Management
Therapy is generally focused on alleviation of symptoms. Care for acute bronchitis is primarily supportive. Care for chronic bronchitis includes avoidance of environmental irritants.
Agents employed for symptomatic treatment include the following:
-Central cough suppressants (eg, codeine and dextromethorphan) – Short-term symptomatic relief of coughing in acute and chronic bronchitis
-Short-acting beta-agonists (eg, ipratropium bromide and theophylline) – Control of bronchospasm, dyspnea, and chronic cough in stable patients with chronic bronchitis; a long-acting beta-agonist plus an inhaled corticosteroid can also be offered to control chronic cough
-Nonsteroidal anti-inflammatory drugs (NSAIDs) – Treatment of constitutional symptoms of acute bronchitis, including mild-to-moderate pain
-Antitussives/expectorants (eg, guaifenesin) – Treatment of cough, dyspnea, and wheezing
-Mucolytics – Management of moderate-to-severe COPD, especially in winter
Among otherwise healthy individuals, antibiotics have not demonstrated any consistent benefit in acute bronchitis. The following recommendations have been made with respect to treatment of acute bronchitis with antibiotics:
Acute bronchitis should not be treated with antibiotics unless comorbid conditions pose a risk of serious complications
Antibiotic therapy is recommended in elderly (>65 years) patients with acute cough if they have had a hospitalization in the past year, have diabetes mellitus or congestive heart failure, or are receiving steroids
Antibiotic therapy is recommended in patients with acute exacerbations of chronic bronchitis
In stable patients with chronic bronchitis, long-term prophylactic therapy with antibiotics is not indicated.
Influenza vaccination may reduce the incidence of upper respiratory tract infections and, subsequently, reduce the incidence of acute bacterial bronchitis. It may be less effective in preventing illness than in preventing serious complications and death.