Remedy for acute bronchitis

Acute bronchitis refers to the inflammation and swelling of the bronchial tubes which carry air to the lungs. This inflammatory process results in production of mucus that makes you cough. It shows up quickly, usually brought on by a virus, and lasts up to three weeks. Chronic bronchitis keeps coming back cumulatively lasting up to three months of the year for two years in a row.

Symptoms

  • Cough producing phlegm, often accompanied by a sore throat
  • Wheezing and chest congestion
  • Fever with the above symptoms, chills, body aches

Who is at risk?

Smokers suffer frequently from bronchitis, as will anyone with chronic obstructive pulmonary disease (COPD). Acute bronchitis often shows up in someone with an upper respiratory tract infection resulting from a cold or flu. It may also result from a bacterial infection or inhalation of smoke or irritating chemicals.

Treatment

With rest, plenty of clear fluids and humidity (humidifier, steam shower, etc.), acute bronchitis should go away after several days to a week. Smokers take much longer to recover. Your doctor might take a chest x-ray to rule out pneumonia, but bronchitis is largely a clinical diagnosis based on your history and the symptoms you are experiencing. Once bronchitis is diagnosed, most doctors will recommend lots of fluid and sometimes an over the counter expectorant to rid the lungs of phlegm. If you are wheezing, you may receive an inhaled medication called Albuterol or Xopenex which can help open inflamed bronchial tubes. “Cough” drops don’t really make a cough go away, but might soothe that sore throat and annoying tickle. Antibiotics are not useful in the treatment of bronchitis.

Emergency Warning Signs: When should I see a doctor?

If you have a crushing chest pain, wheezing and breathing difficulty, blood or yellow/green sputum in your mucus, or any of these along with a fever over 101°F, you should be evaluated by a physician. If you have been treated for bronchitis and your symptoms do not improve in 14 days, call your doctor again. Proceed to a hospital emergency department right away for severe difficulty breathing.

Treatment for Bronchitis is available now at Pulse-MD Urgent Care in Mahopac and Wappingers Falls, NY.

For more information on Bronchitis, see the following websites:

Understanding Bronchitis from WebMD

FamilyDoctor.org Acute Bronchitis

MedicineNet on How to Quit Smoking

Disclaimer: The links above are to sites independent of pulsemdurgentcare.com. The pages will open in a new browser window. The information provided is for educational purposes only, and is not a substitute for professional medical advice, diagnosis, or treatment. If you have or suspect you may have a health problem, you should consult your doctor. Always follow your doctor’s recommendations regarding your specific medical questions, treatments, therapies, and other needs.

When to See a Doctor for Bronchitis

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Bronchitis is an inflammation of the bronchi, the airways leading to the lungs. It is one of the most common respiratory disorders in the United States. Bronchitis can be acute, usually associated with a respiratory infection, or chronic, which lasts for months. Bronchitis symptoms include a wet cough, shortness of breath, wheezing, fatigue, fever, and chest pain (from coughing).

People at highest risk of developing acute bronchitis are infants, children and the elderly, while those at highest risk of developing chronic bronchitis are people over the age of 45 and those who smoke. Chronic bronchitis is a type of chronic obstructive pulmonary disease, or COPD. It’s estimated about 4% of adults in the U.S. have chronic bronchitis.

Common Causes of Bronchitis

Acute and chronic bronchitis have different causes. Acute bronchitis is most frequently caused by viruses, like a cold or flu. It can also be caused by a bacterial infection, usually pneumonia or whooping cough, but this isn’t common. Other causes of acute bronchitis include inhaling dust, smoke or other irritants in the air.

The most common causes of chronic bronchitis are cigarette smoking, long-term exposure to irritants in the air, and repeated gastric reflux. For most people, the symptoms of bronchitis result from inflammation within the airways. Doctors seek to treat both the inflammation and the cause of the inflammation. For example, medical therapy for bronchitis may include antibiotics and a short course of corticosteroids.

