Acute Bronchitis (Chest Cold)

What happens in acute bronchitis

The bronchi are the tubes that carry air from the windpipe into the lungs. In acute bronchitis, an infection, usually the same virus that caused a cold or flu, inflames their lining. The lining swells and produces extra mucus, and the airways become irritable. That irritability is why the cough can continue for weeks after the infection has cleared. Some people also have temporary airway narrowing that causes wheezing, similar to bronchospasm.

Acute bronchitis is different from chronic bronchitis, a form of COPD defined by a productive cough on most days for at least 3 months in 2 consecutive years, usually from smoking.

Acute bronchitis symptoms

• Cough: the main symptom. It may be dry at first, then bring up clear, white, yellow or green mucus. Mucus color does not show whether the infection is bacterial.
• Chest discomfort: soreness or burning in the chest from coughing.
• Chest congestion and a rattling feeling.
• Wheezing or mild shortness of breath with exertion.
• Cold or flu symptoms: sore throat, runny nose, headache, body aches, tiredness.
• Low-grade fever for the first few days, in some people.

Typical timeline

1. Days 1 to 5: cold or flu symptoms, with a developing cough.
2. Days 5 to 14: cough is often at its worst, with mucus, chest soreness and tiredness.
3. Weeks 2 to 3: gradual improvement. A dry, tickly cough can linger for up to 3 weeks or longer, especially at night.

Causes and risk factors

• Viruses (more than 90 percent): rhinovirus, influenza, RSV, seasonal coronaviruses, SARS-CoV-2, adenovirus and parainfluenza.
• Bacteria (uncommon): Bordetella pertussis (whooping cough), Mycoplasma pneumoniae and Chlamydia pneumoniae.
• Irritants: smoke, air pollution, dust and fumes can cause or worsen bronchitis.

You are more likely to get it, or to have a longer illness, if you smoke or vape, have asthma or COPD, are older, have a weakened immune system, or are exposed to smoke or fumes.

Bronchitis vs pneumonia vs other conditions

Diagnosis

Acute bronchitis is diagnosed from your symptoms and an examination. A clinician will ask how long the cough has lasted, about fever, breathlessness and other health problems, and listen to your chest. Tests are not usually needed. They may be done when another diagnosis is possible:

• Chest X-ray if pneumonia is suspected (fast breathing, high fever, fast heart rate, abnormal chest sounds), or in older adults
• Flu or COVID-19 tests when the result would change treatment
• Pertussis testing for a prolonged or whooping cough
• Pulse oximetry to check oxygen levels
• Spirometry later on if asthma or COPD is suspected

Treatment

There is no cure for viral bronchitis. Your body clears the infection, and treatment eases symptoms.

Home care

• Rest and drink plenty of fluids.
• Honey: a teaspoon of honey, alone or in a warm drink, eases cough in adults and children over 1 year. Never give honey to babies under 12 months.
• Humidify the air or breathe steam from a shower.
• Avoid smoke, including secondhand smoke and vaping.
• Pain relievers: acetaminophen (paracetamol) or ibuprofen for fever, aches and chest soreness, at the label dose. Do not give aspirin to children or teenagers.
• Cough medicines: evidence for over-the-counter cough suppressants and expectorants is limited. They are not recommended for children under 6 in the US and UK. Adults may try them for sleep, following the label.
• Throat lozenges for throat irritation in older children and adults.

Medical treatments

• Antibiotics are not recommended for most people with acute bronchitis, because they do not shorten viral illness and they cause side effects and resistance. They are used for whooping cough, confirmed bacterial infection or pneumonia.
• Antiviral medicines for flu or COVID-19 may be offered to people at high risk, ideally started within 2 days of symptoms.
• Inhalers: an albuterol (salbutamol) inhaler may help people who are wheezing, especially those with asthma or COPD.

Complications

Most people recover fully. Possible complications include pneumonia, especially in older adults and people with chronic illness, worsening of asthma or COPD, and a post-viral cough that lingers for weeks. Repeated bronchitis may point to underlying asthma, COPD or another lung condition.

Prevention

• Wash hands often and avoid touching your face.
• Cover coughs and sneezes.
• Do not smoke, and avoid secondhand smoke.
• Get vaccinated against flu, COVID-19, whooping cough (Tdap), pneumococcal disease and RSV where recommended.

Frequently asked questions

How long does acute bronchitis last?

Most symptoms improve within 1 to 2 weeks, but the cough often lasts up to 3 weeks, and sometimes longer, because the airways remain irritated after the infection clears. See a doctor if the cough lasts more than 3 weeks or you develop fever, breathlessness or chest pain.

Is acute bronchitis contagious?

The viruses that cause acute bronchitis are contagious, mostly in the first few days of illness when cold or flu symptoms are present. They spread through coughs, sneezes and contaminated hands. The lingering cough in later weeks is usually not a sign of ongoing contagiousness.

Do I need antibiotics for bronchitis?

Usually not. More than 90 percent of acute bronchitis is caused by viruses, which antibiotics do not kill. Green or yellow mucus does not mean you need them. Antibiotics are reserved for specific bacterial infections such as whooping cough, or if pneumonia develops.

What is the difference between bronchitis and pneumonia?

Bronchitis is inflammation of the airways and mainly causes a cough. Pneumonia is infection of the lung tissue itself and usually causes higher fever, faster breathing, breathlessness, chest pain and feeling more unwell. A doctor can tell them apart by examination and, if needed, a chest X-ray.

What helps acute bronchitis go away faster?

Nothing reliably shortens viral bronchitis, but rest, fluids, honey, humidified air and avoiding smoke help you feel better. Pain relievers ease fever and chest soreness. If you have asthma or COPD, using your inhalers as directed helps control wheezing.