From the Guidelines
Bronchitis treatment should focus on relieving symptoms and addressing the underlying cause, with antibiotics generally not recommended for acute bronchitis unless a bacterial infection is confirmed, as suggested by the most recent guidelines 1.
Treatment Approach
For acute bronchitis, which is typically viral, treatment includes:
- Rest
- Increased fluid intake
- Over-the-counter medications like acetaminophen (Tylenol) or ibuprofen (Advil) for fever and discomfort
- A humidifier to help loosen mucus
- Cough suppressants containing dextromethorphan (such as Robitussin DM) may provide relief at night, although evidence for their effectiveness is mixed 1
Antibiotic Use
Antibiotics are generally not recommended for acute bronchitis unless a bacterial infection is confirmed, as stated in the 2020 Chest expert panel report 1. However, for patients with COPD exacerbations and acute uncomplicated bronchitis who have clinical signs of a bacterial infection, a short course of antibiotics (5 days) may be considered, as recommended by the American College of Physicians 1.
Chronic Bronchitis Management
For chronic bronchitis, treatment may include:
- Bronchodilators like albuterol (2 puffs every 4-6 hours as needed) to help open airways
- Inhaled corticosteroids such as fluticasone (2 puffs twice daily) to reduce inflammation
- Severe cases may require oral steroids like prednisone (typically 40mg daily for 5 days, tapering down)
- Oxygen therapy might be necessary for patients with low blood oxygen levels
- Lifestyle changes, such as quitting smoking, avoiding irritants, and staying current with pneumonia and flu vaccines, are crucial for managing chronic bronchitis
- Pulmonary rehabilitation programs can benefit those with chronic bronchitis by improving breathing techniques and exercise capacity 1
From the FDA Drug Label
Albuterol sulfate inhalation solution is indicated for the relief of bronchospasm in patients 2 years of age and older with reversible obstructive airway disease and acute attacks of bronchospasm.
- Treatment of bronchitis is not explicitly mentioned in the label.
- The label only mentions relief of bronchospasm in patients with reversible obstructive airway disease.
- Albuterol (INH) may be used to relieve bronchospasm associated with bronchitis, but the label does not directly support this indication 2.
From the Research
Treatment Options for Bronchitis
- Acute bronchitis is usually caused by viruses, and therapy is generally supportive 3, 4
- Chronic bronchitis is most often caused by cigarette smoking, which decreases mucociliary transport velocity, and may necessitate antimicrobial therapy 3
- Antibiotics are generally not indicated for bronchitis, and should be used only if pertussis is suspected or if the patient is at increased risk of developing pneumonia 4
- The supplement pelargonium may help reduce symptom severity in adults with acute bronchitis 4
- Albuterol, a bronchodilator, may be more effective than antibiotics in relieving symptoms of acute bronchitis 5
Management of Bronchitis Symptoms
- Symptoms of bronchitis typically last about three weeks 4
- The presence or absence of colored sputum does not reliably differentiate between bacterial and viral lower respiratory tract infections 4
- Viruses are responsible for more than 90 percent of acute bronchitis infections 4
- Cough and cold preparations are not recommended for children younger than six years 4
- Effective communication strategies are necessary to provide the safest therapies available while maintaining patient satisfaction 4
Treatment Approaches
- A systematic review found that antibiotics, antihistamines, antitussives, beta2 agonists, and expectorants/mucolytics have varying degrees of efficacy in treating acute bronchitis 6
- A national survey of family physicians found that 63% of responding physicians indicated that antibiotics are their first choice of treatment for acute bronchitis in otherwise healthy adults 7
- However, previous clinical trials have shown only marginal improvement in symptoms when patients with acute bronchitis are treated with an antibiotic 7