Bronchitis Treatment at Home

Most cases of acute bronchitis clear up on their own. If you have bronchitis, you are coughing and bringing up sputum (phlegm), but you are not having trouble breathing. Here are some suggestions for caring for yourself at home:

  • Drink extra fluids to stay hydrated.

  • Use a vaporizer or humidifier to add moisture to the room air. This helps loosen the mucus in your airway, making it easier to cough up.

  • Use an over-the-counter pain reliever, such as ibuprofen or acetaminophen to relieve throat pain and decrease fever.

  • Rest. Avoid over exertion that will make you breathe harder.

You may be tempted to use a cough medicine to suppress your cough, but if you are bringing up mucus, the cough is important to help clear the mucus away. Cough suppressants are useful if you have a dry cough (no mucus) only.

When to See a Doctor for Bronchitis

It is not common for bronchitis to cause severe complications, but it can happen. If you have bronchitis and you have trouble breathing, call 911 or seek emergency help immediately.

There are other reasons why you should see your doctor for bronchitis treatment if you are not getting better at home. These include:

  • You are still coughing after 3 or 4 weeks.

  • You are wheezing, making a high-pitched sound as you breathe out.

  • You are very short of breath.

  • You have chest pain.

  • You have a fever that lasts more than a week.

  • You begin coughing blood.

Infants and babies should also be evaluated by a doctor for bronchitis as their health status can change quickly. People who have chronic bronchitis should see their doctor if there are any changes in the severity of symptoms.

Who to See for Bronchitis

If you are seeing a doctor because your bronchitis symptoms are not going away or are worsening, you may see your family doctor or primary care physician for evaluation and treatment. If you call 911 or go to an emergency room or urgent care facility, you may see an emergency room physician. Most often, these doctors can manage your care. However, if your acute bronchitis is severe, or if you have chronic bronchitis, you may be referred to a pulmonologist, a doctor who specializes in the respiratory tract. Check with your insurance company to see if you must have a referral from your primary doctor before seeing a pulmonologist.

Bronchitis is a very common respiratory condition that affects children and adults. By caring for yourself at home, it generally goes away on its own. However, if you have any concerns about your breathing, don’t hesitate to seek help.

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Acute Bronchitis

Topic Overview

What is bronchitis?

Bronchitis means that the tubes that carry air to the lungs (the bronchial tubes) are inflamed and irritated. When this happens, the bronchial tubes swell and produce mucus . This makes you cough.

There are two types of bronchitis:

  • Acute bronchitis usually comes on quickly and gets better after 2 to 3 weeks.
  • Chronic bronchitis keeps coming back and can last a long time, especially in people who smoke. Chronic bronchitis means that you have a cough with mucus most days of the month for 3 months of the year and for at least 2 years in a row.

This topic focuses on acute bronchitis. Both children and adults can get acute bronchitis.

Most healthy people who get acute bronchitis get better without any problems. But it can be more serious in older adults and children and in people with other health problems, especially lung diseases such as asthma or COPD. Complications can include pneumonia and repeated episodes of severe bronchitis.

What causes acute bronchitis?

Acute bronchitis is usually caused by a virus . Often a person gets acute bronchitis a few days after having an upper respiratory tract infection such as a cold or the flu. Sometimes acute bronchitis is caused by bacteria .

Acute bronchitis also can be caused by breathing in things that irritate the bronchial tubes, such as smoke. It also can happen if a person inhales food or vomit into the lungs.

What are the symptoms?

The most common symptom of acute bronchitis is a cough that usually is dry and hacking at first. After a few days, the cough may bring up mucus. You may have a low fever and feel tired.

Most people get better in 2 to 3 weeks. But some people continue to have a cough for more than 4 weeks.

If your symptoms get worse, such as a high fever, shaking chills, chest or shoulder pain, or shortness of breath, you could have pneumonia. Pneumonia can be serious, so it’s important to see a doctor if you feel like you’re getting sicker.

