Health Library Acute BronchitisFrom Healthwise

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This topic is about acute bronchitis in people who don't have other health problems. Acute bronchitis may be treated differently if you have a long-term lung disease, such as chronic obstructive pulmonary disease (COPD). For more information, see the topics Chronic Obstructive Pulmonary Disease (COPD) and Pneumonia.

What is bronchitis?

Bronchitis means that the tubes that carry air to the lungs (the bronchial tubes) are inflamed and irritated. When this happens, the tubes swell and produce mucus. This makes you cough.

There are two types of bronchitis:

• Acute bronchitis usually comes on quickly and gets better after 2 to 3 weeks. Most healthy people who get acute bronchitis get better without any problems. See a picture of acute bronchitis.
• Chronic bronchitis keeps coming back and can last a long time, especially in people who smoke. Chronic bronchitis means you have a cough with mucus most days of the month for 3 months of the year for at least 2 years in a row.

This topic focuses on acute bronchitis. Both children and adults can get acute bronchitis.

What causes acute bronchitis?

Acute bronchitis is usually caused by a virus. Often a person gets acute bronchitis after having an upper respiratory tract infection such as a cold or the flu. In rare cases, acute bronchitis is caused by bacteria.

Acute bronchitis also can be caused by breathing in things that irritate the bronchial tubes, such as smoke. It also can happen if a person inhales food or vomit into the lungs.

What are the symptoms?

The most common symptom of acute bronchitis is a cough that is dry and hacking at first. After a few days, the cough may bring up mucus. You may have a low fever and feel tired.

Acute bronchitis symptoms usually start 3 or 4 days after an upper respiratory tract infection. Most people get better in 2 to 3 weeks. But some people continue to have a cough for more than 4 weeks.

Pneumonia can have symptoms like acute bronchitis. Because pneumonia can be serious, it is important to know the differences between the two illnesses. Symptoms of pneumonia can include a high fever, shaking chills, and shortness of breath.

How is acute bronchitis diagnosed?

Your doctor will ask you about your symptoms and examine you. This usually gives the doctor enough information to find out if you have acute bronchitis.

In some cases, the doctor may take a chest X-ray to make sure that you don't have pneumonia or another lung problem.

How is it treated?

Most people can treat symptoms of acute bronchitis at home. Drink plenty of fluids. Use an over-the-counter cough medicine with an expectorant if your doctor recommends it. This can help you bring up mucus when you cough. Suck on cough drops or hard candies to soothe a dry or sore throat. Cough drops won't stop your cough, but they may make your throat feel better.

Most people don't need antibiotics for acute bronchitis.

Check with your doctor if you have heart or lung disease, such as heart failure, COPD, or asthma. You may need more treatment.

Frequently Asked Questions

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	Should I take antibiotics for acute bronchitis?

Acute bronchitis is usually caused by a virus. It is more common during the winter months and often develops after an upper respiratory illness such as influenza (flu) or a cold caused by a virus such as coronavirus, adenovirus, or a rhinovirus. Respiratory syncytial virus (RSV) may be a cause, especially in adults older than 65. About 10% of the time, acute bronchitis is caused by bacteria.¹

Acute bronchitis can also be caused by exposure to smoke, chemicals, or air pollution, all of which can irritate the bronchial tubes. It can also develop from accidentally inhaling (aspirating) food or vomit.

See an illustration of acute bronchitis.

How acute bronchitis is spread

Acute bronchitis is spread when an infected person coughs, sneezes, or talks and liquid droplets containing virus particles or bacteria that may trigger the condition are released into the air and onto objects. Then you may:

• Breathe air that contains the virus particles or bacteria.
• Touch an object that has been touched by an infected person and then touch your eyes, nose, or mouth without washing your hands.

Symptoms of acute bronchitis usually begin 3 to 4 days after an upper respiratory infection, such as a cold or influenza (flu). Symptoms usually include:

• A cough, which is the main symptom of acute bronchitis. It may be dry at first (does not produce mucus) and after a few days may bring up mucus from the lungs (productive cough). The mucus may be clear, yellow, or green. Occasionally, small streaks of blood may be present.
• A mild fever, usually less than 101 °F (38.3 °C). A higher fever may indicate pneumonia.
• A general feeling of tiredness.
• A sensation of tightness, burning, or dull pain in the chest under the breastbone that usually is worse when breathing deeply or coughing.
• Whistling noises (wheezing) when breathing, especially during physical exertion.
• Hoarseness.

