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]; Seyedmahdi Pahlavani, M.D. [3]; Nate Michalak, B.A.

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

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.
• 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.
• 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.

References

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