Bronchitis medical therapy: Difference between revisions

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{{CMG}}
{{CMG}}
{{Bronchitis}}
{{Bronchitis}}
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Bronchitis is usually caused by a viral agent. The treatment of bronchitis is usually symptomatic with [[analgesics]], [[decongestants]], cough suppressant ([[codeine]] or hydrocodone-containing preparations or inhaled [[corticosteroids]]). Use of antibiotics should be limited to conditions when a diagnosis with a definitive pathogen is there. Oseltamivir for influenza (during influenza epidemics), and [[azithromycin]] for atypical bacterias like [[mycoplasma]], [[chlamydiae]] has been shown useful in clinical trials.
Bronchitis is usually caused by a viral agent. The treatment of bronchitis is usually symptomatic with [[analgesics]], [[decongestants]], cough suppressant ([[codeine]] or hydrocodone-containing preparations or inhaled [[corticosteroids]]). Use of antibiotics should be limited to conditions when a diagnosis with a definitive pathogen is there. Oseltamivir for influenza (during influenza epidemics), and [[azithromycin]] for atypical bacterias like [[mycoplasma]], [[chlamydiae]] has been shown useful in clinical trials.


== Treatment==
==Medical Therapy==
===Acute bronchitis===
===Acute Bronchitis===
====Symptomatic====
====Symptomatic====
Treatment for acute bronchitis is primarily symptomatic.
Treatment for acute bronchitis is primarily symptomatic.
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* [[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. Even with no treatment, most cases of acute bronchitis resolve quickly.
====Antimicrobial agent====
====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>  
*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>  
* 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). 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"/>
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* Atypical bacteria (Bordetella pertusis, mycoplasma pneumonia, chlamydiae pneumonia)
* Atypical bacteria (Bordetella pertusis, mycoplasma pneumonia, chlamydiae pneumonia)
** Azithromycin (Zithromax) 500mg on day 1 followed by 250mg from day 2-5.
** Azithromycin (Zithromax) 500mg on day 1 followed by 250mg from day 2-5.
===Other Therapy===
===Other Therapy===
* Various other treatments like beta 2 agonist, mucolytic agents, anti-tussive agent and corticosteroids have been used in different settings but no proven benefits have been shown in any of the clinical trials.
* Various other treatments like beta 2 agonist, mucolytic agents, anti-tussive agent 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 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. 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]].


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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}}
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===
====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>
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>
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>


===Smoking cessation===
====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 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>


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[[Category:General practice]]
[[Category:General practice]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[Category:Overview complete]]
[[Category:primary care]]
 


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Revision as of 14:36, 29 March 2013

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Bronchitis Main page

Patient Information

Overview

Causes

Classification

Acute bronchitis
Chronic bronchitis

Differential Diagnosis

Overview

Bronchitis is usually caused by a viral agent. The treatment of bronchitis is usually symptomatic with analgesics, decongestants, cough suppressant (codeine or hydrocodone-containing preparations or inhaled corticosteroids). Use of antibiotics should be limited to conditions when a diagnosis with a definitive pathogen is there. Oseltamivir for influenza (during influenza epidemics), and azithromycin for atypical bacterias like mycoplasma, chlamydiae has been shown useful in clinical trials.

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.[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.[2] About 15% had chronic obstructive lung disease and their results were not reported separately.[2]
  • However, treatment with antibiotics can be administered in cases with a definitive treatable pathogen is there. For e.g. treatment of influenza virus with oseltamivir decrease the duration of symptoms by approximately 1 day and result 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
  • 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 agonist, mucolytic agents, anti-tussive agent 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.[citation needed]

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.[3]

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.[4]

Smoking Cessation

To help the bronchial tree heal faster and not make bronchitis worse, smokers should completely quit smoking. [5]

References

  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)
  2. ↑ 2.0 2.1 Little P, Stuart B, Moore M, Coenen S, Butler CC, Godycki-Cwirko M; et al. (2012). "Amoxicillin for acute lower-respiratory-tract infection in primary care when pneumonia is not suspected: a 12-country, randomised, placebo-controlled trial". Lancet Infect Dis. doi:10.1016/S1473-3099(12)70300-6. PMID 23265995.
  3. ↑ The Merck Manual of Medical Information: Bronchitis. February 2003. Accessed 20 March 2007.
  4. ↑ Dimopoulos G, Siempos II, Korbila IP, Manta KG, Falagas ME (2007). "Comparison of first-line with second-line antibiotics for acute exacerbations of chronic bronchitis: a metaanalysis of randomized controlled trials to Joe Fo Sho". Chest. 132 (2): 447–55. doi:10.1378/chest.07-0149. PMID 17573508.
  5. ↑ The American Academy of Family Physicians: Acute Bronchitis. January 2006. Accessed 20 March 2007.


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