Most cases of acute bronchitis in otherwise healthy people last only 2 to 3 weeks. However, more than 20% of people with acute bronchitis have a cough that lasts more than 4 weeks.²

Often it is hard to tell the difference between viral and bacterial forms of acute bronchitis, and many conditions have symptoms similar to acute bronchitis, such as asthma and pneumonia. Because pneumonia can be a serious complication, it is important to know the differences between acute bronchitis and pneumonia, such as a fast heart rate with pneumonia.

Acute bronchitis is inflammation of the tubes that carry air to the lungs (bronchial tubes). It is usually caused by a virus and follows an upper respiratory tract infection such as a cold or influenza (flu). The infection moves from the nose, mouth, and throat to the bronchial tubes, causing the tubes to swell and mucus production to increase.

At first, a dry, hacking cough is present. After a few days, the cough may bring up mucus from the lungs. The swollen tubes and increase in mucus may make it more difficult for you to breathe.

See an illustration of acute bronchitis.

Most cases of acute bronchitis in otherwise healthy people last only 2 to 3 weeks. However, more than 20% of people with acute bronchitis have a cough that lasts more than 4 weeks.²

How soon you get better depends on several things, including:

• Your age and health.
• The organism causing the infection. Acute bronchitis from a viral cause is usually less severe than from a bacterial cause.
• Whether you smoke.

Complications

Most people get better without developing complications. If complications occur, they include:

• Pneumonia. Acute bronchitis that gets worse (increased fatigue, high fever, chest pain, and increased shortness of breath) usually indicates that pneumonia has developed.
• Repeated episodes of bacterial acute bronchitis. This condition commonly occurs in people who smoke and in people with immune system problems, such as HIV infection, cystic fibrosis, and cancer.

If you have a long-term (chronic) respiratory disease, such as asthma, acute bronchitis can lead to worsening of your coughing and wheezing and can increase the risk of developing complications. In this case, acute bronchitis is a more serious problem and may be treated differently.

Children and older adults are most at risk for complications.

Children who have repeated bouts of acute bronchitis need to be evaluated to see whether they may have a foreign object in the air passage. Children may also be evaluated for asthma or other respiratory tract problems, such as:

• Cystic fibrosis, an inherited disease that results in the production of thick mucus in the lungs.
• Bronchiectasis, a lung condition in which the airways of the lungs are damaged, get bigger, and are frequently infected. A common symptom is a cough that brings up mucus.
• Allergies, which are an immune system reaction to usually harmless substances. Symptoms include cough and difficulty breathing. Allergic rhinitis (hay fever) is a common allergy.
• Sinusitis, an infection of the mucous membranes that line the inside of the nose and facial sinuses. Symptoms include pain and a chronic cough that produces mucus.
• Adenoiditis, an inflammation of the adenoids, which are small masses of tissue at the back of the nose and throat.

The following factors increase your risk for acute bronchitis.

Risk factors you cannot change

These include:

• Chronic medical conditions, especially lung (pulmonary) diseases such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, or asthma. In this case, acute bronchitis may be a more serious problem and may be treated differently.
• Some conditions that cause immune system problems, such as diabetes and HIV infection. An impaired immune system weakens the body's ability to fight infection.
• A history of recent upper respiratory infection, particularly sinusitis, a cold, or influenza (flu). An upper respiratory infection can spread to the lungs.
• Allergies, such as allergic rhinitis.
• An injury to the chest wall, such as a rib fracture.

Risk factors you can change

These include:

• Smoking or living with someone who smokes. Smoking or breathing secondhand smoke makes the respiratory system less effective at removing organisms from the lower airways.
• Living or working in an area with high levels of air pollution, chemicals, or dust. Breathing in these irritants may make the respiratory system less effective at removing organisms from the lower airways.

