What You Need to Know About Acute Bronchitis

Ghostwritten

Bronchitis is an inflammation of the air tubes in the lungs, called bronchioles. The inflammation causes the bronchioles to produce too much mucus. (1) It causes shortness of breath and a cough that can last for weeks. Acute bronchitis is often referred to as a chest cold.

Acute bronchitis affects 5% of adults every year. It is one of the 10 most common outpatient illnesses. (2) It is most likely to happen during the flu season.

What Is The Difference Between Chronic And Acute Bronchitis? (1)(3)

Chronic bronchitis is defined as a cough that lasts two or three months each year for at least two years. It is often caused by smoking or environmental irritants.

Acute bronchitis is a short-term respiratory illness that is more severe than a cold but less severe than pneumonia. It is most often caused by a viral infection (cold or flu). It can also be caused by bacteria, but this occurs only in about 10% of cases.

It can also be triggered by lung irritants like pollution, dust, cigarette smoke, chemical fumes, etc.

Symptoms Of Acute Bronchitis (4)

The symptoms of acute bronchitis can start with cold or flu symptoms (headache, body aches, etc.), but not always. Symptoms can then progress and include:

  • Cough. This can be wet (producing sputum) or dry. The sputum can be clear, white, yellow, or green. It can also be blood-tinged.
  • Fatigue.
  • Chest discomfort.
  • Shortness of breath.
  • Wheezing.  
  • Low-grade fever. (A higher fever may be a sign of pneumonia (5).)

When Should I See My Doctor? (6)(7)

Call your provider if:

  • You have shortness of breath or painful breathing.
  • You are wheezing or have worsening asthma symptoms.
  • You have a high fever that does not respond to acetaminophen (Tylenol) or aspirin.
  • You have a fever for more than three days.
  • You have chest pain. (You should always call your doctor for chest pain. This is a sign of bronchitis, but it could also be a symptom of a heart condition.)
  • You are age 65 or older.
  • You have a chronic lung or heart condition, are going through chemotherapy, or have a weakened immune system for any other reason. Call your doctor at the first sign of unexplained cough, shortness of breath, or chest pain.
  • You have a cough with blood-tinged mucus.

Risk Factors Of Bronchitis (2)(4)

Cigarette smoke. People who smoke or who live with a smoker are at higher risk of both acute bronchitis and chronic bronchitis.

Low resistance. Adults 65 and older and young children are especially vulnerable to bronchitis. Having another illness, such as a cold or flu, can also compromise your immune system and make it harder to fight off infection.

Exposure to irritants on the job. If you are exposed to chemical fumes, grains, or textiles at work, you are at higher risk of developing bronchitis.

Gastroesophageal reflux disease (GERD). Severe heartburn can irritate your throat and increase your risk of developing bronchitis.

Living in a crowded place. Crowded living situations such as nursing homes make catching viruses from others more likely.

Is It Bronchitis Or Pneumonia? (8)

Bronchitis and pneumonia both affect the chest, so it’s sometimes hard to tell the difference between them. Their symptoms are similar, but their causes and treatment are different.

Both bronchitis and pneumonia can cause cough, sputum production, shortness of breath, and wheezing.

Bronchitis causes a cough, with or without mucus production. It often comes on after a cold with sneezing and runny nose. If you have a fever along with a runny nose, you are more likely to have pneumonia.

Pneumonia is an infection in the alveoli (air sacs) of the lungs. It is usually caused by bacteria and often is accompanied by a high fever. Breathing difficulties and chest pain are usually more severe with pneumonia. It can take up to four weeks to recover, and some people need to be hospitalized.

See the chart below for a more complete comparison.

 BronchitisPneumonia
SymptomsCough with or without colored sputum, chest discomfort, shortness of breath, fatigue, wheezing, sore throat, low-grade fever, nasal congestion, body achesCough (often with colored or bloody sputum), sharp chest pain (especially one-sided), shortness of breath, fatigue, wheezing, high fever, nausea, vomiting, diarrhea, sweating, chills, headache, loss of appetite, confusion (mostly in older adults)
CausesUsually viral infection, sometimes bacterial or environmental. Inflammation in bronchial tubesInflammation of alveoli (air sacs) in the lung. Can be bacterial, viral, or fungal
FeverLow-grade or noneOften, greater than 101° F
CoughStarts with dry cough, may progress to mucus-producingCough with mucus
Risk FactorsCold, flu, age, cigarette smoke, gastroesophageal reflux disease (GERD)Age, diabetes, viral lung infections, heart disease, chronic obstructive pulmonary disease (COPD), bronchial obstruction, intubation
Level of Care RequiredOffice visit for elderly, very young, and patients with weakened immunityHospitalization for elderly, patients with weakened immunity, and other high-risk  patients
TreatmentNo antibiotics for viral infections. Antibiotics for bacterial. For some patients, oral steroids and/or supplemental oxygen. Cough medicine may helpAntibiotics or antivirals. For some patients, oral and IV fluids, supplemental oxygen
DurationMost of the time a few days, though cough often lingers for weeks1 to 4 weeks, sometimes longer

Diagnosing Bronchitis (9)

The first symptoms of bronchitis will feel much like a cold. When you see your provider, they will ask if anyone else in your home has been sick. They will want to know how long you have been having symptoms.

