Bronchitis medical therapy

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 an inflammation of the bronchi (medium-size airways) in the lungs. Acute bronchitis is usually caused by viruses or bacteria and may present as cough with sputum that last several days or weeks (10 days). Other symptoms like shortness of breath, chest discomfort, and sore throat can also be found. Chronic bronchitis is not necessarily caused by infection and is generally part of a syndrome called chronic obstructive pulmonary disease (COPD); it is defined clinically as a persistent cough that produces sputum (phlegm) and mucus, for at least three months in two consecutive years. In late stages, the disease may present with blue discoloration of body (cyanosis) and difficulty in breathing (dyspnea).

Acute bronchitis

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.

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. As most cases of acute bronchitis are caused by viruses, antibiotics should not generally be used, since they are effective only against bacteria. Using antibiotics in patients without bacterial infections promotes the development of antibiotic-resistant bacteria, which may lead to greater morbidity and mortality. However, even in cases of viral bronchitis, antibiotics may be indicated in certain patients in order to prevent the occurrence of secondary bacterial infections.

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.

Smoking cessation

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