What is the treatment for bronchitis?

From the Guidelines

The treatment for bronchitis is generally focused on relieving symptoms and supporting the body's natural recovery process, with antibiotic therapy only considered in cases of suspected bacterial infection or severe exacerbations.

Treatment Approach

• For acute bronchitis in immunocompetent adult outpatients, the consensus is to avoid routine prescription of antibiotics, antivirals, antitussives, and other therapies unless the condition worsens or a complicating bacterial infection is suspected 1.
• In cases of chronic bronchitis, the most effective approach is the avoidance of respiratory irritants, and pharmacologic therapy may be helpful but should be guided by the severity of symptoms and the presence of complicating factors 1.

Pharmacologic Interventions

• Short-acting inhaled β-agonists, inhaled ipratropium bromide, and oral theophylline may improve cough in patients with chronic bronchitis 1.
• Combined regimens of inhaled long-acting β-agonist and an inhaled corticosteroid may also be beneficial for patients with chronic bronchitis, especially those with severe airflow obstruction or frequent exacerbations 1.
• Antibiotics are recommended for the treatment of acute exacerbations of chronic bronchitis, particularly in patients with purulent sputum, increased severity of illness, or more severe airflow obstruction at baseline 1.
• Central cough suppressants like codeine and dextromethorphan may be used for short-term symptomatic relief of coughing in patients with chronic bronchitis 1.

From the Research

Treatment Options for Bronchitis

• The treatment for bronchitis typically involves supportive care, which may include removal of irritants, use of a bronchodilator, oxygen, hydration, use of a systemic corticosteroid, and chest physical therapy 2.
• For acute exacerbation of chronic bronchitis (AECB), antibacterial treatment should be reserved for patients with at least one key symptom (e.g., increased dyspnea, sputum production, sputum purulence) and one risk factor (e.g., age > or = 65 years, forced expiratory volume in 1 second < 50% of the predicted value) 2.
• Antibiotics are generally not indicated for bronchitis, and should be used only if pertussis is suspected to reduce transmission or if the patient is at increased risk of developing pneumonia (e.g., patients 65 years or older) 3.
• Symptomatic treatment of cough is primarily required for patients with acute bronchitis, and may include antitussive agents, protussive agents, and beta-2-agonists 4.
• For chronic bronchitis, management consists primarily in the elimination of noxae (e.g., cigarette smoking), and treatment with antibiotics makes sense only when there is a bacteriological infection of the upper or lower airways in an acute stage 5.

Antibiotic Use in Bronchitis

• The use of antibiotics in bronchitis is generally not recommended, unless there is convincing evidence of a bacterial infection 6.
• Studies have shown that antibiotics are not effective in treating acute bronchitis in healthy adults, and may only be slightly better than placebo in some cases 6.
• The choice of antibiotic should be based on the severity of the exacerbation, with newer macrolides, extended-spectrum cephalosporins, or doxycycline used for moderate severity, and high-dose amoxicillin/clavulanate or a respiratory fluoroquinolone used for severe exacerbations 2.

Non-Pharmacological Treatment Options

• Non-pharmacological options for treating bronchitis may include removal of irritants, use of a humidifier, and chest physical therapy 2.
• Pelargonium supplements may help reduce symptom severity in adults with acute bronchitis 3.
• Effective communication strategies are necessary to provide the safest therapies available while maintaining patient satisfaction, as patient expectations for antibiotics and therapies for symptom management may differ from evidence-based recommendations 3.