Bronchitis is a common complication of viral respiratory infections, including colds and flu. It is an inflammation of the bronchial tubes, the main air passages in the lungs. The U. S. National Library of Medicine's PubMed web site explains that viruses often infect the nose, sinuses, and throat, and then spread to the lungs.
A secondary bacterial infection may follow the viral infection for some patients. Antibiotics may be useful for these cases, but offer no benefits for the majority of infections that are caused by viruses alone.
A bad cough is the main symptom of bronchitis. Carl Llor and colleagues in Spain provided a review of the medical literature on treatment options. “There is clear evidence that antibiotics should not be recommended in non-complicated acute bronchitis,” Llor wrote.
In clinical trials, antibiotics have reduced the duration of symptoms by at most a few hours in illnesses that lasted at least a week. Llor summarized, “The results were statistically significant but clinically trivial.”
Inflammation may cause more damage than the actual infection. Llor hypothesized that ibuprofen, a non-steroidal anti-inflammatory drug (NSAID), may produce better results than antibiotics. He published a protocol for a clinical trial, with patients randomized to three groups as follows:
1. Ibuprofen 600 mg / 8 hours, taken after meals, for 10 days
2. Amoxicillin 500 mg plus clavulanic acid 125 mg / 8 hours, taken after meals for 10 days
3. Placebo, one tablet every 8 hours, taken after meals for 10 days
This study is currently underway.
A key reference for the rationale of anti-inflammatory treatment is a 2006 article by Richard P. Wenzel and Alpha A. Fowler of Virginia Commonwealth University, published in the New England Journal of Medicine.
These authors wrote, “In practice, a brief trial (7 days) of inhaled or oral corticosteroids may be reasonable for troublesome cough (i.e., cough persisting for more than 20 days), but there are no clinical trial data to support this approach.”
Corticosteroids are powerful anti-inflammatory drugs available only by prescription. Non-steroidal anti-inflammatory drugs have similar effects with fewer risks, and are available over the counter.
The PubMed web site suggests aspirin or acetaminophen for the symptoms of bronchitis. Aspirin is an NSAID drug, but acetaminophen is not. Based on Llor's hypothesis, aspirin, ibuprofen, and other over-the-counter NSAIDs may be appropriate treatment options.
It is important to note, that children should not be given aspirin due to risk of developing Reye's syndrome. In general, check with your health care provider before trying self-treatment for bronchitis.
References:
1. U. S. National Library of Medicine. PubMed. Bronchitis. Web. Dec. 1, 2011.
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002078
2. Llor C et al, “Effectiveness of anti-inflammatory treatment versus antibiotic therapy and placebo for patients with non-complicated acute bronchitis with purulent sputum. The BAAP study protocol”, BMC Pulmonary Medicine 2011; 11: 38.
http://www.ncbi.nlm.nih.gov/pubmed/21693045
3. STMRA. BAAP Study Protocol. Web. Dec. 1, 2011.
http://www.stmra.com/index.php/en/bibliography/5419-effectiveness-of-anti-inflammatory-treatment-versus-antibiotic-therapy-and-placebo-for-patients-with-non-complicated-acute-bronchitis-with-purulent-sputum-baap-study-protocol.html
4. Wenzel RP et al, “Clinical practice. Acute bronchitis”, New England Journal of Medicine 2006 Nov 16; 355(20): 2125-30.
http://www.ncbi.nlm.nih.gov/pubmed/17108344
5. I've Heard That Children Should Never Take Aspirin. Is That True?
Q & A by Michael L. Schmitz, M.D., ABC News. Web Dec. 1. 2011.
http://abcnews.go.com/Health/LivingWithPain/story?id=4052474#.Tt5Vr3O4K3Y
Reviewed December 6, 2011
by Michele Blacksberg RN
Edited by Jody Smith