Bronchitis medical therapy

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

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

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).

Medical Therapy

Acute Bronchitis

Symptomatic

Treatment for acute bronchitis is primarily symptomatic.

• 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
• 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. Even with no treatment, most cases of acute bronchitis resolve quickly.

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" and resolve themselves in a few weeks.
• 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. About 15% had chronic obstructive lung disease and their results were not reported separately.
• 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.
• Thus, in case of definitive diagnosis antibiotics can be used for:
• Influenza
  • Oseltamivir (Tamiflu), 75 mg BD for 5 days
  • Zanamivir 2 puffs BD for 5 days
• Atypical bacteria (Bordetella pertusis, mycoplasma pneumonia, chlamydiae pneumonia)
  • Azithromycin (Zithromax) 500mg on day 1 followed by 250mg from day 2-5.

Other Therapy

• 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.

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 (reversible narrowing of smaller bronchi due to constriction of the smooth muscle) with bronchodilators such as inhaled β-Adrenergic agonists (e.g., Salbutamol) and inhaled anticholinergics (e.g., 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.

The most effective method of preventing chronic bronchitis and other forms of COPD is to avoid smoking cigarettes and other forms of tobacco.

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.

Antibiotics

In most cases, acute bronchitis is caused by viruses, 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, antibiotics may be given.

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.

Bronchitis, Infants/Children (Age < 5 years)

Antibiotics are not indicated usually except for a few conditions like:

1. Sinusitis
2. Pneumonia
3. 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:

1. Pertussis
2. Start antitussive with inhaled bronchodilator

Bronchitis, Chronic with Acute Exacerbation

For severe exacerbations consider the following management protocol:

1. If patient has low O2 saturation , order a X-ray.
2. Start inhaled anticholinergic bronhodilator
3. Start oral sterids and then taper it over 2 weeks.
4. Non-invasive positive pressure ventilation.
5. For penicillin resistant S.pneumoniae start Levofloxacin and Moxifloxacin.

Antibiotic therapy

• Acute bronchitis

• 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, smokers should completely quit smoking.

References

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