What is the first-line treatment for bronchitis?

First-Line Treatment for Bronchitis

For immunocompetent adult outpatients with acute bronchitis, symptomatic therapy with albuterol (bronchodilator) is recommended as first-line treatment to reduce the duration and severity of cough. 1

Acute Bronchitis Treatment Algorithm

Initial Assessment

• Acute bronchitis is characterized by cough due to inflammation of the trachea and large airways without evidence of pneumonia 2
• Typical duration of cough is 2-3 weeks, which should be emphasized to patients 1, 2
• Most cases (89-95%) are caused by viral infections 3

First-Line Treatment Recommendations

• Albuterol (short-acting β-agonist) has demonstrated consistent benefit in reducing duration and severity of cough in randomized controlled trials 1
• Approximately 50% fewer patients report presence of cough after 7 days of treatment with albuterol 1
• Treatment should be individualized in patients without clinical evidence of bronchial hyperresponsiveness (wheezing or bothersome cough) 1

Other Symptomatic Treatments

• Antitussives containing dextromethorphan or codeine likely have modest effects on severity and duration of cough in acute bronchitis 1
• Low-cost and low-risk interventions such as elimination of environmental cough triggers and vaporized air treatments are reasonable options 1
• Ipratropium bromide has shown effectiveness in reducing cough frequency and severity in chronic bronchitis but is not first-line for acute bronchitis 1

Important Cautions

• Antibiotics are NOT recommended for routine treatment of uncomplicated acute bronchitis 1
• Antibiotics provide minimal benefit (reducing cough by about half a day) and have potential adverse effects including allergic reactions, nausea, vomiting, and C. difficile infection 2
• Consider antibiotics only if the bronchitis worsens and a complicating bacterial infection is suspected 1

Chronic Bronchitis Treatment

For patients with chronic bronchitis (different from acute bronchitis):

• Short-acting β-agonists should be used to control bronchospasm and relieve dyspnea; may also reduce chronic cough 1
• Ipratropium bromide should be offered to improve cough in stable patients 1
• Theophylline can be considered to control chronic cough with careful monitoring for complications 1
• For acute exacerbations of chronic bronchitis, short-acting β-agonists or anticholinergic bronchodilators should be administered 1

Patient Education

• Explain that cough typically lasts 10-14 days after the office visit 1
• Refer to the illness as a "chest cold" rather than bronchitis 1
• Emphasize that patient satisfaction depends more on physician-patient communication than on receiving antibiotics 1

Common Pitfalls to Avoid

• Prescribing antibiotics for uncomplicated acute bronchitis despite evidence showing lack of benefit 1, 2
• Failing to distinguish between acute bronchitis and exacerbations of chronic bronchitis, which may require different management approaches 1
• Not providing realistic expectations about the natural course of illness, leading to unnecessary follow-up visits or antibiotic requests 1
• Overlooking bronchodilator therapy, which has demonstrated benefit in reducing cough duration and severity 1