Bronchitis medical therapy: Difference between revisions

	Bronchitis Main page
Patient Information
Overview
Causes
Classification Acute bronchitis Chronic bronchitis
Differential Diagnosis

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Latest revision as of 20:44, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chetan Lokhande, M.B.B.S [2]; Seyedmahdi Pahlavani, M.D. [3]; Nate Michalak, B.A.

Overview

The majority of cases of bronchitis are caused by viruses and are self-limited. The treatment of bronchitis is primarily symptomatic and includes analgesics, decongestants, expectorants, and cough suppressants. The administration of antibiotics should be limited to cases in which a definitive pathogen is identified. Pharmacologic therapy for chronic bronchitis includes a combination of inhaled corticosteroids, bronchodilators ( e.g. Salbutamol), and inhaled anticholinergics (e.g. Ipratropium bromide).

Medical Therapy

Acute Bronchitis

Symptomatic

Treatment for acute bronchitis is primarily symptomatic. Even with no treatment, most cases of acute bronchitis resolve quickly.

Non-steroidal anti-inflammatory drugs (NSAIDs) may be used to treat fever and sore throat.
Decongestants can be useful in patients with nasal congestion.
Expectorants may be used to loosen mucus and increase expulsion of sputum.
Cough suppressants may be used if the cough interferes with sleep or is bothersome, although coughing may be useful in expelling sputum from the airways.

Antimicrobial Agent

Approximately 5–10% of bronchitis cases are caused by a bacterial infection. Most cases of bronchitis are caused by a viral infection and are self-limiting, resolving in a few weeks.^[1]
Antimicrobial agents are not recommended in most cases of acute bronchitis. Various randomized controlled trials and systematic reviews have shown a decrease in symptoms by just a fraction of day with use of antibiotics when compared with placebo. These results, though statistically significant, are not clinically significant (as improvement by only a fraction of day).
- Antibiotic therapy did not help in a trial of patients who mainly had bronchitis. Approximately 15% had chronic obstructive lung disease and their results were not reported separately.^[2]
Treatment with antibiotics can be administered in cases in which a definitive treatable pathogen is present.
- Treatment of influenza virus with oseltamivir decreases the duration of symptoms by approximately 1 day and results in an earlier return to normal activity.
- Treatment of patients with pertussis is indicated to limit transmission when the therapy is initiated during the first week of symptoms. However, the symptoms are not less severe even with administration of these antibiotics.
In cases of definitive diagnosis, anti-microbial agent may be used for for the following:
- Influenza
  - Oseltamivir (Tamiflu), 75 mg BD for 5 days
  - Zanamivir 2 puffs BD for 5 days
- Atypical bacteria (Bordetella pertussis, mycoplasma pneumonia, chlamydia pneumonia)
  - Azithromycin (Zithromax) 500mg on day 1 followed by 250mg from day 2-5.

Other Therapy

Various other treatments, such as beta 2 agonists, mucolytic agents, anti-tussive agents, and corticosteroids have been used in different settings but no proven benefits have been shown in any of the clinical trials.

Chronic Bronchitis Treatment

Chronic bronchitis is treated symptomatically.

Inflammation and edema of the respiratory epithelium may be reduced with inhaled corticosteroids.
Wheezing and shortness of breath can be treated by reducing bronchospasm with bronchodilators, such as inhaled β-Adrenergic agonists (e.g., Salbutamol) and inhaled anticholinergics (e.g., Ipratropium bromide).
Hypoxemia can be treated with supplemental oxygen. However, oxygen supplementation can result in decreased respiratory drive, leading to increased blood levels of carbon dioxide and subsequent respiratory acidosis.

Smoking Cessation

To help the bronchial tree heal faster and limit progression of bronchitis, smokers should quit smoking.^[3]

References

↑ Hueston WJ (1997). "Antibiotics: neither cost effective nor 'cough' effective". The Journal of Family Practice. 44 (3): 261–5. PMID 9071245. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
↑
↑ The American Academy of Family Physicians: Acute Bronchitis. January 2006. Accessed 20 March 2007.

Template:WikiDoc Sources

[Cough-1] Hueston WJ (1997). "Antibiotics: neither cost effective nor 'cough' effective". The Journal of Family Practice. 44 (3): 261–5. PMID 9071245. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)

[pmid23265995-2] ↑

[3] The American Academy of Family Physicians: Acute Bronchitis. January 2006. Accessed 20 March 2007.

