What is the management of a cough following acute bronchitis (inflammation of the bronchial tubes) infection?

From the Guidelines

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, or oral NSAIDs is suggested until such treatments have been shown to be safe and effective at making cough less severe or resolve sooner 1.

Management of Post-Bronchitis Cough

The management of a cough following bronchitis infection involves a combination of supportive care and targeted treatments.

• For most patients, the cough will resolve on its own within 3-8 weeks, but several interventions can help manage symptoms during recovery.
• Over-the-counter cough suppressants containing dextromethorphan can provide relief, particularly for coughs that disrupt sleep.
• For daytime coughs, guaifenesin can help thin mucus and make coughs more productive.
• Honey is effective for soothing throat irritation, especially before bedtime.
• Staying well-hydrated with 8-10 glasses of water daily helps thin mucus secretions, while using a humidifier adds moisture to the air, reducing cough triggers.

Considerations for Treatment

• Antibiotic therapy should only be considered if a complicating bacterial infection is thought likely 1.
• Differential diagnoses, such as exacerbations of chronic airways diseases (COPD, asthma, bronchiectasis), should also be considered, as they may require other therapeutic management.
• Patients should seek medical attention if the cough is accompanied by fever, shortness of breath, chest pain, or if it produces discolored sputum, as these may indicate complications requiring different management.

Persistent Coughs

For persistent coughs lasting beyond 8 weeks, prescription options may include inhaled corticosteroids or short-term oral steroids, which work by reducing the airway inflammation that persists after the infection has cleared, often the underlying cause of the lingering cough reflex.

• Inhaled corticosteroids like beclomethasone (40-80 mcg per nostril twice daily) can be effective.
• Short-term oral steroids such as prednisone (typically 40 mg daily for 5 days, tapering down) may also be considered.

From the FDA Drug Label

Helps loosen phlegm (mucus) and thin bronchial secretions to make coughs more productive. The management of a cough following bronchitis infection may include the use of guaifenesin (PO) to help loosen phlegm and thin bronchial secretions, making coughs more productive 2.

• The goal is to make coughs more productive, allowing for easier clearance of mucus and secretions.
• Guaifenesin is an option for managing cough following bronchitis infection.

From the Research

Management of Cough Following Bronchitis Infection

• The management of cough following bronchitis infection involves the use of expectorants such as guaifenesin to loosen mucus in the airways and make coughs more productive 3, 4.
• Guaifenesin has a well-established and favorable safety and tolerability profile in adult and pediatric populations, and its dosing range allows for flexible dose titration 3.
• For acute bronchitis, symptom relief and patient education regarding the expected duration of cough (2-3 weeks) are recommended, and strategies such as delayed antibiotic prescriptions and describing acute bronchitis as a chest cold can help decrease antibiotic prescribing 5.
• A case report also showed improvement in symptoms and quality of life with long-term use of guaifenesin for the treatment of mucus-related symptoms in a patient with chronic bronchitis 6.

Treatment Options

• Guaifenesin is considered a safe and effective expectorant for the treatment of mucus-related symptoms in acute upper respiratory tract infections and stable chronic bronchitis 3, 4.
• Non-pharmacological measures such as smoking cessation and chest physiotherapy can also help decrease mucus hypersecretion and increase mucus clearance 4.
• Pharmacological interventions such as long-acting beta2-adrenergic receptor agonists, anticholinergics, glucocorticoids, phosphodiesterase-4 inhibitors, antioxidants, and antibiotics may also be used in certain cases 4.

Important Considerations

• Antibiotics do not contribute to the overall improvement of acute bronchitis and may expose patients to antibiotic-related adverse effects 5.
• Diagnostic testing is not indicated unless there is concern for other potential causes of acute cough, such as community-acquired pneumonia, influenza, or COVID-19 5.