How is acute bronchitis diagnosed?

Your doctor will ask you about your symptoms and examine you. This usually gives the doctor enough information to find out if you have acute bronchitis.

In some cases, you may need a chest X-ray or other tests to make sure that you don’t have pneumonia, whooping cough, or another lung problem. This is especially true if you’ve had bronchitis for a few weeks and aren’t getting better. More testing also may be needed for babies, older adults, and people who have lung disease (such as asthma or COPD) or other health problems.

How is it treated?

Most people can treat symptoms of acute bronchitis at home and don’t need antibiotics or other prescription medicines. (Antibiotics don’t help with viral bronchitis. And even bronchitis caused by bacteria will usually go away on its own.)

The following may help you feel better:

  • Don’t smoke.
  • Suck on cough drops or hard candies to soothe a dry or sore throat. Cough drops won’t stop your cough, but they may make your throat feel better.
  • Breathe moist air from a humidifier, a hot shower, or a sink filled with hot water. The heat and moisture can help keep mucus in your airways moist so you can cough it out easily.
  • Ask your doctor if you can take nonprescription medicine, such as acetaminophen, ibuprofen, or aspirin, to relieve fever and body aches. Don’t give aspirin to anyone younger than age 20. Be safe with medicines. Read and follow all instructions on the label.
  • Rest more than usual.
  • Drink plenty of fluids so that you do not become dehydrated.
  • Use an over-the-counter cough medicine if your doctor recommends it. (Cough medicines may not be safe for young children or for people who have certain health problems.) Cough suppressants may help you to stop coughing. Expectorants can help you bring up mucus when you cough.

If you have signs of bronchitis and have heart or lung disease (such as heart failure, asthma, or COPD) or another serious health problem, talk to your doctor right away. You may need treatment with antibiotics or medicines to help with your breathing. Early treatment may prevent complications, such as pneumonia or repeated episodes of acute bronchitis caused by bacteria.

What can you do to avoid getting bronchitis?

There are several things you can do to help prevent bronchitis.

  • Avoid cigarette smoke. If you smoke, stop. People who smoke or are around others who smoke have acute bronchitis more often.
  • Wash your hands often during the cold and flu season.
  • Avoid contact with people who are sick with a cold or the flu, especially if you have other health problems.
  • Get a flu vaccine every year, and talk to your doctor about whether you should get a pneumococcal vaccine.

Diagnosing and Treating Acute Bronchitis

It is important to get your questions about acute bronchitis answered by a healthcare professional.

What to Expect

  • A physical examination, and possibly an X-ray if you’ve had fever
  • Resting and getting plenty of fluids
  • Symptoms that last a few weeks

How Is Acute Bronchitis Diagnosed?

Healthcare providers diagnose acute bronchitis by asking patients questions about symptoms and doing a physical examination. They rarely order additional tests to diagnose acute bronchitis. If you have or recently had a fever, your provider might order a chest X-ray to rule out pneumonia.

How Is Acute Bronchitis Treated?

Most cases of acute bronchitis go away on their own. The infection simply has to run its course over several weeks. Your doctor may recommend rest, fluids, a cough suppressant and/or a pain reliever. A humidifier or steam may also help. You may need inhaled medicine to open your airways if you are wheezing. Antibiotics haven’t been proven to shorten the course of acute bronchitis or lessen symptoms. Because viruses cause most cases, antibiotics are not generally used, as they are only effective against bacteria. Additionally, using antibiotics when they aren’t recommended can not only cause side effects, but also might mean that your body won’t respond to antibiotics when it needs to. If your doctor thinks that bacteria caused your acute bronchitis, he or she might then prescribe antibiotics.

