How is bronchitis treated?
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Treatment Approaches for Bronchitis
Acute Bronchitis Treatment in Children: Complementary and Alternative Medicine (CAM)
Acute bronchitis in children is predominantly caused by viral infections, leading to a high but often inappropriate use of antibiotics. Complementary and alternative medicine (CAM) therapies have been explored as potential treatments to reduce antibiotic use and complement conventional therapies. Herbal remedies, particularly Pelargonium sidoides extract (EPs® 7630), have shown efficacy in several studies1. Anthroposophic medicine, including ribwort-containing remedies, and homeopathic treatments like Monapax® and Droperteel® have also been investigated, though more randomized controlled trials (RCTs) are needed to confirm their effectiveness1.
Chronic Bronchitis: Positive Expiratory Pressure (PEP) and Chest Physiotherapy
For chronic bronchitis, long-term treatment with chest physiotherapy, with or without the use of a positive expiratory pressure (PEP) mask, has been studied. Patients using PEP masks experienced significantly less cough and mucus production, fewer acute exacerbations, and reduced use of antibiotics and mucolytics compared to those receiving conventional chest physiotherapy2. This suggests that PEP masks can help reduce morbidity and potentially slow the decline in lung function in chronic bronchitis patients2.
Antibiotic Use in Severe Exacerbations of Chronic Bronchitis
Antibiotics are commonly used to treat purulent exacerbations of chronic bronchitis. Tetracycline, penicillin with streptomycin, and ampicillin are frequently prescribed, though comparative trials to determine the most effective antibiotic regimen are lacking3. The choice of antibiotic often depends on the severity of the illness and the specific bacterial pathogens involved3.
Innovative Bronchoscopic Treatments for Chronic Bronchitis
Several new bronchoscopic treatments are being investigated for chronic bronchitis. These include liquid nitrogen metered cryospray, bronchial rheoplasty, and balloon desobstruction, which aim to destroy hyperplastic goblet cells and excess submucous glands. Targeted lung denervation (TLD) is another technique that reduces acetylcholine release to decrease smooth muscle tone and mucus production. While these treatments show promise, larger RCTs are needed to confirm their efficacy and durability5.
Bronchiolitis Management: Supportive Care and Pharmacologic Options
Bronchiolitis, a common viral respiratory infection in infants, is primarily managed with supportive care. This includes fluid replacement, gentle suctioning of nasal secretions, prone positioning, oxygen therapy, and respiratory support if necessary7 10. Pharmacological treatments such as bronchodilators, corticosteroids, and antibiotics have not shown consistent clinical benefits and are not routinely recommended6 7. Nebulized hypertonic saline may offer some benefit for patients with prolonged hospital stays, and high-flow nasal cannula can reduce intubation rates7.
Conclusion
The treatment of bronchitis varies significantly depending on whether it is acute or chronic and the age of the patient. CAM therapies show potential for treating acute bronchitis in children, while PEP masks and innovative bronchoscopic treatments offer promising options for chronic bronchitis. Supportive care remains the cornerstone of bronchiolitis management, with limited evidence supporting the use of pharmacological agents. Further research, particularly RCTs, is essential to validate these treatment approaches and improve patient outcomes.
Sources and full results
Most relevant research papers on this topic
Complementary and alternative medicine in the treatment of acute bronchitis in children: A systematic review.
Complementary and alternative medicine (CAM) approaches show a favorable effect in treating acute bronchitis in children, but more randomized controlled trials are needed for reliable statements on effectiveness.
Systematic ReviewLong-term treatment of chronic bronchitis with positive expiratory pressure mask and chest physiotherapy.
Long-term treatment with a positive expiratory pressure mask and chest physiotherapy can reduce morbidity and preserve lung function in chronic bronchitis patients.
RCTAntibiotic regimens in severe and acute purulent exacerbations of chronic bronchitis.
Tetracycline, penicillin with streptomycin, and ampicillin show similar efficacy in treating severe and acute purulent exacerbations of chronic bronchitis, but tetracycline is more effective in treating acute exacerbations.
RCT
Highly CitedDiagnosis and Management of Bronchiolitis
This clinical practice guideline outlines diagnostic and therapeutic interventions for bronchiolitis in children, focusing on bronchodilators, corticosteroids, antiviral and antibacterial agents, hydration, chest physiotherapy, and oxygen.
Highly CitedNew bronchoscopic treatment modalities for patients with chronic bronchitis
Innovative bronchoscopic treatments show promising results for chronic bronchitis, but future work should focus on symptom improvement and treatment sustainability.
Controversies in the treatment of bronchiolitis
Routine use of bronchodilators, epinephrine, or corticosteroids for treating bronchiolitis in young children is not justified without demonstrated clinical benefits for individual patients.
Systematic ReviewBronchiolitis Care in the Hospital.
Supportive care remains the mainstay of therapy for bronchiolitis in the hospital setting, with no evidence supporting the use of bronchodilators, racemic epinephrine, deep suctioning, systemic corticosteroids, or antibiotics without a concomitant bacterial infection
Systematic ReviewBronchitis in children under one year of age and methods of its treatment
Bronchitis in children under one year of age requires specific treatment methods, including etiotropic, symptomatic, and hospital treatment for obstructive bronchitis and bronchiolitis.
Management of bronchiectasis in adults
Bronchiectasis management is evolving, with evidence supporting long-term macrolide therapy, inhaled therapies, physiotherapy, and pulmonary rehabilitation.
Literature Review
Rigorous JournalHighly CitedCurrent therapy for bronchiolitis
Nebulised epinephrine offers short-term benefits, while oral dexamethasone with nebulised epinephrine potentially decreases hospitalization and length of stay in infants with bronchiolitis.
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