Bronchitis medical therapy: Difference between revisions
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{{CMG}}; {{AE}} {{chetan}} | {{CMG}}; {{AE}} {{chetan}}{{MehdiP}} | ||
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* Atypical bacteria (Bordetella pertusis, mycoplasma pneumonia, chlamydiae pneumonia) | * Atypical bacteria (Bordetella pertusis, mycoplasma pneumonia, chlamydiae pneumonia) | ||
** Azithromycin (Zithromax) 500mg on day 1 followed by 250mg from day 2-5. | ** Azithromycin (Zithromax) 500mg on day 1 followed by 250mg from day 2-5. | ||
===Other Therapy=== | ====Other Therapy==== | ||
* Various other treatments like beta 2 agonists, mucolytic agents, anti-tussive agents and corticosteroids have been used in different settings but no proven benefits have been shown in any of the clinical trials. | * Various other treatments like beta 2 agonists, mucolytic agents, anti-tussive agents and corticosteroids have been used in different settings but no proven benefits have been shown in any of the clinical trials. | ||
===Chronic Bronchitis Treatment=== | ===Chronic Bronchitis Treatment=== | ||
Chronic bronchitis is treated symptomatically. Inflammation and edema of the respiratory epithelium may be reduced with inhaled [[corticosteroid]]s. Wheezing and shortness of breath can be treated by reducing [[bronchospasm]] (reversible narrowing of smaller bronchi due to constriction of the [[smooth muscle]]) with [[bronchodilator]]s such as inhaled [[beta agonist|β-Adrenergic agonist]]s (e.g., [[Salbutamol]]) and inhaled [[anticholinergic]]s (e.g., [[ipratropium|Ipratropium bromide]]). [[Hypoxemia]] | Chronic bronchitis is treated symptomatically. Inflammation and edema of the respiratory epithelium may be reduced with inhaled [[corticosteroid]]s. Wheezing and shortness of breath can be treated by reducing [[bronchospasm]] (reversible narrowing of smaller bronchi due to constriction of the [[smooth muscle]]) with [[bronchodilator]]s such as inhaled [[beta agonist|β-Adrenergic agonist]]s (e.g., [[Salbutamol]]) and inhaled [[anticholinergic]]s (e.g., [[ipratropium|Ipratropium bromide]]). [[Hypoxemia]](too little oxygen in the blood) can be treated with supplemental oxygen. However, oxygen supplementation can result in decreased respiratory drive, leading to increased blood levels of [[carbon dioxide]] and subsequent [[respiratory acidosis]]. | ||
====Smoking Cessation==== | ====Smoking Cessation==== | ||
To help the bronchial tree heal faster and not make bronchitis worse, [[tobacco smoking|smokers]] should completely quit smoking. <ref>[http://familydoctor.org/677.xml The American Academy of Family Physicians: Acute Bronchitis]. January 2006. Accessed [[20 March]] [[2007]].</ref> | To help the bronchial tree heal faster and not make bronchitis worse, [[tobacco smoking|smokers]] should completely quit smoking. <ref>[http://familydoctor.org/677.xml The American Academy of Family Physicians: Acute Bronchitis]. January 2006. Accessed [[20 March]] [[2007]].</ref> | ||
Revision as of 15:46, 16 September 2016
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chetan Lokhande, M.B.B.S [2]Seyedmahdi Pahlavani, M.D. [3]
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Bronchitis Main page |
Overview
The majority of cases of bronchitis are caused by viruses and are self-limited. The treatment of bronchitis is primarily symptomatic and includes analgesics, decongestants, expectorants, and cough suppressants. The administration of antibiotics should be limited to cases in which a definitive pathogen is identified. Pharmacologic therapy for chronic bronchitis includes a combination of inhaled corticosteroids, bronchodilators ( e.g. Salbutamol), and inhaled anticholinergics (e.g. Ipratropium bromide).
Medical Therapy
Acute Bronchitis
Symptomatic
Treatment for acute bronchitis is primarily symptomatic.
- Non-steroidal anti-inflammatory drugs (NSAIDs) may be used to treat fever and sore throat.
- Decongestants can be useful in patients with nasal congestion, and
- Expectorants may be used to loosen mucus and increase expulsion of sputum.
- Cough suppressants may be used if the cough interferes with sleep or is bothersome, although coughing may be useful in expelling sputum from the airways. Even with no treatment, most cases of acute bronchitis resolve quickly.
Antimicrobial Agent
- Only about 5–10% of bronchitis cases are caused by a bacterial infection. Most cases of bronchitis are caused by a viral infection and are "self-limiting" and resolve themselves in a few weeks.[1]
- Antimicrobial agents are not recommended in most cases of acute bronchitis. Various randomized controlled trials and systematic reviews have shown a decrease in symptoms by just a fraction of day with use of antibiotics when compared with placebo. These results though statistically significant are not clinically significant (as improvement by only a fraction of day). Antibiotic therapy did not help in a trial of patients who mainly had bronchitis.[2] About 15% had chronic obstructive lung disease and their results were not reported separately.[2]
- However, treatment with antibiotics can be administered in cases in which a definitive treatable pathogen is present. For e.g. treatment of influenza virus with oseltamivir decreases the duration of symptoms by approximately 1 day and results in an earlier return to normal activity. Similarly, treatment of patients with pertussis is indicated to limit transmission when the therapy is initiated during the first week of symptoms. However, the symptoms are not less severe even with administration of these antibiotics.
- Thus, in case of definitive diagnosis anti-microbial agent can be used for:
- Influenza
- Oseltamivir (Tamiflu), 75 mg BD for 5 days
- Zanamivir 2 puffs BD for 5 days
- Atypical bacteria (Bordetella pertusis, mycoplasma pneumonia, chlamydiae pneumonia)
- Azithromycin (Zithromax) 500mg on day 1 followed by 250mg from day 2-5.
Other Therapy
- Various other treatments like beta 2 agonists, mucolytic agents, anti-tussive agents and corticosteroids have been used in different settings but no proven benefits have been shown in any of the clinical trials.
Chronic Bronchitis Treatment
Chronic bronchitis is treated symptomatically. Inflammation and edema of the respiratory epithelium may be reduced with inhaled corticosteroids. Wheezing and shortness of breath can be treated by reducing bronchospasm (reversible narrowing of smaller bronchi due to constriction of the smooth muscle) with bronchodilators such as inhaled β-Adrenergic agonists (e.g., Salbutamol) and inhaled anticholinergics (e.g., Ipratropium bromide). Hypoxemia(too little oxygen in the blood) can be treated with supplemental oxygen. However, oxygen supplementation can result in decreased respiratory drive, leading to increased blood levels of carbon dioxide and subsequent respiratory acidosis.
Smoking Cessation
To help the bronchial tree heal faster and not make bronchitis worse, smokers should completely quit smoking. [3]
References
- ↑ Hueston WJ (1997). "Antibiotics: neither cost effective nor 'cough' effective". The Journal of Family Practice. 44 (3): 261–5. PMID 9071245. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ 2.0 2.1 Little P, Stuart B, Moore M, Coenen S, Butler CC, Godycki-Cwirko M; et al. (2012). "Amoxicillin for acute lower-respiratory-tract infection in primary care when pneumonia is not suspected: a 12-country, randomised, placebo-controlled trial". Lancet Infect Dis. doi:10.1016/S1473-3099(12)70300-6. PMID 23265995.
- ↑ The American Academy of Family Physicians: Acute Bronchitis. January 2006. Accessed 20 March 2007.