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Managing and Preventing “

Management

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Supportive care and symptom management are the mainstay of treatment for acute bronchitis. The role of antibiotics is limited. Since 2005, the National Committee for Quality Assurance has recommended avoidance of antibiotic prescribing for acute bronchitis as a Healthcare Effectiveness Data and Information Set Measure.27 All major guidelines on bronchitis, including those from the American College of Chest Physicians, recommend against using antibiotics for acute bronchitis unless the patient has a known pertussis infection.2,22 The American Academy of Pediatrics recommends that antibiotics not be used for apparent viral respiratory illnesses, including sinusitis, pharyngitis, and bronchitis.28 Despite these recommendations, antibiotics are often prescribed for acute bronchitis.29

OVER-THE-COUNTER MEDICATIONS

Over-the-counter medications are often recommended as first-line treatment for acute cough. However, a Cochrane review on over-the-counter medications for acute cough in the community setting showed a paucity of good data; existing trials are of low quality and report conflicting results.30

A randomized controlled trial showed that compared with placebo, there was no benefit from ibuprofen in decreasing severity or duration of cough in patients with acute bronchitis.31 Another randomized controlled trial comparing ibuprofen, acetaminophen, and steam inhalation found that those with a lower respiratory tract infection or age younger than 16 years had a modest reduction in symptom severity when taking ibuprofen over acetaminophen, although the ibuprofen group was more likely to seek care again for new or nonresolving symptoms.32

Antihistamines are often used in combination with decongestants in the treatment of acute cough. Two trials of antihistamines alone showed no benefit compared with placebo in relieving cough symptoms. Combination decongestant/antihistamines are more likely to have adverse effects with no to modest improvement in cough symptom scores.30 In 2008, The U.S. Food and Drug Administration warned against the use of over-the-counter cough medications containing antihistamines and antitussives in young children because of the high risk for harm, and these medications are no longer labeled for use in children younger than four years. They are continuing to investigate the safety of these medications in children up to 11 years of age.30,33

ANTITUSSIVES

Antitussives work by reducing the cough reflex and can be divided into central opioids and peripherally acting agents. Codeine is a centrally acting, weak opioid that suppresses cough. Two studies show no benefit from codeine in decreasing cough symptoms,30 and the American College of Chest Physicians does not recommend its use in the treatment of upper respiratory tract infections.22

Dextromethorphan is a nonopioid, synthetic derivative of morphine that works centrally to decrease cough. Three placebo-controlled trials show that dextromethorphan, 30 mg, decreased the cough count by 19% to 36% (P < .05) compared with placebo, which is equivalent to eight to 10 fewer coughing bouts per 30 minutes.30

Benzonatate is a peripherally acting antitussive that is thought to suppress cough via anesthesia of the respiratory stretch receptors. One small study comparing benzonatate, guaifenesin, and placebo showed significant improvement with the combination of benzonatate and guaifenesin, but not with either agent alone.34

EXPECTORANTS

Guaifenesin is a commonly used expectorant. It is thought to stimulate respiratory tract secretions, thereby increasing respiratory fluid volumes and decreasing mucus viscosity, and it may also have antitussive properties.

A Cochrane review including three trials of guaifenesin vs. placebo showed some benefit.30 In one trial, patients reported that guaifenesin decreased cough frequency and intensity by 75% at 72 hours compared with 31% in the placebo group (number needed to treat = 2). A second trial showed decreased cough frequency (100% of the guaifenesin group vs. 94% of the placebo group; P = .5) and improved cough severity (100% of the guaifenesin group vs. 91% of the placebo group; P = .2) at 36 hours, and reduced sputum thickness (96% of the guaifenesin group vs. 54% of the placebo group; P = .001). A third trial using an extended-release formulation of guaifenesin showed improved symptom severity at day 4 but no difference at day 7.30