They will then listen to your chest for wheezing and signs of mucus clogging your airways (rhonchi).

Your provider will measure the oxygen in your blood (oxygen saturation) with a painless device that is placed on a finger. They may also do simple blood tests.

If your doctor suspects bronchitis, they will probably not order more tests.

If they feel there may be another cause for your symptoms, they may then do any of the following: (4)

  • Chest x-ray. This is to done to check for pneumonia. It’s particularly important if you are a present or former smoker or if you’re exposed to secondhand smoke.
  • Sputum tests. A sputum sample can be tested to diagnose allergies or other illnesses that could be treated with antibiotics.
  • Pulmonary function tests. This test is to check for asthma or emphysema. You blow into a spirometer, and the device measures how much air you can hold in your lungs and how quickly you move it out of your lungs.

How Is Acute Bronchitis Treated? (7)(9)

The good news is that acute bronchitis almost always resolves on its own. However, the cough can linger for a month or two after the infection is gone.

Because acute bronchitis is usually caused by a virus, antibiotics will not help you to feel better. In fact, taking unneeded antibiotics can be harmful. You could have side effects (like rash or diarrhea) or develop a resistance to the antibiotics, making future conditions more difficult to treat.

Your doctor will likely recommend just treating your symptoms. Acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen (Advil) or naproxen (Aleve) should help with achiness and fever.

You should also rest and drink 8 to 12 glasses of fluid a day. This will help break up the mucus so it will be easier to cough up. Warm, moist air will also help thin the mucus. Try a warm-mist humidifier or vaporizer or standing in a hot shower for a few minutes.

Depending on your individual situation, your provider might also prescribe a bronchodilator inhaler to help open your airways.

Avoid alcohol and caffeine. Some people find home remedies such as honey, garlic, hot teas, and vitamin C helpful.

If you have bacterial bronchitis, which is far less common, your doctor may prescribe an antibiotic.

What About Cough Medication? (10)

You should ask you doctor before taking any cough medications for bronchitis.

There are two types of cough medication doctors sometimes suggest for patients with a severe cough. An expectorant (like guaifenesin) thins the mucus in the bronchi so it can be coughed up more easily. Unfortunately, there is little to no evidence that this is effective for bronchitis.

A cough suppressant (like dextromethorphan or codeine) is designed to stop the coughing. But suppressing a cough is not always a good idea. It may make you more comfortable temporarily, but coughing serves an important purpose—moving the mucus out of your bronchi. Your doctor may feel that it’s not appropriate to suppress the cough. Or he may suggest taking the medication only at night if the cough is keeping you awake.

Is Bronchitis Contagious? (11)

That depends on which type of bronchitis you have. Chronic bronchitis is not contagious because it’s caused mostly by damage from smoking or environmental irritants.

Acute bronchitis, however, is contagious when it’s caused by a virus. It’s important that you take precautions not to spread it to others. You can spread the germs through touch, coughing, and sneezing.

Good handwashing is one of the best ways to prevent spreading infection. You should also stay away from people who are at high risk, such as the elderly, young children, and anyone whose immune system is compromised.

If you are one of the 10% of cases that have bacterial bronchitis, or if your symptoms are caused by chemicals or other irritants, then you are not contagious. However, people with viral bronchitis are usually most contagious at the beginning stages of the illness. Until you know for sure what the cause of your symptoms is, it’s best to assume that you are contagious.

Complications Of Bronchitis

Acute bronchitis can lead to complications. If you have any acute worsening of your symptoms, call your doctor right away. You may need an x-ray to rule out the following:

  • Secondary pneumonia. Sometimes a bout of acute bronchitis can turn into pneumonia. If you are having worsening symptoms, a cough with mucus, and a fever, you should see your doctor. A chest x-ray will determine whether your bronchitis has developed into pneumonia. This is especially important if you are over 65, if you are a smoker, or if you have a condition that weakens your immune system. (2)
  • Pulmonary embolism (PE). This is a condition where a blood clot creates a blockage in one of the pulmonary arteries in your lungs. If you have unexplained shortness of breath, chest pain, or blood in your sputum, get emergency help immediately. A PE can be life-threatening, so prompt treatment is critical.  (12)
  • Pneumothorax. This is a collapsed lung caused by air leaking into the pleura, the space between your lungs and your chest wall. It can be brought on by aggressive coughing. Symptoms are sudden chest pain on one side and shortness of breath. This can also be life-threatening, so get emergency help right away. You may need a chest tube to release the air. (13)
  • Pneumomediastinum. This is when air leaks from your lungs into the middle of your chest cavity. It can also be brought on by intense coughing. It is usually not serious, but it can cause severe pain. Get care right away if you have symptoms, because this can lead to pneumothorax. (14)

