Acute bronchitis is inflammation of the windpipe (trachea) and the airways that branch off the trachea (bronchi) caused by infection.
Acute bronchitis is usually caused by a viral upper respiratory tract infection.
Symptoms are a cough that may or may not produce mucus (sputum).
The diagnosis is based primarily on symptoms.
Treatments, such as medications to reduce fever and cough, may be used to make the person more comfortable until the episode ends.
Antibiotics are rarely needed.
Bronchitis can be either:
Acute
Chronic
Acute bronchitis usually lasts days to a few weeks. Bronchitis that lasts for months or years is usually classified as chronic bronchitis. When people say "bronchitis," they usually mean acute bronchitis, and only acute bronchitis is discussed here.
When people with chronic bronchitis have decreased airflow from the lungs when they breathe out (airflow obstruction), they are considered to have chronic obstructive pulmonary disease (COPD). If people who have COPD or other chronic lung disorders such as bronchiectasis or cystic fibrosis develop symptoms of acute bronchitis, doctors consider this a flare-up of the underlying disorder rather than acute bronchitis.
Causes of Acute Bronchitis
Acute bronchitis is caused by infection due to:
Viruses (most common)
Bacteria
Understanding Bronchitis
Bronchitis occurs most often during the winter.
Viral bronchitis may be caused by a number of common viruses, including the influenza virus and the viruses that cause the common cold, including respiratory syncytial virus (RSV). Acute bronchitis can also occur as part of the SARS-CoV-2 infection. Even after a viral infection has cleared up, the irritation it causes can continue to cause symptoms for weeks.
Bacteria cause less than one in 20 cases of bronchitis. Mycoplasma pneumoniae, Chlamydia pneumoniae, and Bordetella pertussis infection (which causes whooping cough) are among the bacteria that cause acute bronchitis. Bacterial causes of acute bronchitis are more likely when many people in the same area are affected at the same time (an outbreak).
Sometimes excessive levels of air pollution or breathing in toxic fumes can also inflame the airways and cause bronchitis.
Cough in adults has many causes besides acute bronchitis. Cough in children has similar causes as in adults.
Symptoms of Acute Bronchitis
Infections causing acute bronchitis typically begin with the symptoms of a common cold: runny nose, sore throat, and fatigue.
After several days, cough begins (usually dry at first). People may cough up small amounts of thin, white mucus. This mucus often changes from white to green or yellow and becomes thicker. The color change does not indicate a bacterial infection. Color change means only that cells associated with inflammation have moved into the airway and are coloring the sputum.
People do not usually have a high fever or chills unless the bronchitis was caused by a more serious infection, such as influenza, or pneumonia has developed.
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Because bronchitis can temporarily narrow the airways, people may develop wheezing and/or shortness of breath, as well as chest tightness due to the narrowing, and/or chest pain due to incessant coughing, similar to what happens in an asthma attack.
Acute bronchitis itself does not cause serious complications. However, the cough can last for 2 to 3 weeks or even longer. A viral bronchitis can lead to infection of the lung tissue (pneumonia) either by itself or by a secondary bacterial infection. This occurs usually only in people who smoke, who are 60 years or older, or those who have problems with immune defenses.
Diagnosis of Acute Bronchitis
A doctor's evaluation
Sometimes a chest x-ray
Doctors usually make a diagnosis of acute bronchitis based on the symptoms. Doctors may do a chest x-ray to look for pneumonia if they hear congestion in the lungs, or if people have high or prolonged fever or shortness of breath.
Doctors rarely do tests to find the cause of acute bronchitis, and blood tests are not helpful. However, testing for SARS-CoV-2 infection, influenza, RSV, or pertussis may be done. Also, if a cough persists for more than 8 weeks, a chest x-ray is done to make sure that pneumonia has not developed or a different lung disease is not causing the cough.
Treatment of Acute Bronchitis
Treatments to relieve symptoms
People may take acetaminophen to reduce fever and general feelings of illness and should drink plenty of fluid. People may take acetaminophen to reduce fever and general feelings of illness and should drink plenty of fluid.
Antibiotics do not help viral bronchitis. Since most acute bronchitis is viral, doctors give antibiotics only when the infection is clearly caused by bacteria (for example, during an outbreak) or when the symptoms are getting worse over time rather than improving, indicating a secondary bacterial infection. When an antibiotic is used, doctors typically give a medication such as azithromycin or clarithromycin. Sometimes doctors prescribe antibiotics but recommend that they be used only if symptoms persist.Antibiotics do not help viral bronchitis. Since most acute bronchitis is viral, doctors give antibiotics only when the infection is clearly caused by bacteria (for example, during an outbreak) or when the symptoms are getting worse over time rather than improving, indicating a secondary bacterial infection. When an antibiotic is used, doctors typically give a medication such as azithromycin or clarithromycin. Sometimes doctors prescribe antibiotics but recommend that they be used only if symptoms persist.
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People who are wheezing may benefit from inhaled bronchodilators for a few days; however, side effects such as tremor, nervousness, and shaking can occur.
Cough medicines can be used to suppress a cough that is distressing or interferes with sleep. However, the degree of effectiveness of these medications is not clear. Expectorants are over-the-counter medications that may help thin secretions and make them easier to cough up, but whether this measure is helpful is not clear. Cough suppressants and expectorants are usually not recommended in young children (see also Cough in Children).
