What Is Bronchitis?
Acute bronchitis is an inflammatory reaction to an infection in the airways. Most cases of acute bronchitis are caused by a viral infection, although some cases may be due to a bacterial infection.
Symptoms include an acute-onset cough with or without sputum production, low-grade fever, shortness of breath, and noisy breathing.
The diagnosis is made clinically, although testing may be ordered to rule out other conditions.
Treatment focuses on alleviating symptoms and may include over-the-counter painkillers, cough suppressants, and expectorants. Although antibiotics are often prescribed, antibiotics have been shown to provide no benefit in most cases of acute bronchitis and are associated with an increased risk of side effects.
You can safely treat this condition on your own by resting, drinking fluids and taking acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to alleviate fever and discomfort. If the condition lasts longer than a few weeks, or if your symptoms are worsening, you may want to see a doctor who may prescribe an inhaler or pursue other treatment options.
Acute bronchitis is a clinical diagnosis defined by the presence of an acute-onset cough and symptoms of a lower respiratory tract infection without chronic lung disease or another cause such as pneumonia (infection of the lung tissue) or sinusitis (infection of the sinuses) . It is the ninth most common illness among outpatient visits .
The defining symptom of acute bronchitis is an acute-onset cough that may seem similar to a common cold. However, the cough can be further described by the following characteristics :
- Lasting more than five days, as long as 10 to 20 days
- A cough may persist for four or more weeks
- Productive of purulent sputum: This usually represents sloughed cells lining the airways rather than an active bacterial infection.
The following symptoms are also common in cases of acute bronchitis, including:
- Fever: This may develop in the first few days. However, the fever is usually low-grade (less than 100 degrees Fahrenheit), and typically does not persist beyond the first few days .
- Shortness of breath: The shortness of breath is usually not as severe as what can be seen in pneumonia.
- Noisy breathing: Specific noises include wheezing, a high-pitched noise usually heard on expiration, and rhonchi, a coarse rattling sound usually heard on inspiration. The noisy breathing may clear after coughing.
- Headache, nasal congestion , and runny nose: Some people with acute bronchitis may develop symptoms of an upper respiratory infection. These symptoms usually occur early or precede the development of a cough.
The symptoms of acute bronchitis are thought to be due to the inflammatory response to an infection in the airways, which can cause damage to the cells lining the airways and thickening of the mucosa. Causes of acute bronchitis include:
- Viral infection of the airways: Viral infection of the airways is the most common cause of acute bronchitis, constituting approximately 95 percent of cases in healthy adults . The most commonly identified viruses that cause acute bronchitis are rhinovirus, enterovirus, influenza A and B, parainfluenza, coronavirus and respiratory syncytial virus .
- Bacterial infection of the airways: Bacterial infection of the airways is an uncommon cause of acute bronchitis. Bacteria have been detected in one to 10 percent of cases of acute bronchitis, although it is unclear if they were the cause of acute bronchitis . Types of bacteria that can cause acute bronchitis are usually "atypical bacteria" such as Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Bordetella pertussis .
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Treatment Options and Prevention for Bronchitis
Acute bronchitis is usually treated with supportive care and symptom management. Various over-the-counter medications are often used for acute bronchitis, although most have limited evidence for benefit. Antibiotics are often prescribed for acute bronchitis, although antibiotics have not shown to be beneficial for most cases of acute bronchitis, and the American Academy of Pediatrics recommends that antibiotics not be used for viral respiratory infections .
Over-the-counter pain medications
Over-the-counter pain medications such as acetaminophen (Tylenol) and NSAIDs such as ibuprofen (Advil, Motrin) may help relieve symptoms such as fever and pain in some people with acute bronchitis.
For children with acute bronchitis, one study found that honey was better than no treatment in decreasing frequency and severity of coughing and improving quality of sleep. However, honey should not be given to children younger than one year of age due to the risk of a condition called infant botulism.
Cough suppressants, or antitussives, are medications that reduce the cough reflex to relieve symptoms of a cough. Examples of cough suppressant medications include codeine, dextromethorphan, and benzonatate. Small studies have shown some benefit with some cough suppressant medications for acute bronchitis, but overall there is not strong evidence that they provide significant benefit. Of note, in a systematic review, combination antihistamine-dextromethorphan medications (Bromfed DM, Dimaphen DM, Children's Dimetapp Cold & Cough, others) were associated with higher rates of adverse effects in children .
Expectorants are medications that help stimulate respiratory tract secretions and make mucus easier to cough up. Guaifenesin (Mucinex) is an expectorant that was shown to significantly decrease cough frequency and intensity in one study, although it showed no benefit over placebo ("dummy treatment") in two other studies .
Beta-agonists are a class of medication usually used for asthma. One example of a short-acting beta-agonist is albuterol (Ventolin). Beta-agonists may work by dilating the airways and countering airway hyperreactivity. They may be helpful for acute bronchitis in people with underlying asthma or reactive airway disease, but there is limited evidence that they help in people without an underlying lung disease.
Antibiotics are over-prescribed for acute bronchitis. One study found that antibiotics were prescribed for 71 percent of visits for acute bronchitis. However, a systematic review found that there is limited benefit to using antibiotics for acute bronchitis and that the use of antibiotics was associated with an increased risk of side effects including nausea, vomiting, diarrhea, headache, and rash . Acute bronchitis caused by Bordetella pertussis, a specific type of bacteria, does require treatment with antibiotics.
Prevention of acute bronchitis includes practicing good hand washing around people you know who are sick or in otherwise unclean environments. You should also get the annual flu vaccine since influenza is one viral cause of acute bronchitis.
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When to Seek Further Consultation for Bronchitis
If you develop symptoms of acute bronchitis that are concerning to you, you should go see your physician. Your physician can evaluate you to determine if your symptoms are due to acute bronchitis or a potentially more serious condition.
Questions Your Doctor May Ask to Determine Bronchitis
To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
- Any fever today or during the last week?
- Is your cough constant or come-and-go?
- Are you sick enough to consider going to the emergency room right now?
- Have you experienced any nausea?
If you've answered yes to one or more of these questions
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- Wenzel RP, Fowler AA. Acute bronchitis. The New England Journal of Medicine. 2006;355:2125-2130. NEJM Link
- Singh A, Zahn E. Acute bronchitis. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing: 2018 Jan-. NCBI Link
- Smith SM, Schroeder K, Fahey T. Over-the-counter (OTC) medications for acute cough in children and adults in community settings. Cochrane Database Syst Rev. 2014;(11):CD001831. NCBI Link
- Smith SM, Fahey T, Smucny J, Becker LA. Antibiotic treatment for people with acute bronchitis. Cochrane. Published June 19, 2017. Cochrane Link
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