The recommendations are consistent with those made by the British Thoracic Society in Recommendations for the management of cough in adults [Morice et al, 2006].

• Analgesics: there is limited evidence from controlled trials that both paracetamol and ibuprofen reduce some symptoms of cold such as pain and temperature. However, they have no effect on the specific symptoms of acute bronchitis such as cough. Ibuprofen has more contraindications than paracetamol, but has the advantage of probably being more effective at reducing temperature and requiring less frequent dosing.
• Aspirin and other nonsteroidal anti-inflammatory drugs (other than ibuprofen) are not recommended, as they are more likely to cause serious adverse effects.
• In particular, aspirin should be avoided in older people who are more prone to its adverse effects, or who are taking concomitant nonsteroidal anti-inflammatory drugs or aspirin for cardiovascular purposes.
• Preventing dehydration:
• In clinical practice dehydration is a commonly observed problem for people that are unwell with a chest infection.
• It occurs because they have increased fluid losses from sweating and/or a reduced fluid intake due to general malaise.
• It may not be recognized by someone who is unwell because many of the symptoms of dehydration such as headache, dry mouth, and general malaise may be wrongly attributed to their infective illness rather than dehydration.
• For someone who is unwell dehydration may be most easily recognized by observing urine colour and output, and may be relieved by increasing fluid intake appropriately.
• Cough medicines to suppress a productive cough are not recommended because they suppress the natural mechanism that keeps the airway clear. In principle, suppression of an unproductive cough is unlikely to cause harm [SIGN, 2002]. However:
• Cough medicines that are available over the counter are largely ineffective, and may have associated adverse effects [Morice et al, 2006].
• They may have a useful placebo effect. Because they have little effect at suppressing cough, there is probably no harm in someone continuing to use them even for a productive cough if they have already bought them.
• Opioids in doses higher than recommended in over-the-counter preparations may suppress cough but also have significant adverse effects and are therefore not recommended.
• Smoking cessation is widely advocated because:
• Smoking cessation reduces irritation to the bronchial tree already inflamed due to infection, and theoretically may reduce coughing.
• Smoking is a risk factor for acute bronchitis. Smoking cessation reduces the risk of further episodes of acute bronchitis, in addition to conferring many other health benefits.
• Beta₂-agonists are not routinely recommended for the treatment of acute bronchitis. A Cochrane review (search date: November 2005) found beta₂-agonists only benefited adults with evidence of airway obstruction, and that overall the evidence did not support the use of these drugs in people with acute bronchitis [Smucny et al, 2006].
• Chinese medicinal herbs are not recommended in people with acute bronchitis. A Cochrane review (search date: March 2005) found that although some studies did suggest benefit, these were open to study bias and methodological flaws, and as such overall they cannot be recommended for routine use [Wei et al, 2005].