Diagnosis and Conventional Treatment
Diagnosis of acute bronchitis is based on clinical examination and symptoms. In some circumstances chest X-rays, sputum culture, or pulmonary function tests may help differentiate acute bronchitis from other conditions (Mayo Clinic 2011b).
Signs and symptoms of acute bronchitis sometimes resemble other respiratory diseases, and it is important that the physician correctly identify the patient’s condition in order to employ the right treatment. Acute bronchitis is distinct from health conditions like bronchiolitis (inflammation of bronchioles [ie, smaller branches of the bronchi]) or asthma (chronic inflammatory disease of the small respiratory airways), though a bout of acute bronchitis can sometimes trigger asthma and/or asthma symptoms such as wheezing (caused by bronchospasm), shortness of breath, breathlessness, and tightness in the chest (Löwhagen 2012; Killeen 2013). Another condition known as bronchiectasis can sometimes be mistaken for acute bronchitis when it is accompanied by chronic, productive cough; this condition (bronchiectasis) is marked by the destruction of the elastic and muscular tissue in the bronchial walls and their permanent dilation (Rosen 2006; Wenzel 2006). Acute bronchitis should also be differentiated from chronic bronchitis, which is a component of COPD and is characterized by coughing and sputum production on most days for at least three months of two consecutive years (Brunton 2004; Hueston 1998). On the other hand, acute bronchitis is usually self-limited and resolves within 3 weeks in about half of the cases, but around a quarter of them last longer than a month (Braman 2006; Worrall 2008).
Antibiotics are often hastily prescribed for acute bronchitis. For example, 75% of patients with acute bronchitis were reported in one study to receive an antibiotic prescription (Tackett, Atkins 2012). However, this practice is ineffective because the vast majority of cases of acute bronchitis in otherwise healthy adults are caused by viral infection for which antibiotics are not helpful. Antibiotics treat bacterial infections, not viral infections. Accordingly, several professional medical organizations, including the American Academy of Family Physicians, U.S. Centers for Disease Control and Prevention, and Infectious Disease Society of America have issued guidelines aimed at discouraging physicians from indiscriminately prescribing antibiotics to most patients with acute bronchitis, as this can result in the development of antibiotic resistance (Gonzales 2001; American Academy of Family Physicians 2013; CDC 2012).
People with acute bronchitis are advised to refrain from intense activity, drink clear fluids (water), humidify the air, and use anti-inflammatory medication (A.D.A.M. 2012). Bronchodilators, which dilate the airways, may help reduce symptoms, but their benefits for routine use are not well established in the treatment of acute bronchitis.
There is contradictory evidence regarding the benefit of over-the-counter (OTC) cough medications. A 2012 review found “no good evidence for or against the effectiveness of OTC medicines in acute cough” (Smith 2012). However, some evidence suggests symptomatic relief with certain cough medications (Becker 2011; First Consult 2013; Smith 2012). When cough medications are used, the type of medication is generally targeted to the type of cough: expectorants for productive cough and cough suppressants (antitussives) for dry cough (Silverstone 1997; Ford 2009). Antitussives, such as codeine and dextromethorphan, may help reduce cough for individuals with acute bronchitis but are not recommended for routine use or for children (First Consult 2013). Even though cough can be a debilitating symptom in many respiratory diseases, cough suppression is particularly contraindicated when clearing secretions is an important goal (Morice 2006). The 2012 Cochrane review mentioned earlier analyzed 26 randomized, controlled trials comparing oral OTC cough preparations with placebo in children and adults suffering from acute cough. The trials showed variable results for antitussives, expectorants, and antihistamine-decongestant combinations in adults. In children, antihistamine-decongestants, antitussives, and antitussive-bronchodilator combinations were no more effective than placebo (Smith 2012).
Whether treated or not, acute bronchitis should typically resolve on its own as the inflammation within the bronchi gradually subsides and the symptoms ease. Nevertheless, the condition can be uncomfortable and frustrating, so early intervention—at the first signs of viral infection—is important to manage acute bronchitis (Matthys, Heger 2007b; WebMD 2010).