Bronchitis - Uncomplicated Acute Management

Symptomatic Therapy  

The choice of therapy depends on which symptoms are most bothersome to the patient.

Analgesics (Non-Opioid) and Antipyretics  

Example drugs: Ibuprofen, Paracetamol  

Analgesics (non-opioid) and antipyretics are beneficial when influenza symptoms, such as malaise and fever, are prominent. Salicylates should be avoided in children ≤18 years of age because of the risk of Reye Syndrome.

Beta₂-Agonist Bronchodilators  

Example drug: Salbutamol  

Beta_₂-agonist bronchodilators may be used to reduce the duration and severity of cough in some patients, but routine use for cough palliation is not recommended. Their use should be individualized to those who are most likely to benefit. It is justified in patients with clinical evidence of airflow obstruction or bronchial hyper-responsiveness such as wheezing or bothersome cough, and underlying pulmonary disease. Studies have shown that more patients report a decrease in cough after 7 days of inhaled bronchodilator as compared to placebo or antibiotic.

Cough and Cold Preparations  

Example drugs: Codeine, Dextromethorphan, Guaifenesin  

Cough and cold preparations may be justified for a non-productive, irritating cough and are given short term for cough relief. Codeine is a weak, centrally acting opioid that suppresses cough, while Dextromethorphan is a non-opioid that acts centrally to decrease cough. Patients with cough lasting more than 2–3 weeks are the most likely to benefit. These agents suppress the cough reflex by direct action on the cough center in the medulla of the brain. They have a modest effect on the severity and duration of cough but are typically not very effective in patients with acute or early cough due to colds or other viral URTIs. Guaifenesin is an expectorant which acts by stimulating respiratory tract secretions, leading to increased respiratory fluid volumes and decreased mucus viscosity. It also has antitussive activity, and its effectiveness in reducing cough frequency and intensity was shown in several clinical trials. Though evidence is lacking to recommend mucolytic monotherapy for acute bronchitis, studies show that changes in the character of sputum help improve respiratory symptoms with its use.

Other Treatments  

Pelargonium sidoides  

Pelargonium sidoides may be used as monotherapy or in combination with symptomatic therapy and/or antibiotics. It modulates the immune response, has bacteriostatic properties that prevent the proliferation of bacteria that cause secondary bacterial superinfection, and possesses expectorant and mucolytic properties. It also reduces the duration and severity of respiratory tract infections caused by viruses.  

Vitex negundo L (Lagundi leaf)  

Studies show improvement of respiratory symptoms with Lagundi treatment when compared with Theophylline.  

Antibiotics for Pertussis  

Use of antibiotics for pertussis is supported only for confirmed or suspected Bordetella pertussis cases when there is a high probability of exposure or during an outbreak. Erythromycin is the drug of choice for treatment and prophylaxis of pertussis in people of all ages. Two small comparative studies suggest that Clarithromycin and Azithromycin are at least as effective as Erythromycin for pertussis treatment. Co-trimoxazole may be used as an alternative when macrolides cannot be given. Antibiotics are primarily used to decrease shedding of the pathogen and therefore decrease the spread of the disease. Patient isolation for 5 days from the start of treatment is a necessary precaution. While antibiotic therapy does not appear to resolve symptoms if it is initiated 7–10 days after the onset of illness but prevents spread of disease.

Patient Education  

Patient education should include a discussion of the expected course of illness and the treatment plan with the patient. It is important to reassure the patient that their condition is self-limiting and will typically resolve with supportive therapy.  

Supportive Measures  

Supportive measures include encouraging the patient to increase fluid intake to help prevent drying of bronchial secretions and assist in clearing of sputum. Bed rest should be advised, especially when fatigue and fever are prominent. The patient should eliminate cough triggers such as dust and dander. Increasing humidity with vaporized air treatments is recommended in dry environments. Throat lozenges, hot tea and honey may provide symptomatic relief.  

Smoking Cessation  

Severity of acute bronchitis attacks may be increased by exposure to cigarette smoke and air pollutants; thus, second-hand smoke exposure should be avoided. In a patient who smokes, this may be a good opportunity to encourage smoking cessation.  

Emphasize Lack of Benefit to Antibiotic Treatment  

Antibiotic therapy is not justified because acute bronchitis is primarily a viral illness, with the exception being confirmed or probable bacterial infection, such as whooping cough. Management should be individualized and adequately explained to patients. There is evidence that patient satisfaction does not depend on receiving antibiotics but rather on the quality of the patient–physician communication.  

The quality of communication may be increased by reviewing the following with the patient: 

• Antibiotics provide little or no benefit in the treatment of the disease
• Risks associated with unnecessary antibiotic use (eg infection with resistant bacteria, GI side effects, risk of allergic reactions)
• Condition is not serious and is expected to improve without antibiotics
• Cough is part of the body’s defense mechanism and duration of cough may last for 10-21 days

Other  

Patients should be advised to contact their health care provider if their condition worsens.