What is the management of a cough following acute bronchitis?

From the Guidelines

The most effective management of a cough following bronchitis involves a combination of supportive care and targeted treatments, with a focus on avoiding respiratory irritants and using medications such as short-acting inhaled β-agonists, inhaled ipratropium bromide, and oral theophylline, as well as central cough suppressants like codeine and dextromethorphan for short-term symptomatic relief. The management of a cough following bronchitis can be broken down into several key components, including:

• Avoiding respiratory irritants, such as personal tobacco use, passive smoke exposure, and workplace hazards, which can help reduce or eliminate cough in patients with chronic bronchitis and persistent exposure to these irritants 1
• Using medications such as short-acting inhaled β-agonists, inhaled ipratropium bromide, and oral theophylline, which may improve cough in patients with chronic bronchitis 1
• Using central cough suppressants like codeine and dextromethorphan for short-term symptomatic relief of coughing 1
• Considering the use of inhaled bronchodilators, oral antibiotics, and oral corticosteroids (or in severe cases IV corticosteroids) for the treatment of an acute exacerbation of chronic bronchitis, although their effects on cough have not been systematically evaluated 1
• Avoiding the use of prophylactic antibiotics, oral corticosteroids, expectorants, postural drainage, and chest physiotherapy, as there is no proven benefit for these treatments in managing cough in patients with chronic bronchitis 1 It's also important to note that patient satisfaction with care for acute bronchitis depends most on physician–patient communication rather than whether an antibiotic is prescribed 1, and that antibiotics are rarely effective for acute cough and are not indicated for acute cough from the common cold, acute bronchitis, asthma, mild exacerbations of chronic bronchitis related to smoking; or environmental irritants 1. In recent years, a chest expert panel report suggested that for immunocompetent adult outpatients with cough due to acute bronchitis, no routine prescription of antibiotic therapy, antiviral therapy, antitussives, inhaled beta agonists, inhaled anticholinergics, inhaled corticosteroids, oral corticosteroids, oral NSAIDs or other therapies is recommended until such treatments have been shown to be safe and effective at making cough less severe or resolve sooner 1. Overall, the management of a cough following bronchitis requires a comprehensive approach that takes into account the underlying cause of the cough, the presence of any underlying respiratory conditions, and the potential benefits and risks of different treatments.

From the FDA Drug Label

Helps loosen phlegm (mucus) and thin bronchial secretions to make coughs more productive. temporarily relieves: cough due to minor throat and bronchial irritation as may occur with a cold or inhaled irritants The management of a cough following bronchitis may include the use of guaifenesin or codeine to help loosen phlegm and make coughs more productive, as well as to temporarily relieve cough due to minor throat and bronchial irritation 2 3.

• Guaifenesin can be used to thin bronchial secretions and make coughs more productive.
• Codeine can be used to temporarily relieve cough due to minor throat and bronchial irritation.

From the Research

Management of Cough Following Bronchitis

The management of cough following bronchitis involves various approaches, including pharmacological and non-pharmacological interventions.

• Guaifenesin, an expectorant, is used to loosen mucus in the airways and make coughs more productive, providing relief for wet cough and chest congestion due to the common cold and stable chronic bronchitis 4, 5.
• Non-pharmacological measures include smoking cessation and chest physiotherapy 5.
• Pharmacological interventions include expectorants and mucolytics, along with long-acting beta2-adrenergic receptor agonists, anticholinergics, glucocorticoids, phosphodiesterase-4 inhibitors, antioxidants, and antibiotics 5.
• The use of guaifenesin has been associated with improved quality of life in patients with chronic obstructive pulmonary disease (COPD) and stable chronic bronchitis 6.

Treatment Approaches

Treatment approaches for cough vary depending on the underlying cause and may involve:

• Identifying and treating underlying causes and potentiators of cough 7.
• Using anti-inflammatory treatment for cough variant asthma (CVA)/eosinophilic bronchitis and promotility agents for non-acid reflux 8.
• Reducing hypersensitivity through neuromodulation, such as with low-dose morphine, gabapentin, or pregabalin 8.
• Cough suppression therapy performed by competent practitioners 8.

Specific Considerations

Specific considerations for children with cough include:

• Pursuing an underlying cause for cough, such as inhalation of a foreign body or persistent bacterial bronchitis 8.
• Using a pediatric-specific algorithm for diagnosis and treatment 8.
• Antibiotics may be curative for persistent bacterial bronchitis in children 8.