Albuterol for Acute Bronchitis: Recommendations and Considerations

Albuterol should not be routinely used for uncomplicated acute bronchitis, as it shows no consistent benefit for cough relief in most patients. 1

Evidence-Based Recommendations for Albuterol Use in Acute Bronchitis

In most patients with acute bronchitis, β2-agonist bronchodilators like albuterol should not be routinely used to alleviate cough (Grade of recommendation: D) 1
The American College of Chest Physicians (ACCP) guidelines specifically recommend against routine use of bronchodilators for acute bronchitis due to lack of consistent benefit 1
A Cochrane review examining β-agonists for acute bronchitis found no significant benefit on daily cough scores or number of patients still coughing after 7 days 1
Adverse effects including tremor, nervousness, and shakiness were more common in treatment groups receiving bronchodilators 1

In select adult patients with acute bronchitis who have wheezing accompanying the cough, treatment with β2-agonist bronchodilators may be useful (Grade of recommendation: C) 1
For patients who might benefit, a carefully monitored trial of albuterol with objective evaluation of response is recommended 2
Continue bronchodilator use only if there is a documented positive clinical response using objective measures 1, 2

For outpatient management of acute bronchitis with wheezing, albuterol via metered-dose inhaler (MDI) is appropriate 2, 3
For more severe cases requiring emergency department care, nebulized albuterol solution (0.083%, equivalent to 2.5 mg/3 mL) may be used 4
Nebulized albuterol solution contains 0.83 mg of albuterol (as 1 mg of albuterol sulfate) per mL in an isotonic, sterile, aqueous solution 4

Some studies have shown modest improvement with albuterol in acute bronchitis:
- One study found patients treated with albuterol MDI were less likely to be coughing after 7 days compared to placebo (61% vs 91%, p=0.02) 3
- Another study showed patients treated with oral albuterol were less likely to be coughing after 7 days than those treated with erythromycin (41% vs 88%, p<0.05) 5
However, these limited positive findings are outweighed by the overall evidence showing lack of consistent benefit 1

For cough management in acute bronchitis, antitussive agents (codeine or dextromethorphan) may be occasionally useful for short-term symptomatic relief (Grade of recommendation: C) 1
Mucokinetic agents (expectorants, mucolytics) are not recommended due to lack of consistent favorable effects on cough in acute bronchitis 1
Antibiotics are not justified for routine treatment of acute bronchitis (Grade of recommendation: D) 1

Continuing albuterol without documented benefit - studies show most patients with viral respiratory infections do not benefit from bronchodilators 2
Prescribing antibiotics for viral respiratory infections - patient satisfaction depends more on physician-patient communication than receiving antibiotics 2
Failing to distinguish between acute bronchitis and other conditions like asthma exacerbation or COPD, which would warrant different management approaches 2
Not objectively measuring response to bronchodilator therapy when a trial is attempted 1, 2

In pediatric patients, carefully distinguish between acute bronchitis and bronchiolitis, as management differs significantly 1
For bronchiolitis in children, bronchodilators should not be used routinely as RCTs have failed to demonstrate consistent benefit 1
If bronchiolitis is suspected in a child, nebulized epinephrine may be more effective than albuterol for short-term symptom relief 6