Call 911 or other emergency services immediately if:

• You have chest pain that is crushing or squeezing, is increasing in intensity, or occurs with any other symptoms of a heart attack.
• You have severe difficulty breathing.
• You are coughing up large amounts of blood (more than streaks of blood or blood mixed with mucus).

Call your health professional today if you:

• Feel short of breath, even when at rest.
• Notice new or increasing whistling sounds when breathing (wheezing) or difficulty breathing, even at rest.
• Have a cough that frequently produces yellow or green sputum from the lungs (not postnasal drainage), lasts longer than 2 days, and occurs along with a fever of 101 °F (38.3 °C) or higher.
• Are coughing up small streaks of blood.
• Develop symptoms of acute bronchitis and you have a chronic lung disease such as asthma or chronic obstructive pulmonary disease (COPD).

Call your health professional in 1 to 2 days if you:

• Notice increased shortness of breath after any physical activity.
• Have a cough that causes you to vomit frequently.
• Have a cough that has lasted longer than 4 weeks.
• Are being treated for acute bronchitis and your symptoms have not improved after 14 days of treatment.

Watchful Waiting

Watchful waiting is a period of time during which you and your health professional observe your symptoms or condition without using medical treatment. Watchful waiting is often appropriate in otherwise healthy people with acute bronchitis unless you have:

• A persistent cough and increasing amounts of mucus being coughed up from the lungs (especially if the mucus is becoming thicker and has more color).
• Shortness of breath.
• Pain in the chest.
• Ongoing fever or fever that gets worse.

Who To See

Acute bronchitis can be diagnosed and treated by most health professionals, including:

• Family medicine doctors.
• General practitioners.
• Internists.
• Pediatricians.
• Nurse practitioners.
• Physician assistants.

If you have complications, such as pneumonia or repeated episodes of acute bronchitis caused by bacteria, you may go to a pulmonologist for diagnosis and treatment. Complications rarely occur.

To prepare for your appointment, see the topic Making the Most of Your Appointment

There are no routine tests to diagnose acute bronchitis. Diagnosis is usually based on your medical history, including your symptoms, and a physical examination. Your health professional will make sure you do not have pneumonia or risk factors for more serious diseases, such as chronic obstructive pulmonary disease (COPD), that may affect treatment.

If your health professional feels that your acute bronchitis is caused by:

• A virus, then no more testing is needed in most cases.
• Bacteria, then more testing may be done and antibiotics may be prescribed.

More testing may be necessary for infants and people older than 65, or if:

• Acute bronchitis does not clear up in 2 to 3 weeks.
• Pneumonia, heart failure, or tuberculosis is suspected or has been recently diagnosed.
• Your immune system is not functioning well (impaired immune system). People with immune problems are more likely to develop complications, such as pneumonia.
• You have a chronic respiratory disease, such as asthma or chronic obstructive pulmonary disease (COPD).
• You do not get better with antibiotic therapy, or you require hospitalization.
• You have a heart rate greater than 100 beats per minute, a respiratory rate greater than 24 breaths per minute, and a fever greater than 100.4 °F (38 °C).
• Whooping cough, a bacterial infection of the upper respiratory system, is suspected.
• Influenza (flu), a viral upper respiratory illness, is suspected.

Sometimes other tests may be needed. Possible tests include:

• Chest X-ray. The result of a chest X-ray of people who have acute bronchitis is usually normal.
• Gram stain and culture and sensitivity of the mucus from the lungs. These tests may help determine if bacteria are causing the infection and which antibiotic will be effective.
• Other tests, including tests to measure blood oxygen levels. These tests can help identify bacteria and viruses and can determine whether acute bronchitis is seriously harming lung function.

Treatment for acute bronchitis in otherwise healthy people usually includes taking steps to reduce cough, fever, and pain. Prescription medications, such as antibiotics, generally are not beneficial. If you already have a disease, such as chronic obstructive pulmonary disease (COPD), heart failure, or asthma, evaluation and treatment may be more extensive.

