Management of Acute Viral Bronchitis

General Recommendation: Do Not Use Routinely

The American College of Chest Physicians recommends that β2-agonist bronchodilators should not be used routinely in most patients with acute viral bronchitis (Quality of evidence: reasonable; benefit: none; grade of recommendation: D) 1, 2, 3
A Cochrane review of five trials in adults concluded that β-agonists are not recommended for the treatment of uncomplicated acute bronchitis 1, 2
Statistical analysis revealed no significant benefit of using β2-agonists in reducing daily cough scores or the number of patients still coughing after 7 days 1, 2, 3
Adverse effects (tremors, nervousness, and agitation) were more common in the treatment groups 1, 2

In select adult patients with acute viral bronchitis and wheezing accompanying cough, treatment with β2-agonist bronchodilators may be useful (Quality of evidence: reasonable; benefit: small/weak; grade of recommendation: C) 1, 2, 3
The presence of wheezing at the onset of illness is a criterion to consider bronchodilators 1, 2, 3
Evidence of airway obstruction at the onset (subgroups with these characteristics showed some benefit) is another criterion to consider bronchodilators 1, 2, 4

Salbutamol/albuterol inhaler: 2-4 inhalations (200-400 μg) via inhaler every 4 hours for mild episodes 4
For moderately severe episodes: 400 μg (4 inhalations) every 4 hours 4

The American Academy of Pediatrics strongly recommends not administering albuterol/salbutamol to infants and children with a diagnosis of bronchiolitis (Quality of evidence: B; strength of recommendation: strong) 5
A Cochrane review of 30 randomized controlled trials with 1992 infants found no benefit in the clinical course of infants with bronchiolitis who received bronchodilators 5

The effect of inhaled anticholinergic agents on cough in acute bronchitis has not been studied and therefore cannot be recommended based on evidence 1, 2, 3

If a therapeutic trial is initiated, response must be objectively assessed; if no documented improvement, treatment should be discontinued 4, 6
Do not confuse acute viral bronchitis with exacerbation of COPD or asthma, where bronchodilators are clearly indicated 7, 6

The American College of Chest Physicians recommends against using expectorants for acute bronchitis with wheezing, as their beneficial effects have not been proven for treatment of cough in bronchitis 8
Mucokinetic agents are not useful during acute exacerbations of bronchitis, and there is limited evidence to justify their use to control cough in patients with bronchitis 8