BETA2 AGONISTS

Many patients with acute bronchitis have bronchial hyperreactivity, leading to impaired airflow in a mechanism similar to asthma. A 2015 Cochrane review does not support the routine use of beta2 agonists for acute cough.35 Two trials included children and found no benefit from albuterol in decreasing daily cough scores, daily proportion of cough, or median duration of cough, although both studies excluded children who were wheezing at the time of evaluation or had signs of bronchial obstruction. The studies of adults had mixed results, but the findings suggest that beta2 agonists should be avoided if there is no underlying history of lung disease or evidence of wheeze or airway obstruction. However, beta2 agonists may have some benefit in certain adults, especially those with wheezing at the time of evaluation who do not have a previous diagnosis of asthma or chronic obstructive pulmonary disease. Because there is limited supportive evidence, the use of such medications should be weighed against the risk of adverse effects, including tremor, shakiness, and nervousness.35

HERBAL AND OTHER PREPARATIONS

Alternative medications are commonly used in the treatment of acute bronchitis. Pelargonium sidoides has some reported modest effectiveness in the treatment of acute bronchitis, but the quality of evidence is considered low, and the studies were all done by the manufacturer in Ukraine and Russia.36 There are insufficient data to recommend for or against the use of Chinese medicinal herbs for the treatment of acute bronchitis, and there are safety concerns.37

A Cochrane review of honey for acute cough in children included two small trials comparing honey with dextromethorphan, diphenhydramine (Benadryl), and no treatment.38 Honey was found to be better than no treatment in decreasing the frequency and severity of cough, decreasing bothersome cough, and improving quality of sleep. Given the warnings against the use of antitussives in young children, honey is a reasonable alternative for the relief of acute cough in children older than one year.38

ANTIBIOTICS

At least 90% of acute bronchitis episodes are viral, yet antibiotics are commonly prescribed. Unnecessary antibiotic prescriptions result in adverse effects and contribute to rising health care costs and antimicrobial resistance. A recent study of antibiotic prescribing trends from 1996 to 2010 found that antibiotics were prescribed in 71% of visits for acute bronchitis and that the rate of prescribing increased during the study period.29 Although clinicians are more likely to prescribe antibiotics in patients with purulent sputum, a prospective observational study showed no difference in outcomes when antibiotics were prescribed to patients with green or yellow sputum, indicating that this is not a useful indicator of bacterial infection.39 Smokers are also more likely to receive antibiotic prescriptions, with some populations of smokers being prescribed antibiotics more than 90% of the time despite no difference in outcomes.40

A Cochrane review suggests there is no net benefit to using antibiotics for acute bronchitis in otherwise healthy individuals.41 Although antibiotics decreased cough duration by 0.46 days, decreased ill days by 0.64 days, and decreased limited activity by 0.49 days, there was no difference in clinical improvement at follow-up. The most common adverse effects reported were nausea, diarrhea, headache, skin rash, and vaginitis with a number needed to harm of 5. Given minimal symptom improvement in an otherwise self-limited condition, increased rate of adverse effects, and potential for antibiotic resistance, it is wise to limit the use of antibiotics in the general population; further study in frail older persons and individuals with multiple comorbidities is needed.41 If pertussis is confirmed or suspected because of a persistent cough accompanied by symptoms of paroxysmal cough, whooping cough, and post-tussive emesis, or recent pertussis exposure, treatment with a macrolide is recommended.10

STRATEGIES TO REDUCE INAPPROPRIATE ANTIBIOTIC USE

Delayed prescribing, in which the patient is given an antibiotic prescription at the visit but told not to fill it unless symptoms continue beyond a predetermined time, significantly decreases antibiotic use.42 A Cochrane review showed no difference in clinical outcomes between patients with acute bronchitis who were treated immediately with antibiotics and those with delayed or no antibiotic treatment. In addition, patients reported comparable satisfaction when given immediate vs. delayed antibiotics (92% vs. 87%).43

Patients who present with the expectation that they will receive an antibiotic are more likely to receive one, even if the clinician thinks the prescription is unnecessary.44 In fact, the strongest predictor for an antibiotic prescription is the clinician’s perception of patient desire for antibiotics.45 However, patients want symptom relief and will often accept leaving without an antibiotic prescription if the clinician addresses their concerns, shows personal interest, discusses the expected course of the illness, and explains the treatment plan.45 Calling the infection a chest cold44 and educating the patient about the expected duration of illness (two to three weeks)15 are also helpful. Table 2 includes strategies for reducing antibiotic prescriptions for acute bronchitis.29,42,43

Enlarge

Table 2.

