From the Guidelines
For immunocompetent adult outpatients with cough due to acute bronchitis, we suggest no routine prescription of antibiotic therapy, antiviral therapy, antitussives, inhaled beta agonists, inhaled anticholinergics, inhaled corticosteroids, oral corticosteroids, oral NSAIDs or other therapies until such treatments have been shown to be safe and effective at making cough less severe or resolve sooner 1. The treatment of bronchitis typically involves managing symptoms while the body fights the infection. For acute bronchitis, rest, increased fluid intake, and over-the-counter medications like acetaminophen (Tylenol) or ibuprofen (Advil) at standard doses can help reduce fever and discomfort. A humidifier or steam inhalation can loosen mucus. For cough relief, dextromethorphan (Robitussin DM) or guaifenesin (Mucinex) may help. Antibiotics are typically not recommended for acute bronchitis as it's usually viral. Some key points to consider in the treatment of bronchitis include:
- Avoiding routine investigations with chest x-ray, spirometry, peak flow measurement, sputum for microbial culture, respiratory tract samples for viral PCR, serum C-Reactive Protein (CRP) or procalcitonin for immunocompetent adult outpatients with cough due to suspected acute bronchitis 1
- Considering treatment with antibiotic therapy if a complicating bacterial infection is thought likely in cases where the acute bronchitis worsens 1
- Smoking cessation is crucial for recovery as continued smoking irritates the bronchial tubes and prolongs healing
- If symptoms worsen, include high fever, difficulty breathing, or persist beyond three weeks, medical attention should be sought as this could indicate pneumonia or another serious condition. The body generally clears acute bronchitis within 1-3 weeks as the inflammation in the bronchial tubes subsides. For chronic bronchitis, bronchodilators like albuterol may be prescribed to open airways, along with inhaled corticosteroids to reduce inflammation. In stable patients with chronic bronchitis, therapy with short-acting β-agonists should be used to control bronchospasm and relieve dyspnea; in some patients, it may also reduce chronic cough 2. In stable patients with chronic bronchitis, therapy with ipratropium bromide should be offered to improve cough 2. In patients with an acute exacerbation of chronic bronchitis, therapy with short-acting β-agonists or anticholinergic bronchodilators should be administered during the acute exacerbation 2. For patients with an acute exacerbation of chronic bronchitis, theophylline should not be used for treatment 2. It is essential to consider the patient's overall health and medical history when determining the best course of treatment for bronchitis. Differential diagnoses, such as exacerbations of chronic airways diseases (COPD, asthma, bronchiectasis), should also be considered 1. The initial clinical evaluation is crucial in the longitudinal care of patients, and targeted investigations should be considered if the acute bronchitis persists or worsens 1. Passive smoke exposures and hazardous environments in the home and workplace are predisposing factors of chronic bronchitis, and smoke-free workplace and public place laws should be enacted in all communities 2. Avoidance of respiratory irritants, such as personal tobacco use and workplace hazards, is the most effective means to improve or eliminate the cough of chronic bronchitis, with 90% of patients experiencing resolution of their cough after smoking cessation 2. In stable patients with chronic bronchitis, there is no role for long-term prophylactic therapy with antibiotics, and the use of antibiotics is recommended only in patients with severe exacerbations or those with more severe airflow obstruction at baseline 2. In stable patients with chronic bronchitis, treatment with a long-acting β-agonist when coupled with an inhaled corticosteroid should be offered to control chronic cough, and inhaled corticosteroid therapy should be offered to patients with an FEV1 of < 50% predicted or those with frequent exacerbations of chronic bronchitis 2.
From the Research
Bronchitis Treatment Overview
- Bronchitis is a common diagnosis in primary care physician's offices, especially during winter 3.
- Acute bronchitis is usually caused by viruses, while chronic bronchitis is most often caused by cigarette smoking 3.
Treatment Approaches
- Therapy for acute bronchitis is generally supportive, and antibiotics are not indicated unless pertussis is suspected or the patient is at increased risk of developing pneumonia 4, 5.
- The presence or absence of colored sputum does not reliably differentiate between bacterial and viral lower respiratory tract infections 4.
- Antimicrobial agents and vaccines may have both prophylactic and therapeutic roles in the management of chronic bronchitis 3.
Management of Symptoms
- The typical therapies for managing acute bronchitis symptoms have been shown to be ineffective 4.
- The U.S. Food and Drug Administration recommends against using cough and cold preparations in children younger than six years 4.
- The supplement pelargonium may help reduce symptom severity in adults 4.
- Patient satisfaction with care for acute bronchitis depends most on physician-patient communication rather than on antibiotic treatment 5.