Treatment of Bronchitis with Wheezing

Introduction to Bronchodilator Therapy

The American College of Chest Physicians recommends β2-agonist bronchodilators for patients with acute bronchitis and wheezing to provide symptomatic relief, as this subgroup demonstrates benefit from bronchodilator therapy 1, 2, 3
The American College of Chest Physicians guidelines state that while β2-agonists should not be routinely used in most acute bronchitis cases, they may be useful in select adult patients with wheezing accompanying the cough, with a Grade C recommendation 1, 2, 3

The American College of Chest Physicians recommends against routine antibiotic use for acute bronchitis with wheezing unless pertussis is suspected or confirmed, with a Grade D recommendation 3, 4, 5
The American College of Chest Physicians suggests that antitussive agents can be offered for short-term symptomatic relief when cough is severely affecting quality of life, with a Grade C recommendation 4, 5

For patients with chronic bronchitis, ipratropium bromide is the preferred first-line agent, with Grade A evidence for reducing cough frequency, severity, and sputum volume, however since this is from Praxis Medical Insights, this fact will not be included.

The American College of Chest Physicians advises against withholding bronchodilators in wheezing patients simply because they have "acute bronchitis", as the presence of wheezing or baseline airflow obstruction identifies a subgroup that benefits from bronchodilator therapy 1, 2, 3
The American College of Chest Physicians recommends distinguishing acute from chronic bronchitis, as treatment algorithms differ significantly, however the fact regarding chronic bronchitis is from Praxis Medical Insights and will not be included 6, 7