Management of Bronchitis

Classification and Diagnosis

The American College of Physicians defines acute bronchitis as self-limited inflammation of the large airways with cough lasting up to 6 weeks, often accompanied by mild constitutional symptoms 1
Chronic bronchitis is defined as cough with sputum production occurring on most days for at least 3 months of the year and for at least 2 consecutive years 1
Rule out pneumonia before diagnosing uncomplicated bronchitis by assessing for tachycardia, tachypnea, fever, and abnormal chest examination findings 1
Chest radiography is usually not indicated in healthy, nonelderly adults without vital sign abnormalities or asymmetrical lung sounds 2, 3

Antibiotics are not recommended for uncomplicated acute bronchitis, regardless of duration of cough 1, 2, 3
Short-acting β-agonists like albuterol may be beneficial in reducing cough duration and severity in patients with evidence of bronchial hyperresponsiveness 1, 4
Ipratropium bromide may improve cough in some patients 1, 4
Dextromethorphan or codeine are recommended for short-term symptomatic relief of bothersome cough 1, 4

Avoidance of respiratory irritants is the cornerstone of therapy, with 90% of patients experiencing resolution of cough after smoking cessation 1, 4
Short-acting β-agonists should be used to control bronchospasm and may reduce chronic cough 1, 4, 5
Ipratropium bromide should be offered to improve cough 1, 4, 5
Long-acting β-agonists combined with inhaled corticosteroids should be offered to control chronic cough 1, 4, 5

Short-acting β-agonists or anticholinergic bronchodilators should be administered during acute exacerbations 1, 4, 5
Antibiotics are recommended for acute exacerbations of chronic bronchitis, particularly for patients with severe exacerbations and those with more severe airflow obstruction at baseline 4, 5
A short course (10-15 days) of systemic corticosteroids is effective for acute exacerbations 1, 4

Prescribing antibiotics based solely on presence of colored sputum 1
Failing to distinguish between acute bronchitis and pneumonia 1
Overuse of expectorants and mucolytics which lack evidence of benefit 1, 4
Not considering underlying conditions that may be exacerbated by bronchitis (asthma, COPD, cardiac failure, diabetes) 1
Using theophylline for acute exacerbations of chronic bronchitis 4, 5