If you have any symptoms that last more than six weeks, get rechecked. You may be developing a complication. (2)

Prognosis For Acute Bronchitis

For most people with acute bronchitis, the infection will get better on its own with only symptomatic treatment. However, when bronchitis develops into pneumonia or one of the complications noted above—especially in older adults or the very young—it can be fatal.

Prevention Of Bronchitis (8)(15)(16)

There are things you can do during cold and flu season to reduce your risk of an acute bronchitis infection.

  • Wash your hands often with soap and water or hand sanitizer.
  • Get your yearly flu vaccines.
  • Stay away from people who are coughing or having other signs of infection.
  • Avoid tobacco smoke.
  • If you have bronchitis or are recovering from it, cough or sneeze into a tissue or your elbow to avoid infecting others who may potentially pass it back to you.
  • Talk to your doctor about pneumonia vaccination. If you are 65 or older, there are two recommended pneumonia vaccines.
  • Avoid lung irritants. If you smoke, quit. If you work with paint, paint remover, or varnish, wear a mask to keep from breathing in the fumes.
  • Take care of yourself. Eating a healthy diet and getting regular exercise are the most important things you can do to lower your risk of illness.

References

1) “Bronchitis.” Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/3993-bronchitis. Reviewed 01/25/2015. Accessed 06/28/2019.

2) Singh A, Zahn E. “Acute Bronchitis.” In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan. https://www.ncbi.nlm.nih.gov/books/NBK448067/. Updated 03/22/2019. Accessed 06/28/2019.

3) “Acute Bronchitis Symptoms, Causes, and Risk Factors.” American Lung Association.   https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/acute-bronchitis/symptoms-causes-risk-factors.html. Updated 03/13/2018. Accessed 06/28/2019.

4) “Bronchitis.” Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/bronchitis/diagnosis-treatment/drc-20355572. 04/11/2017. Accessed 06/28/2019.

5) Komaroff, Anthony L., M.D. “What Causes Acute Bronchitis?” Harvard Health Publishinghttps://www.health.harvard.edu/diseases-and-conditions/what-causes-acute-bronchitis. 09/2018. Accessed 06/27/2019.

6) “Acute Bronchitis.” Harvard Health Publishing. https://www.health.harvard.edu/lung-health-and-disease/acute-bronchitis. Updated 05/07/2018. Accessed 06/27/2019.

7) “What is Bronchitis?” Antibiotic Prescribing and Use in Doctor’s Offices: Bronchitis (Chest Cold). Centers for Disease Control and Prevention.https://www.cdc.gov/antibiotic-use/community/for-patients/common-illnesses/bronchitis.html. Reviewed 04/07/2017. Accessed 06/28/2019.

8) “Cough Culprits.” News in Health. National Institutes of Health, Department of Health and Human Services.https://newsinhealth.nih.gov/2017/05/cough-culprits.  05/2017.  Accessed 06/27/2019.

9) “Acute Bronchitis A to Z.” Harvard Health Publishing. https://www.health.harvard.edu/a_to_z/acute-bronchitis-a-to-z. 12/2018. Accessed 06/28/2019.

10) “That Nagging Cough.” Harvard Health Publishing. https://www.health.harvard.edu/staying-healthy/that-nagging-cough. Updated 02/07/2019. Accessed 06/28/2019.

11) “Is Bronchitis Contagious?” UC Berkeley School of Public Health.  https://www.healthandwellnessalerts.berkeley.edu/alerts/lung_disorders/Is-Bronchitis-Contagious_8161-1.html. Reviewed 9/27/2018. Accessed 06/28/2019.

12) “Pulmonary Embolism.” Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/pulmonary-embolism. Accessed 06/28/2019.

13) “Pneumothorax.” https://www.hopkinsmedicine.org/health/conditions-and-diseases/pneumothorax. 03/07/2018.  Accessed 06/28/2019.

14) “Pneumomediastinum.” Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/pneumomediastinum

15) “Bronchitis or Pneumonia?” AARP. https://www.aarp.org/health/conditions-treatments/info-2017/bronchitis-and-pneumonia-symptoms.html. 03/16/2017. Accessed 06/28/2019.

16) “Managing and Preventing Acute Bronchitis.” American Lung Association.  https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/acute-bronchitis/managing-and-preventing-acute-bronchitis.html. Updated 3/13/2018. Accessed 06/28/2019.