Treatment of Persistent Bronchitis Cough with Wheezing

Distinguishing Types of Bronchitis

Acute bronchitis is a self-limiting condition that typically resolves within 10 days, although cough may persist longer 1
Chronic bronchitis is defined as a productive cough occurring on most days for at least 3 months of the year and for at least 2 consecutive years 2
Nonasthmatic eosinophilic bronchitis can be identified and treated with inhaled corticosteroids 4

For patients with acute bronchitis and wheezing, treatment with β2-agonist bronchodilators may be useful for symptomatic relief 5, 6
Routine use of antibiotics is not justified for acute bronchitis 6
For short-term symptomatic relief of coughing, central cough suppressants such as codeine and dextromethorphan are recommended 2, 6
For stable chronic bronchitis, oral corticosteroids should NOT be used for long-term maintenance therapy due to lack of evidence and known side effects 3
For patients with chronic bronchitis, short-acting inhaled β-agonists, inhaled ipratropium bromide, and oral theophylline may improve cough 2
Combined regimen of inhaled long-acting β-agonist and inhaled corticosteroid may improve cough in patients with chronic bronchitis 2, 3
For patients with severe or very severe airflow obstruction or frequent exacerbations, inhaled corticosteroid therapy should be offered 3

First-line treatment for nonasthmatic eosinophilic bronchitis is inhaled corticosteroids 4
If symptoms persist despite high-dose inhaled corticosteroids, oral corticosteroids should be considered for nonasthmatic eosinophilic bronchitis 4
When a causal allergen or occupational sensitizer is identified, avoidance is the best treatment for nonasthmatic eosinophilic bronchitis 4

For acute bronchitis with wheezing, start with short-acting β2-agonist bronchodilators for symptomatic relief 5, 6
Consider central cough suppressants for short-term relief in acute bronchitis with wheezing 2, 6
Avoid systemic corticosteroids in acute bronchitis 1
For chronic bronchitis with persistent cough and wheezing, first-line treatment is short-acting bronchodilators (β-agonists or ipratropium bromide) 2, 3
Consider testing for eosinophilic inflammation (sputum analysis) in chronic bronchitis 4
If evidence of eosinophilia or airflow obstruction, add inhaled corticosteroids in chronic bronchitis 4, 3
For severe cases of chronic bronchitis, combined therapy with long-acting β-agonist and inhaled corticosteroid may be used 2, 3
For acute exacerbations of chronic bronchitis, use short-acting bronchodilators plus systemic corticosteroids for 10-15 days 2, 3