Strategies to Reduce Antibiotic Use for Acute Bronchitis

Use delayed prescription strategies, such as asking patients to call for or pick up an antibiotic or to hold an antibiotic prescription for a set amount of time

Address patient concerns in a compassionate manner

Discuss the expected course of illness and cough duration (two to three weeks)

Explain that antibiotics do not significantly shorten illness duration and are associated with adverse effects and antibiotic resistance

Discuss the treatment plan, including the use of nonantibiotic medications to control symptoms

Describe the infection as a viral illness or chest cold

Information from references 29, 42, and 43.

Table 2.

Use delayed prescription strategies, such as asking patients to call for or pick up an antibiotic or to hold an antibiotic prescription for a set amount of time

Address patient concerns in a compassionate manner

Discuss the expected course of illness and cough duration (two to three weeks)

Explain that antibiotics do not significantly shorten illness duration and are associated with adverse effects and antibiotic resistance

Discuss the treatment plan, including the use of nonantibiotic medications to control symptoms

Describe the infection as a viral illness or chest cold

Information from references 29, 42, and 43.

Data Sources: The PubMed database was searched in Clinical Queries using the term acute bronchitis. Systematic reviews were searched and narrowed by etiology, diagnosis, therapy, prognosis, and clinical prediction guidelines. The Agency for Healthcare Research and Quality, National Guideline Clearinghouse, National Quality Measures Clearinghouse, and Essential Evidence Plus were also searched. Search date: January 2015.

note: This review updates a previous article on this topic by Albert,46 Knutson and Braun,47 and Hueston and Mainous.48

What Is It?

Published: December, 2018

Acute bronchitis is an inflammation of the lining of the bronchial tubes, the hollow air passages that connect the lungs to the windpipe (trachea). The inflammation can be caused by an infection or by other factors that irritate the airways, such as cigarette smoking, allergies and exposure to fumes from some chemicals.

Acute bronchitis caused by an infection usually starts with an upper respiratory illness, such as the common cold or flu (influenza), that spreads from your nose and throat down into the airways. Acute bronchitis does not affect the lungs like pneumonia does. Pneumonia shows up on a chest X-ray, but acute bronchitis usually does not.

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You have a miserable case of bronchitis, and your cough could wake the dead. Your family members and coworkers are losing patience. Even your pets are getting annoyed by your constant hacking.

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Is there anything you can do to calm your agitated airways? Family physician Donald Ford, MD, shares his advice for treating bronchitis at home.

Bronchitis treatment

Bronchitis is especially annoying because the cough can last for weeks, even after the infection is gone. So what can you do?

First, make sure you actually have bronchitis. If you’re unsure or you have a high fever, see your doctor to rule out more serious problems like pneumonia, Dr. Ford advises.

If you are battling bronchitis, expect your cough to last several frustrating weeks. Bronchitis is almost always caused by a virus. That means antibiotics won’t help, and there’s not much you can do to speed up the recovery process.

Still, people try all sorts of things to help ease symptoms. Some work well. Others, not as much. Here’s the scoop on 7 common remedies for your lingering cough.

