Bronchitis: How to Treat It
Also known as: Acute bronchitis, Chest cold
Overview
Bronchitis is inflammation of the bronchi, the airways that carry air to the lungs. There is acute bronchitis, which is very common, and chronic bronchitis, which is associated with obstructive lung disease. In the United States, acute bronchitis ranks among the ten most common outpatient illnesses, affecting about 5 percent of adults each year and accounting for more than 3 million office visits annually. Cases peak in winter, tracking the season for viruses like influenza and RSV, and usually follow a seasonal viral infection. Symptoms tend to ease within 7 to 10 days, though the cough itself can linger for two to three weeks after the infection has cleared.
Causes and risk factors
Most cases of acute bronchitis are viral, caused by the same viruses behind colds and the flu (rhinovirus, influenza virus, respiratory syncytial virus). A bacterial cause is possible but less common. Risk factors include:
- Active or secondhand smoking, the main cause of bronchial irritation
- Exposure to air pollution, dust, vapors, fumes, or chemical substances
- A weakened immune system (diabetes, immunosuppressive treatment)
- Cold, damp weather, which helps viruses spread
- A history of asthma or chronic respiratory disease
Symptoms
Bronchitis symptoms usually progress through two phases:
- Dry, irritating cough: the first sign, often bothersome, appearing in the first few days
- Productive cough: with clear mucus at first, then yellowish or greenish
- Low-grade fever, chills, general fatigue
- Chest pain that feels like a burning sensation when coughing
- Mild shortness of breath in some cases
- Associated upper respiratory symptoms: runny nose, sore throat
Fever with bronchitis is usually low-grade. A high fever with shaking chills points instead toward pneumonia and needs medical attention.
Diagnosis
Bronchitis diagnosis is mostly clinical: the doctor relies on your history and a lung exam, which may reveal wheezing or crackling sounds. Without warning signs, no additional testing is needed. A chest X-ray may be ordered if pneumonia is suspected, and pulse oximetry can check the oxygen level in your blood. A complete blood count and chemistry panel may be part of the workup when there is a fever, and a procalcitonin level can help your doctor decide whether antibiotics should be prescribed when the diagnosis is uncertain.
Treatments
Viral acute bronchitis usually clears up on its own. Treatment focuses on relieving symptoms:
- Rest and plenty of fluids: the foundation of treatment, supporting recovery and easing mucus clearance
- Cough suppressants (dextromethorphan): for a very disruptive dry cough, only on medical advice. They relieve the cough but do not treat its cause or speed recovery, and they are a poor fit for a heavily productive cough
- Fever and pain relievers (acetaminophen, ibuprofen): to ease fever and chest discomfort
- Mucolytics and expectorants (guaifenesin): can help loosen bronchial secretions
- Bronchodilators (albuterol): for associated wheezing or bronchospasm, especially in people with asthma
- Antibiotics: not recommended for viral bronchitis; reserved for documented bacterial infection or higher-risk patients (older adults, immunocompromised, COPD)
- Quitting smoking is essential for the duration of the illness
Prevention
Several measures can help reduce the risk of bronchitis:
- Wash your hands regularly, especially during winter
- Ventilate indoor spaces and avoid crowded, enclosed environments
- Quit smoking, a major risk factor for chronic bronchitis and complications
- Get a flu shot every year. An annual flu vaccine is recommended for everyone 6 months and older, and it matters most if you are at higher risk of complications
- Avoid close contact with people who are sick
- Protect your airways when exposed to pollutants or chemicals (wear an appropriate mask)
When should you see a doctor?
See a doctor promptly if you have:
- A high fever or shaking chills, or a low-grade fever lasting 3 or more days
- Blood-streaked sputum (hemoptysis)
- Significant difficulty breathing or intense chest pain
- A cough lasting more than 3 weeks, or a cough that goes away and comes back
- Thick, yellow-green mucus
- A significantly worsened overall condition
Sources
- MedlinePlus: Acute Bronchitis, U.S. National Library of Medicine health information
- MedlinePlus Medical Encyclopedia: Acute bronchitis, symptoms, tests, low-grade fever, and when to contact a provider
- StatPearls: Acute Bronchitis (NIH National Library of Medicine), US epidemiology, fever, and diagnostic workup
- American Academy of Family Physicians: Acute Bronchitis, Rapid Evidence Review, annual US outpatient visits and diagnostic testing
- American Lung Association, patient education and resources
- MedlinePlus: Flu Shot, annual influenza vaccination guidance
- MedlinePlus: Dextromethorphan, drug information