What are empiric therapy regimens for chronic bronchitis?

Updated: Jul 22, 2021
  • Author: Jazeela Fayyaz, DO; Chief Editor: John J Oppenheimer, MD  more...
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Answer

Answer

Chronic bronchitis is typically defined as cough and sputum production on most days of the month for at least 3 months of the year for 2 consecutive years. Chronic bronchitis results from excessive airway mucus due to increased production (ie, inflammation, oxidative stress, infection) and decreased clearance (ie, poor ciliary function, airway occlusion, respiratory muscle weakness). It is a phenomenon with variable presentations that is most common in individuals with inhalation exposures, such as smoking, and often coincides with chronic obstructive pulmonary disease (COPD).

  • Empiric antibiotic therapy is not recommended.

  • Although chronic macrolide therapy, known for its anti-inflammatory properties, reduces COPD exacerbations, it does not show any additional benefit in patients with baseline chronic bronchitis.

  • Reduce mucus production.

    • Smoking cessation and avoidance of environmental irritants will decrease goblet cell stimulation and hyperplasia.

    • Anticholinergics decrease mucus secretion via their action on the muscarinic receptors; however, use with caution as they may dehydrate airways making secretions more difficult to expectorate.

    • Inhaled glucocorticoids reduce inflammation and thus mucus production.

    • PDE-4 inhibitors (eg, roflumilast) may decrease COPD exacerbations in patients with concomitant chronic bronchitis by decreasing mucus secretions; however, evidence is limited.

  • Facilitate mucus elimination.

    • Physical maneuvers such as chest physical therapy or flutter valve may help to augment shear stressors to aid mucus breakdown and clearance (minimal evidence available).

    • Methylxanthines and short-acting beta agonists increase airway lumen diameter, intensify ciliary beat frequency, and promote mucus hydration via activation of the cystic fibrosis transmembrane regulator.

    • Inhale hypertonic saline directly rehydrate airways and promotes cough (minimal evidence to show benefit).

    • Expectorants (eg, guaifenesin) vagally medicate increase in airway secretions improving mucus clearance in the short term (no long-term benefit found).


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