Bronchitis: Drug Therapy

Acute bronchitis

Therapeutic Objective

Drug therapy for acute bronchitis is intended to prevent the spread of pathogens with far-reaching complications.

Therapy recommendations

• In acute bronchitis, the causative agent is >90% viral.
• In uncomplicated acute bronchitis, antibiotic therapy is not required (only leads to a shortening of the duration of illness by less than one day).
• Symptomatic therapy: if necessary, expectorants (drug that promotes the expectoration of bronchial secretions), it is important to ensure a sufficient amount of drinking (> 1.5 l / d); at night, if necessary, antitussives (cough suppressants); no combination of antitussives and expoctorants!
• Spastic bronchitis (common in babies and young children; rare in adults): ß-sympathomimetics (inhalation or spray) or ipratropium bromide (anticholinergic); in bes. severe cases glucocorticoids.
• Indications for antibiotic therapy are:
  • Existing lung disease
  • In patients with severe chronic diseases or immunodeficiencies.
  • Hospital-acquired acute bronchitis.
  • Suspected bacterial infection
  • Purulent sputum and
    • Older age
    • Concurrent comorbidity (concomitant diseases: chronic obstructive pulmonary disease, COPD; diabetes mellitus, immune incompetence, coronary artery disease, CAD/coronary artery disease).
  • Symptoms persisting for longer than a week, as well as CRP elevation and leukocytosis (inflammatory parameter).
• Spastic bronchitis (common in babies and young children; rare in adults): ß-sympathomimetics
• See also under “Other therapy.”

Notice:

• Drug Safety Communication: because of the risk of serious complications, antibiotics from the fluoroquinolone group should no longer be used to treat sinusitis, bronchitis, and uncomplicated urinary tract infections.
• The detection of Candida in bronchial secretions is not an indication for antifungal therapy (German Society for Infectiology).
• The FDA (U. S. Food and Drug Administration; Food and Drug Administration of the United States) warns of neuropsychiatric complications of montelukast and advises against prescribing the drug in patients with mild symptoms, especially those with allergic rhinitis.

Further notes

• Yellow or green discoloration of sputum (sputum) in acute bronchitis is not associated with a higher probability of bacterial infection. Bacteria can be detected in only 12% of bronchitis patients with yellow-green sputum.
• The spontaneous course of cough in acute bronchitis is on average four weeks until complete resolution.

Phytotherapeutics

• Myrtol (side effects: mild gastrointestinal symptoms).
• Pelargonium sidoides (Umckaloabo, EPs 7630) (note: possible liver toxicity is not completely excluded).
• Thyme ivy preparation
• Thyme / primrose root
• Echinacea (if used early)

There is insufficient study basis for essential oil inhalation. Note: Essential oils should not be used in young children because of the risk of laryngospasm (vocal spasm).

Supplements (dietary supplements; vital substances)

Suitable supplements wg cough should contain the following vital substances:

• Vitamins (vitamin C (ascorbic acid))
• Trace elements (zinc)

Suitable supplements for natural defense should contain the following vital substances:

• Vitamins (A, C, E, D3, B1, B2 B3, B5, B6, B12, folic acid, biotin).
• Trace elements (chromium, iron, copper, manganese, molybdenum, selenium, zinc).
• Omega-3 fatty acids (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)).
• Secondary plant compounds (eg beta-carotene, flavonoids, lycopene, polyphenols).
• Probiotics

Note: The listed vital substances are not a substitute for drug therapy. Food supplements are intended to supplement the general diet in the particular life situation.

Chronic bronchitis

Therapy Objectives

• Symptom relief
• Prevention of disease progression
• Healing

Therapy recommendations

• First clarification of a chronic cough (>8 weeks duration) requires a stepwise diagnosis:
  1. X-ray chest/thorax and pulmonary function testing; if chest x-ray and pulmonary function are normal: 2nd step; nonspecific bronchial provocation.
  2. Methacholine test (methacholine provocation test, English methacholine challenge test) – nonspecific, inhaled provocation test to measure bronchial obstruction (constriction (obstruction) of the bronchi) and hyperreactivity (excessively strong (“exaggerated”) reaction to a stimulus), e.g., in bronchial asthma
  3. Bronchoscopy (lung endoscopy) or computed tomography (CT); at the end of the diagnosis, a bronchoscopy is always indicated if the cough remains unclear!
• In the clarification of chronic cough of the further note: Presence of:
  • Upper respiratory tract infection (e.g., rhinitis/cold) treated too briefly?
  • Gastroesophageal reflux (reflux of gastric contents into the esophagus); treatment with proton pump inhibitors (PPI; acid blockers), e.g., 2 x 20 mg omeparazole, treatment duration 2-3 months.
  • Cardiac (“heart-related”) causes (e.g., left heart failure/left heart failure with impaired or preserved left ventricular ejection fraction) overlooked?
  • ACE inhibitor use; check medication history!
• Symptomatic therapy: if necessary, expectorants (drug that promotes the expectoration of bronchial secretions), it is important to ensure adequate drinking (> 1.5 l / d); at night, if necessary, antitussives (cough suppressants); no combination of antitussives and expoctorants!
• Note: A smoker’s cough improves under nicotine abstinence already after four to six weeks (but does not disappear completely in advanced cases).
• Therapy for chronic cough and proven bronchial hyperreactivity (BHR) without asthma symptoms: inhaled glucocorticosteroid (ICS), alternatively montelukast, ß-sympathomimetics.
• In chronic obstructive bronchitis, see under the disease of the same name; the same applies to other diseases.