[1]

[2]

[3]

@@ Line 1: / Line 1: @@
 __NOTOC__
-{{CMG}}; {{AE}} {{chetan}}
+{{CMG}}; {{AE}} {{chetan}}; {{MehdiP}}; {{NRM}}
 {{Bronchitis}}
 ==Overview==
-Most cases of bronchitis are due to viruses and are typically self-limiting.  The treatment of bronchitis is primarily symptomatic and includes [[analgesics]], [[decongestants]], expectorants, and cough suppressants. The use of antibiotics should be limited to cases in which a definitive pathogen is identified.  Pharmacologic therapies for chronic bronchitis include inhaled [[corticosteroids]], [[bronchodilators]] ( e.g., [[Salbutamol]]), and inhaled anticholinergics (such as Ipratropium bromide).
+The majority of cases of bronchitis are caused by [[Virus|viruses]] and are self-limited. The treatment of bronchitis is primarily symptomatic and includes [[analgesics]], [[decongestants]], [[expectorants]], and cough suppressants. The administration of [[Antibiotic|antibiotics]] should be limited to cases in which a definitive pathogen is identified. Pharmacologic therapy for chronic bronchitis includes a combination of inhaled [[corticosteroids]], [[bronchodilators]] ( e.g. [[Salbutamol]]), and inhaled [[anticholinergics]] (e.g. [[Ipratropium bromide]]).
 ==Medical Therapy==
 ===Acute Bronchitis===
 ====Symptomatic====
-Treatment for acute bronchitis is primarily symptomatic.
+Treatment for acute bronchitis is primarily symptomatic. Even with no treatment, most cases of acute bronchitis resolve quickly.
 * [[Non-steroidal anti-inflammatory drugs]] (NSAIDs) may be used to treat fever and sore throat.
-* [[Decongestants]] can be useful in patients with nasal congestion, and
+* [[Decongestants]] can be useful in patients with nasal congestion.
-* [[Expectorant]]s may be used to loosen mucus and increase expulsion of sputum.
+* [[Expectorant]]s may be used to loosen mucus and increase expulsion of [[sputum]].
-* [[Cough suppressant]]s may be used if the cough interferes with sleep or is bothersome, although coughing may be useful in expelling sputum from the airways. Even with no treatment, most cases of acute bronchitis resolve quickly.
+* [[Cough suppressant]]s may be used if the cough interferes with sleep or is bothersome, although coughing may be useful in expelling sputum from the airways.
 ====Antimicrobial Agent====
-*Only about 5–10% of bronchitis cases are caused by a bacterial infection. Most cases of bronchitis are caused by a viral infection and are "[[Self-limiting_(biology)|self-limiting]]" and resolve themselves in a few weeks.<ref name="Cough">{{cite journal | author = Hueston WJ | title = Antibiotics: neither cost effective nor 'cough' effective | journal = The Journal of Family Practice | volume = 44 | issue = 3 | pages = 261–5 | year = 1997 | month = March | pmid = 9071245 | accessdate = 2009-06-30 }}</ref>
+*Approximately 5–10% of bronchitis cases are caused by a bacterial infection. Most cases of bronchitis are caused by a viral infection and are [[Self-limiting_(biology)|self-limiting]], resolving in a few weeks.<ref name="Cough">{{cite journal | author = Hueston WJ | title = Antibiotics: neither cost effective nor 'cough' effective | journal = The Journal of Family Practice | volume = 44 | issue = 3 | pages = 261–5 | year = 1997 | month = March | pmid = 9071245 | accessdate = 2009-06-30 }}</ref>
-* Antimicrobial agents are not recommended in most cases of acute bronchitis. Various randomized controlled trials and systematic reviews have shown a decrease in symptoms by just a fraction of day with use of antibiotics when compared with placebo. These results though statistically significant are not clinically significant (as improvement by only a fraction of day). Antibiotic therapy did not help in a trial of patients who mainly had bronchitis.<ref name="pmid23265995">{{cite journal| author=Little P, Stuart B, Moore M, Coenen S, Butler CC, Godycki-Cwirko M et al.| title=Amoxicillin for acute lower-respiratory-tract infection in primary care when pneumonia is not suspected: a 12-country, randomised, placebo-controlled trial. | journal=Lancet Infect Dis | year= 2012 | volume=  | issue=  | pages=  | pmid=23265995 | doi=10.1016/S1473-3099(12)70300-6 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23265995  }} </ref> About 15% had chronic obstructive lung disease and their results were not reported separately.<ref name="pmid23265995"/>