Most cases of acute bronchitis go away in 2 to 3 weeks, but some may last more than 4 weeks. Home treatment to relieve symptoms is usually all that is necessary. This includes:

• Relieving your cough by drinking fluids, using cough drops, and avoiding lung irritants. You may also use nonprescription cough suppressants, which may help you to stop coughing, and expectorants, which may make coughing easier so you can bring up mucus. Research on cough suppressants and expectorants does not show that they stop a cough, but some people might find them helpful. Do not give cough and cold medicines to a child younger than 2 unless your child’s doctor has told you to. If your child’s doctor tells you to give a medicine, be sure to follow what he or she tells you to do.
• Avoiding caffeine and alcohol, which cause you to lose extra fluid from your body and may lead to dehydration.
• Stopping smoking, if you smoke.
• Getting enough rest so your body has the energy needed to fight the infection. Generally, you feel better sooner if you rest more than usual while you have acute bronchitis.
• Using nonprescription medication, such as acetaminophen, ibuprofen, or aspirin, to relieve fever and body aches. Do not give aspirin to anyone younger than age 20.
• Breathing moist air from a humidifier, hot shower, or sink filled with hot water. The heat and moisture can help keep mucus in your airways moist so it can be coughed out easily.

If prescription medications are required, they may include:

• Inhaled beta2-agonists, which enlarge (dilate) the airways and may relieve coughing in people who have a hard time breathing. However, the possible benefit should be weighed against possible side effects of shaking, tremor, and nervousness.
• Antibiotics, which may be used to treat people who are at increased risk for complications from acute bronchitis. They may also be used if symptoms do not improve after using a beta2-agonist and home treatment. For acute bronchitis in otherwise healthy people, antibiotics generally are not beneficial. For more information, see:

  Should I take antibiotics for acute bronchitis?

What To Think About

Most cases of acute bronchitis are caused by viruses, which are not affected by antibiotics. Using antibiotics when they are not needed is expensive, it can lead to side effects from antibiotic therapy, and some bacteria may become resistant to the antibiotic. This resistance may make the antibiotic less effective the next time it is used. Talk to your health professional about antibiotics; find out whether they are necessary and what their benefits and risks are in treating acute bronchitis.

It is important to seek medical care if you have a long-term (chronic) lung disease such as asthma or chronic obstructive pulmonary disease (COPD) and you develop signs of acute bronchitis. Early treatment of acute bronchitis may prevent complications, such as pneumonia or repeated episodes of acute bronchitis caused by bacteria. This commonly occurs in people who smoke and in people with immune system problems, such as HIV infection, cystic fibrosis, and cancer.

You can help prevent acute bronchitis by:

• Avoiding cigarette smoke. If you smoke, stop. People who smoke or are around others who smoke have more frequent bouts of acute bronchitis. Smoke (including secondhand smoke) reduces the body's ability to remove bacteria and viruses that can cause infections in the lungs.
• Wearing a face mask while working around irritants, such as dust. Specially designed masks are available to filter out dangerous chemicals or dust.
• Avoiding contact with those who have an upper respiratory tract infection, such as a cold, especially if you have an impaired immune system or another medical condition. Wash your hands often during the cold and flu season. If you catch a cold or influenza (flu), you are at an even higher risk for developing bronchitis.
• Discussing with your health professional whether you should get a vaccine for the flu.

If you have had acute bronchitis in the past, you can help avoid getting it again by:

• Avoiding air pollution and other irritants in the air. Stay indoors with the doors and windows closed if air pollution is at a high level.
• Avoiding the use of wood-burning stoves in the winter, if possible.
• Avoiding situations that may trigger an allergic reaction if you have an allergy.

If you have an upper respiratory tract infection, it never hurts to:

• Get plenty of rest.
• Drink enough liquids to avoid getting dehydrated.

Most cases of acute bronchitis go away in 2 to 3 weeks. Home treatment may help you feel better.

Home treatment may include:

• Relieving your cough by drinking fluids, using cough drops, and avoiding lung irritants. You may also use nonprescription cough suppressants, which help you stop coughing, and expectorants, which make coughing easier so you can bring up mucus. Research on cough suppressants and expectorants does not show that they stop a cough, but some people might find them helpful. Do not give cough and cold medicines to a child younger than 2 unless your child’s doctor has told you to. If your child’s doctor tells you to give a medicine, be sure to follow what he or she tells you to do.
• Avoiding caffeine and alcohol, which cause you to lose extra fluid from your body and may lead to dehydration.
• Cutting back or stopping smoking, if you smoke.
• Getting enough rest so your body has the energy needed to fight the infection. Generally, you feel better sooner if you rest more than usual while you have acute bronchitis.
• Using nonprescription medication, such as acetaminophen, ibuprofen, or aspirin, to relieve fever and body aches. Do not give aspirin to anyone younger than age 20.
• Breathing moist air from a humidifier, hot shower, or sink filled with hot water. The heat and moisture can help keep mucus in your airways moist so it can be coughed out easily.

