What Matters

NSAIDs for bronchitis


’Tis the season to be coughing.

The most common condition we are seeing and will be seeing in the coming months is bronchitis. Bronchitis is a self-limited inflammation of the bronchi due to upper airway infection (i.e., cough without pneumonia), which is most commonly viral in etiology. Antibiotics are not recommended for treatment.

Many of our patients will be making appointments to see us when they hit 10-14 days without improvement. But remember that the cough from bronchitis can last up to 4 weeks or more. Reports indicate that more than 60%-90% percent of patients with acute bronchitis who seek care receive antibiotics. Furthermore, 75% of all antibiotic prescriptions are written for upper respiratory infections – yet most patients, if not all, do not need them.

Many of our patients will say that they have tried the usual over-the-counter remedies, which can ruin the best-laid plans for conservative management. But have they tried ibuprofen? (Assuming there is no contraindication, of course.)

Dr. Carl Llor and his colleagues recently published a randomized, blinded clinical trial evaluating the comparative efficacy of an anti-inflammatory, antibiotic, or placebo in the resolution of cough in patients with bronchitis (BMJ 2013 Oct. 4;347:f5762).

Adults aged 18-70 years were eligible to be randomized if they were presenting with a respiratory tract infection less than 1 week in duration and had cough, discolored sputum, and at least one of three symptoms: dyspnea, wheezing, or chest discomfort or chest pain. Subjects were randomized to ibuprofen 600 mg three times a day, amoxicillin-clavulanic acid 500 mg/125 mg three times a day, or placebo three times a day. Treatment was given for 10 days.

The median number of days with frequent cough was numerically lower, but not statistically significantly lower, in the ibuprofen group (9 days; 95% CI: 8-10 days), compared with participants receiving antibiotics (11 days; 95% CI: 10-12 days) or placebo (11 days; 95% CI: 8-14 days). Adverse events were more common in the antibiotic arm (12%), compared with ibuprofen or placebo (5% and 3%, respectively, P = .008).

Other nonantibiotic cough remedies have been evaluated in the treatment of patients presenting with cough. Inhaled fluticasone may be effective, but the cost might be prohibitive for many patients.

For ibuprofen, the price is right – and it may buy us some time before we feel compelled to prescribe antibiotics.

Dr. Ebbert is a professor of medicine, a general internist, and a diplomate of the American Board of Addiction Medicine who works at the Mayo Clinic in Rochester, Minn. The opinions expressed are those of the author.

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