1. Medicine

While there’s no cure for bronchitis, medicine can help ease symptoms, Dr. Ford says:

  • Cough expectorant: Look for meds with guaifenesin, a common ingredient in over-the-counter cold medicines. It’s an expectorant, meaning it helps loosen mucus.
  • Cough suppressant: Other OTC cough medicines can suppress your hacking — an especially useful trick if your cough is keeping you up at night. For really stubborn coughs, doctors can prescribe prescription cough medicines.
  • Steroid medications: Some patients benefit from prescription steroid medications, which ease inflammation in the airways.

2. Water

Swallow plenty of it to help loosen mucus so that you can cough it up and out (gross, but gratifying). Unfortunately, wine and coffee don’t have the same hydration benefit, so stick to H2O, herbal tea and broths.

3. Steam

When you have a deep cough, it feels like you can’t clear the gunk from your lungs. Steam helps loosen the mucus so you can get rid of it. If you belong to a health club, this is definitely your chance to hit up the sauna. Or just turn on the shower in your own bathroom and let the room get steamy.

You can also fill a pan or pot with boiling water and lean over it to inhale the steam. “But be careful,” Dr. Ford cautions. “Don’t cover your head with a towel to trap the steam, because it can get too hot and burn your airways.”

4. Saline sprays and saltwater gargles

Use a saline nasal spray or neti pot to flush your sinuses. “Even if symptoms are in the chest, most people have some congestion as well. Nasal saline helps clear out mucus and also hydrates your tissues,” Dr. Ford says. Gargling with salt water can also soothe and hydrate a sore throat.

5. Honey

Tea with honey is an old classic for treating colds.Mother Nature’s favorite sweetener probably won’t do much to clear your cough, Dr. Ford says, but it can soothe the sore throat that often goes along with it.

6. Cough drops

Despite the name, they don’t do much to clear up mucus. But like honey, they can soothe a raw throat and help you feel better.

7. Essential oils

Yes, they’re on trend, but there’s no evidence that essential oils can help with bronchitis symptoms. However, some people find breathing steam spiked with menthol oil is especially soothing, Dr. Ford says. “It doesn’t necessarily work better than plain steam, but it can feel good.”

Unfortunately, you’ll still have to practice patience as you recover from bronchitis. But with these tricks, you’ll feel at least a little better while you wait.

Diagnosis and Treatment of Acute Bronchitis

Treatment

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Treatment of acute bronchitis is typically divided into two categories: antibiotic therapy and symptom management. Physicians appear to deviate from evidence-based medical practice in the treatment of bronchitis more than in the diagnosis of the condition.

Because of the risk of antibiotic resistance and of Clostridium difficile infection in the community, antibiotics should not be routinely used in the treatment of acute bronchitis, especially in younger patients in whom pertussis is not suspected. Although 90 percent of bronchitis infections are caused by viruses, approximately two thirds of patients in the United States diagnosed with the disease are treated with antibiotics.8 Patient expectations may lead to antibiotic prescribing. A survey showed that 55 percent of patients believed that antibiotics were effective for the treatment of viral upper respiratory tract infections, and that nearly 25 percent of patients had self-treated an upper respiratory tract illness in the previous year with antibiotics left over from earlier infections.9 Studies have shown that the duration of office visits for acute respiratory infection is unchanged or only one minute longer when antibiotics are not prescribed.10,11 The American College of Chest Physicians (ACCP) does not recommend routine antibiotics for patients with acute bronchitis, and suggests that the reasoning for this be explained to patients because many expect a prescription.12

Clinical data support that antibiotics do not significantly change the course of acute bronchitis, and may provide only minimal benefit compared with the risk of antibiotic use itself. A meta-analysis examining the effects of antibiotics in patients with acute bronchitis showed reduction of cough at follow-up (number needed to treat = 5.6) but no change in patients’ activity limitations. The meta-analysis also showed a number needed to harm (based on antibiotic adverse effects) of 16.7.13 In a study of 230 patients diagnosed with acute bronchitis (i.e., presence of cough for two to 14 days) who received azithromycin (Zithromax) or a low-dose of vitamin C, more than one half of patients had fever or purulent sputum, although none had chest findings. Outcomes at days 3 and 7 were no different between the two groups, and 89 percent of patients in both groups had clinical improvement.14

