomplicated acute LRTI in primary care 1

Treatment for Chronic Bronchitis

Bronchodilator therapy

• Ipratropium bromide is recommended as first-line therapy to improve cough in stable chronic bronchitis patients 1, 4
• Short-acting β-agonists (like albuterol) can be used to control bronchospasm and may reduce chronic cough in some patients 1, 5
• Theophylline may be considered to control chronic cough but requires careful monitoring for complications 1, 4

Anti-inflammatory therapy

• For patients with severe airflow obstruction (FEV1 <50%) or frequent exacerbations, inhaled corticosteroids combined with long-acting β-agonists are recommended 1, 4
• Long-term oral corticosteroids are not recommended due to lack of benefit and significant side effects 1

For acute exacerbations of chronic bronchitis

• Short-acting bronchodilators (β-agonists or anticholinergics) should be administered 1, 4
• A short course (10-15 days) of systemic corticosteroids is recommended 1, 4
• Antibiotics are indicated for patients with:
  • At least two of the Anthonisen criteria (increased dyspnea, increased sputum volume, increased sputum purulence) 1
  • Or at least one key symptom plus one risk factor (age ≥65, FEV1 <50%, ≥4 exacerbations/year, or comorbidities) 6

Supportive Measures for All Bronchitis Patients

Environmental modifications

• Avoidance of respiratory irritants, especially smoking cessation, is crucial 1, 4
• Smoking cessation can lead to resolution of cough in 90% of patients with chronic bronchitis 1

Symptomatic relief

• For troublesome cough in chronic bronchitis, short-term use of central cough suppressants like codeine or dextromethorphan may provide relief 1, 4
• Proper hydration and humidification may help loosen secretions 6

Common Pitfalls to Avoid

• Mistaking chronic bronchitis for acute bronchitis, leading to inappropriate treatment 5
• Prescribing antibiotics for uncomplicated acute bronchitis, which contributes to antibiotic resistance 1, 3
• Using expectorants without evidence of benefit - currently available expectorants have not been proven effective for cough in chronic bronchitis 1, 4
• Failing to address underlying causes such as smoking or environmental exposures 1, 4

Special Considerations

• Patients with underlying chronic conditions (asthma, COPD, cardiac failure, diabetes) may experience flare-ups during respiratory infections and may need adjustment of their chronic medications 1
• Consider pertussis in patients with cough lasting more than 2 weeks accompanied by paroxysmal cough, whooping, or post-tussive emesis 3