Contact your health professional if your acute bronchitis gets worse, because this may indicate pneumonia. Signs of worsening acute bronchitis include:

• A persistent cough and increasing amounts of mucus being coughed up from the lungs (especially if the mucus is becoming thicker and has more color).
• Shortness of breath.
• Pain in the chest wall.
• Ongoing fever or fever that gets worse.

Most cases of acute bronchitis in otherwise healthy people go away in 2 to 3 weeks. You generally only need nonprescription medications to treat your symptoms. Most people do not need to use prescription medications, such as antibiotics.

Medication Choices

• Nonprescription cough suppressants, which may help relieve coughing, and expectorants, which may make coughing easier so you can bring up mucus. Do not give cough and cold medicines to a child younger than 2 unless your child’s doctor has told you to. If your child’s doctor tells you to give a medicine, be sure to follow what he or she tells you to do.
• Nonprescription pain relievers and fever reducers, such as aspirin, ibuprofen, or acetaminophen. Do not give aspirin to anyone younger than age 20.

Your health professional may prescribe:

• Inhaled beta2-agonists, such as albuterol, which enlarge the airways and may relieve coughing in people who have a hard time breathing. However, the possible benefits should be weighed against possible side effects of shaking, tremor, and nervousness.
• Antibiotics, which may be used to treat people who are at increased risk for complications from acute bronchitis. For acute bronchitis in otherwise healthy people, antibiotics generally are not beneficial. For more information, see:

  Should I take antibiotics for acute bronchitis?

What To Think About

Most cases of acute bronchitis are caused by viruses, which are not affected by antibiotics. Using antibiotics when they are not needed is expensive, it can lead to side effects from antibiotic therapy, and some bacteria may become resistant to the antibiotic. This resistance may make the antibiotic less effective the next time it is used. Talk to your health professional about antibiotics; find out whether they are necessary and what their benefits and risks are in treating acute bronchitis.

If your health professional prescribes antibiotics, take the entire prescription. Don't stop taking the medication when you start to feel better. If you do not take the entire prescription, the bacteria causing the infection may not be entirely destroyed.

Corticosteroids, which may help relieve difficulty breathing, frequent wheezing, or a persistent cough, may be prescribed if other medical conditions such as chronic obstructive pulmonary disease (COPD) or asthma are present.

Other medications may be prescribed to treat complications, such as pneumonia. The medication used depends on the complication.

There is no surgical treatment for acute bronchitis.

Rest, fluids, and home treatment are all that is needed to treat most cases of acute bronchitis in otherwise healthy people. People who have certain chronic respiratory diseases, such as chronic obstructive pulmonary disease (COPD), may need additional treatment.

Organization

• Asthma in Teens and Adults
• Chronic Obstructive Pulmonary Disease (COPD)
• Cystic Fibrosis
• Influenza
• Pneumonia

Citations

1. Gonzales RG, et al. (2001). Principles of appropriate antibiotic use for treatment of uncomplicated acute bronchitis: Background. Annals of Internal Medicine, 134(6): 521–529.

2. Simon HB (2004). Acute bronchitis section of Pneumonia and other pulmonary infections. In DC Dale, DD Federman, eds., ACP Medicine, section 7, chap. 20. New York: WebMD.

Other Works Consulted

• Knutson D, Braun C (2002). Diagnosis and management of acute bronchitis. American Family Physician, 65(10): 2039–2044.

Author:	Sabra L. Katz-Wise	Last Updated: August 31, 2006
Medical Review:	Kathleen Romito, MD - Family Medicine Robert L. Cowie, MB, FCP(SA), MD, MSc, MFOM - Pulmonology
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