Although antibiotics are not recommended for routine use in patients with bronchitis, they may be considered in certain situations. When pertussis is suspected as the etiology of cough, initiation of a macrolide antibiotic is recommended as soon as possible to reduce transmission; however, antibiotics do not reduce duration of symptoms. Antiviral medications for influenza infection may be considered during influenza season for highrisk patients who present within 36 hours of symptom onset. An argument for the use of antibiotics in acute bronchitis is that it may decrease the risk of subsequent pneumonia. In one large study, the number needed to treat to prevent one case of pneumonia in the month following an episode of acute bronchitis was 119 in patients 16 to 64 years of age, and 39 in patients 65 years or older.15

Because of the clinical uncertainty that may arise in distinguishing acute bronchitis from pneumonia, there is evidence to support the use of serologic markers to help guide antibiotic use. Two trials in the emergency department setting showed that treatment decisions guided by procalcitonin levels helped decrease the use of antibiotics (83 versus 44 percent in one study, and 85 versus 99 percent in the other study) with no difference in clinical outcomes.16,17 Another study showed that office-based, point-of-care testing for C-reactive protein levels helps reduce inappropriate prescriptions without compromising patient satisfaction or clinical outcomes.18

SYMPTOM MANAGEMENT

Because antibiotics are not recommended for routine treatment of bronchitis, physicians are challenged with providing symptom control as the viral syndrome progresses. Common therapies include antitussives, expectorants, inhaler medications, and alternative therapies. Several small trials and Cochrane reviews help guide therapy for symptom control.

The ACCP guidelines suggest that a trial of an antitussive medication (such as codeine, dextromethorphan, or hydrocodone) may be reasonable despite the lack of consistent evidence for their use, given their benefit in patients with chronic bronchitis.12 Studies have shown that dextromethorphan is ineffective for cough suppression in children with bronchitis.19 These data coupled with the risk of adverse events in children, including sedation and death, prompted the American Academy of Pediatrics and the FDA to recommend against the use of antitussive medications in children younger than two years.20 The FDA subsequently recommended that cough and cold preparations not be used in children younger than six years. Use of adult preparations in children and dosing without appropriate measuring devices are two common sources of risk to young children.21

Although they are commonly used and suggested by physicians, expectorants and inhaler medications are not recommended for routine use in patients with bronchitis.22,23 Expectorants have been shown to be ineffective in the treatment of acute bronchitis.22 Results of a Cochrane review do not support the routine use of beta-agonist inhalers in patients with acute bronchitis; however, the subset of patients with wheezing during the illness responded to this therapy.23 Another Cochrane review suggests that there may be some benefit to high-dose, episodic inhaled corticosteroids, but no benefit occurred with low-dose, preventive therapy.24 There are no data to support the use of oral corticosteroids in patients with acute bronchitis and no asthma.

COMPLEMENTARY AND ALTERNATIVE THERAPIES

Many patients also use nonprescription, alternative medications for relief of their bronchitis symptoms. Studies have assessed the benefits of echinacea, pelargonium, and honey. Trials of echinacea in patients with bronchitis and the common cold have yielded inconsistent results, although studies showing positive results have been modest at best.25 Several randomized trials have evaluated pelargonium (also known as kalwerbossie, South African geranium, or the folk remedy rabassam) as a therapy for bronchitis. 26–28 Modest benefits have been noted, primarily in symptom scoring by patients.27 In one randomized trial, patients taking pelargonium for bronchitis returned to work an average of two days earlier than those taking placebo.28

One recent trial examined the effectiveness of dark honey for symptom relief in children with bronchitis compared with dextromethorphan or placebo. Although the authors concluded that symptom scores from patients treated with dark honey were superior to those treated with placebo, the clinical benefit was small.29

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