How can I effectively counsel patients on the expected duration and self-management of acute bronchitis symptoms?

Expected Duration: Acute bronchitis is usually a self-limiting illness, with the cough typically lasting about 3 to 4 weeks. Patients should be informed that antibiotics generally do not significantly shorten the duration of symptoms, reducing cough duration by only about half a day on average, and may cause adverse effects such as diarrhoea and nausea. They should be advised to seek medical help if symptoms worsen rapidly or significantly, do not improve after 3 to 4 weeks, or if they become systemically very unwell.

Self-Management Strategies: Counsel patients to maintain adequate fluid intake and use paracetamol or ibuprofen for symptomatic relief of fever and pain. Some patients may find benefit from self-care treatments such as honey, pelargonium (a herbal medicine), or over-the-counter cough medicines containing guaifenesin (an expectorant) or cough suppressants (excluding codeine) if they do not have a persistent cough or excessive secretions. Smoking cessation should be strongly advised if the patient smokes.

Antibiotic Use: Antibiotics should not be routinely offered to patients who are not systemically very unwell or at higher risk of complications. Immediate antibiotic prescriptions are reserved for those who are systemically very unwell, and backup prescriptions may be considered for patients at higher risk of complications, such as those with pre-existing comorbidities or older age with additional risk factors.

Follow-up and Reassessment: Routine follow-up is not necessary for most patients with acute bronchitis. Reassessment should be considered if symptoms worsen rapidly or significantly, or if there are signs suggestive of more serious conditions such as pneumonia or sepsis. Patients should be advised to return if symptoms persist beyond the expected duration or if their condition deteriorates.