Management of acute bronchitis

For a summary of managing a patient with acute bronchitis, see Approach to managing a patient with acute bronchitis.

Most cases of acute bronchitis are self-limiting. Reassure patients that acute cough usually resolves without treatment after 3 weeks and most patients have complete cough resolution within 4 weeksThompson, 2013. Occasionally, the cough may persist for up to 8 weeks.

Antibiotic therapy is not indicated for acute bronchitis because it has limited and conflicting low-quality evidence of benefitSmith, 2017Little, 2021Little, 2022National Institute for Health and Care Excellence (NICE), 2019. Despite this, antibiotic therapy is often inappropriately prescribed for acute bronchitis.

Note: Do not use antibiotic therapy for acute bronchitis.

A decision aid for consumers to support discussions is available from the Australian Commission on Safety and Quality in Health Care (ACSQHC).

Drug and nondrug interventions (eg measures to reduce further irritation to the larynx) may be considered for cough – see Cough in adults or Cough in children. There is limited and conflicting low-quality evidence for over-the-counter and complimentary medicines in managing acute bronchitisSierocinski, 2021Volp, 2022Wopker, 2020.

For patients with acute bronchitis, limited evidence suggests no or minimal benefit from the use of oral or inhaled corticosteroids, or inhaled short-acting beta2 agonistsNational Institute for Health and Care Excellence (NICE), 2019.

Figure 1. Approach to managing a patient with acute bronchitis. Printable figureHickner, 2016Kinkade, 2016

To manage a patient presenting with acute bronchitis:

  • Exclude important differential diagnoses and other causes of cough. A chest X-ray is not indicated for acute bronchitisCao, 2013Gordon, 2015Moore, 2017Royal Australian College of General Practitioners (RACGP), 2016. If pneumonia is suspected, consider chest X-ray to confirm the diagnosis – see Diagnostic imaging for CAP in adults or Diagnosis of HAP. Consider performing NAAT (eg PCR) to detect respiratory viruses and Bordetella pertussis if clinically indicated.
  • Reassure the patient that acute bronchitis is self-limiting. Explain that the cough may last for up to 3 weeks and that most patients have cough resolution by 4 weeksThompson, 2013. Occasionally, the cough may persist for up to 8 weeks.
  • For pain or fever, paracetamol and/or NSAIDs can be used (for dosages, see here for adults or here for children). Drug and nondrug interventions (eg measures to reduce further irritation to the larynx) can also be considered for cough – see Cough in adults or Cough in children.
  • Ask the patient to return for reassessment if symptoms take longer than 3 weeks to resolveWoodhead, 2011, or earlier if fever persists, symptoms worsen or new symptoms occur. If the cough persists for more than 8 weeks, investigate causes of chronic cough – see Chronic cough in adults or Causes of chronic cough in children.
  • If a prescription for antibiotic therapy is requested, explain that antibiotic therapy is of no benefit for acute bronchitis and is associated with harms – see Consider benefits versus harms of antimicrobial therapy. A decision aid is available to help with discussing the benefits versus harms of antibiotic therapy [NB1].
Note:

NAAT = nucleic acid amplification testing; NSAIDs = nonsteroidal anti-inflammatory drugs; PCR = polymerase chain reaction

NB1: A decision aid for consumers to support discussions is available from the Australian Commission on Safety and Quality in Health Care (ACSQHC).