+* Antimicrobial agents are not recommended in most cases of acute bronchitis. Various randomized controlled trials and systematic reviews have shown a decrease in symptoms by just a fraction of day with use of antibiotics when compared with placebo. These results, though statistically significant, are not clinically significant (as improvement by only a fraction of day).
-* However, treatment with antibiotics can be administered in cases in which a definitive treatable pathogen is present. For e.g. treatment of influenza virus with [[oseltamivir]] decreases the duration of symptoms by approximately 1 day and results in an earlier return to normal activity. Similarly, treatment of patients with pertussis is indicated to limit transmission when the therapy is initiated during the first week of symptoms. However, the symptoms are not less severe even with administration of these antibiotics.
+** Antibiotic therapy did not help in a trial of patients who mainly had bronchitis. Approximately 15% had [[chronic obstructive lung disease]] and their results were not reported separately.<ref name="pmid23265995" />
-* Thus, in case of definitive diagnosis antibiotics can be used for:
+* Treatment with antibiotics can be administered in cases in which a definitive treatable pathogen is present.
-* Influenza
+** Treatment of [[influenza virus]] with [[oseltamivir]] decreases the duration of symptoms by approximately 1 day and results in an earlier return to normal activity.
-** [[Oseltamivir]] ([[Tamiflu]]), 75 mg BD for 5 days
+** Treatment of patients with [[pertussis]] is indicated to limit transmission when the therapy is initiated during the first week of symptoms. However, the symptoms are not less severe even with administration of these antibiotics.
-** [[Zanamivir]] 2 puffs BD for 5 days
+* In cases of definitive diagnosis, anti-microbial agent may be used for for the following:
-* Atypical bacteria (Bordetella pertusis, mycoplasma pneumonia, chlamydiae pneumonia)
+** Influenza
-** Azithromycin (Zithromax) 500mg on day 1 followed by 250mg from day 2-5.
+*** [[Oseltamivir]] ([[Tamiflu]]), 75 mg BD for 5 days
-===Other Therapy===
+*** [[Zanamivir]] 2 puffs BD for 5 days
-* Various other treatments like beta 2 agonists, mucolytic agents, anti-tussive agents and corticosteroids have been used in different settings but no proven benefits have been shown in any of the clinical trials.
+** Atypical bacteria ([[Bordetella pertussis]], [[mycoplasma pneumonia]], [[chlamydia pneumonia]])
+*** [[Azithromycin]] (Zithromax) 500mg on day 1 followed by 250mg from day 2-5.
+====Other Therapy====
+* Various other treatments, such as beta 2 agonists, mucolytic agents, anti-tussive agents, and [[corticosteroids]] have been used in different settings but no proven benefits have been shown in any of the clinical trials.
 ===Chronic Bronchitis Treatment===
-Chronic bronchitis is treated symptomatically. Inflammation and edema of the respiratory epithelium may be reduced with inhaled [[corticosteroid]]s. Wheezing and shortness of breath can be treated by reducing [[bronchospasm]] (reversible narrowing of smaller bronchi due to constriction of the [[smooth muscle]])  with [[bronchodilator]]s such as inhaled [[beta agonist|β-Adrenergic agonist]]s (e.g., [[Salbutamol]]) and inhaled [[anticholinergic]]s (e.g., [[ipratropium|Ipratropium bromide]]). [[Hypoxemia]], too little oxygen in the blood, can be treated with supplemental oxygen. However, oxygen supplementation can result in decreased respiratory drive, leading to increased blood levels of [[carbon dioxide]] and subsequent [[respiratory acidosis]].
+Chronic bronchitis is treated symptomatically.
+* Inflammation and [[edema]] of the respiratory epithelium may be reduced with inhaled [[corticosteroid]]s.
-The most effective method of preventing chronic bronchitis and other forms of COPD is to avoid smoking cigarettes and other forms of tobacco.
