bronchitis%20-%20uncomplicated%20acute
BRONCHITIS - UNCOMPLICATED ACUTE
Uncomplicated acute bronchitis is a self-limiting infection of the trachea and bronchi that usually lasts for 1 to 3 weeks. A healthy patient experiences sudden onset of cough, with or without sputum production.
It is an inflammatory response to infections of the bronchial epithelium of the large airways of the lungs that begins with mucosal injury, epithelial cell damage and release of proinflammatory mediators.
There is transient airflow obstruction and bronchial hyperresponsiveness.
Purulence can result from either bacterial or viral infection.

Pharmacotherapy

  • Routine use of antibiotics is highly discouraged and should only be considered in patients with bacterial infection or pneumonia; consider local resistance patterns when planning use of antibiotics
Symptomatic Therapy

Choice of therapy depends on which symptoms are most bothersome to the patient

Analgesics (Non-Opioid) and Antipyretics

  • Eg Paracetamol, Ibuprofen
  • Beneficial when influenza symptoms eg malaise and fever are prominent
  • Avoid salicylates in children ≤18 years of age because of the risk of Reye Syndrome

Bronchodilators: Beta2-Agonists

  • Eg Albuterol 
  • May be used to reduce the duration and severity of cough in some patients, but routine use for cough palliation is not recommended
  • Use should be individualized to those who are most likely to benefit
    • Justified in patients with clinical evidence of airflow obstruction or bronchial hyperresponsiveness (eg wheezing or bothersome cough)
  • Studies have shown that more patients report decrease in cough after 7 days of inhaled bronchodilator as compared to placebo or antibiotic

Cough and Cold Preparations

  • Codeine or Dextromethorphan
    • May be justified for a nonproductive irritating cough, given short term for cough relief
      • Codeine is a weak, centrally acting opioid that suppresses cough
      • Dextromethorphan is a non-opioid that acts centrally to decrease cough
    • Patients with cough lasting >2-3 weeks are the most likely to benefit
    • Suppress the cough reflex by a direct action on the cough center in the medulla of the brain
    • Modest effect on severity and duration of cough
    • Typically not very effective in patients with acute or early cough due to colds or other viral upper respiratory tract infection (URTI)
  • Though evidence is lacking to recommend mucolytic monotherapy for acute bronchitis, studies show changes in the character of sputum and improvement in respiratory symptoms with its use
  • Guiafenesin is an expectorant which acts by stimulating respiratory tract secretions leading to increased fluid volumes and decreased mucus viscosity
    • Also have antitussive activity
    • Effectiveness in reducing cough frequency and intensity was shown in several clinical trials

Other Treatments

  • Pelargonium sidoides
    • May be used  as monotherapy or in combination with symptomatic therapy and/or antibiotics
    • Modulates immune response, has bacteriostatic properties preventing proliferation of bacteria that causes secondary bacterial superinfection and has expectorant and mucolytic properties
    • Reduces duration and severity of respiratory tract infections caused by viruses
  • Vitex negundo L. (Lagundi leaf)
    • Studies show improvement of respiratory symptoms with Lagundi treatment when compared with Theophylline 

Antibiotics for Pertussis

  • Use is supported only for confirmed or suspected B pertussis cases when there is a high probability of exposure or during an outbreak
  • Erythromycin is the drug of choice for treatment and prophylaxis of pertussis in people of all ages
  • Two small comparative studies suggest that Clarithromycin and Azithromycin are at least as effective as Erythromycin for pertussis treatment
  • Co-trimoxazole may be used as an alternative when macrolides cannot be given
  • Antibiotics are primarily used to decrease shedding of the pathogen and therefore decrease the spread of the disease
    • Patient isolation for 5 days from the start of treatment is a necessary precaution
    • Antibiotic therapy does not appear to resolve symptoms if it is initiated 7-10 days after the onset of illness but does prevent spread to others

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