+* Wheezing and shortness of breath can be treated by reducing [[bronchospasm]] with [[bronchodilator]]s, such as inhaled [[beta agonist|β-Adrenergic agonist]]s (e.g., [[Salbutamol]]) and inhaled [[anticholinergic]]s (e.g., [[ipratropium|Ipratropium bromide]]).
+* [[Hypoxemia]] can be treated with supplemental oxygen. However, oxygen supplementation can result in decreased respiratory drive, leading to increased blood levels of [[carbon dioxide]] and subsequent [[respiratory acidosis]].
-On pulmonary tests, a bronchitic (bronchitis) may present a decreased FEV1 and FEV1/FVC. However, unlike the other common obstructive disorders, asthma and emphysema, bronchitis rarely causes a high residual volume. This is because the air flow obstruction found in bronchitis is due to increased resistance, which, in general, does not cause the airways to collapse prematurely and trap air in the lungs.{{Citation needed|date=October 2009}}
-====Antibiotics====
-In most cases, acute bronchitis is caused by [[virus]]es, not [[bacteria]] and it will go away on its own without antibiotics. To treat acute bronchitis that appears to be caused by a bacterial infection, or as a precaution, [[antibiotic]]s may be given.<ref>[http://www.merck.com/mmhe/sec04/ch041/ch041a.html The Merck Manual of Medical Information: Bronchitis].  February 2003.  Accessed [[20 March]] [[2007]].</ref>
-If antibiotics are used, a [[meta-analysis]] found that "amoxicillin/clavulanic acid, macrolides, second-generation or third-generation cephalosporins, and quinolones" may be more effective.<ref name="pmid17573508">{{cite journal |author=Dimopoulos G, Siempos II, Korbila IP, Manta KG, Falagas ME |title=Comparison of first-line with second-line antibiotics for acute exacerbations of chronic bronchitis: a metaanalysis of randomized controlled trials to Joe Fo Sho |journal=Chest |volume=132 |issue=2 |pages=447-55 |year=2007 |pmid=17573508 |doi=10.1378/chest.07-0149}}</ref>
-=====Bronchitis, Infants/Children (Age < 5 years)=====
-Antibiotics are not indicated usually except for a few conditions like:
-#[[Sinusitis]]
-#[[Pneumonia]]
-#Patient doesn't improve even after one week.
-=====Bronchitis, Acute, Age > 5 years=====
-Antibiotics are ineffective most of the times and not recommended except for:
-#[[Pertussis]]
-#Start antitussive with inhaled bronchodilator
-=====Bronchitis, Chronic with Acute Exacerbation=====
-For severe exacerbations consider the following management protocol:
-#If patient has low O2 saturation , order a X-ray.
-#Start inhaled anticholinergic bronhodilator
-#Start oral sterids and then taper it over 2 weeks.
-#Non-invasive positive pressure ventilation.
-#For penicillin resistant S.pneumoniae start [[Levofloxacin]] and [[Moxifloxacin]].
-====Antibiotic therapy====
-* '''Acute bronchitis'''<ref name="pmid16428698">{{cite journal| author=Braman SS| title=Chronic cough due to acute bronchitis: ACCP evidence-based clinical practice guidelines. | journal=Chest | year= 2006 | volume= 129 | issue= 1 Suppl | pages= 95S-103S | pmid=16428698 | doi=10.1378/chest.129.1_suppl.95S | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16428698  }} </ref>
-:* 1.'''Treatment of acute bronchitis with no suspicion of pertussis'''
-::* Preferred regimen: Supportive care. Antimicrobial therapy not recommended.
-:* 2.'''Treatment of acute bronchitis with suspected or confirmed pertussis'''
-::* Preferred regimen (1): [[Erythromycin]] 15 mg/kg PO tid for 5-14 days
-::* Preferred regimen (2): [[Azithromycin]] 500 mg PO single dose {{then}} [[Azithromycin]] 250 mg PO qd for 4 days
 ====Smoking Cessation====
-To help the bronchial tree heal faster and not make bronchitis worse, [[tobacco smoking|smokers]] should completely quit smoking. <ref>[http://familydoctor.org/677.xml The American Academy of Family Physicians: Acute Bronchitis].  January 2006.  Accessed [[20 March]] [[2007]].</ref>
+To help the bronchial tree heal faster and limit progression of bronchitis, [[tobacco smoking|smokers]] should quit smoking.<ref>[http://familydoctor.org/677.xml The American Academy of Family Physicians: Acute Bronchitis].  January 2006.  Accessed [[20 March]] [[2007]].</ref>
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