Introduction

Photo of a patient being examined by a doctor (PantherMedia / alexraths)

In acute bronchitis, the lower airways (bronchi) are temporarily inflamed. The inflammation is usually caused by cold viruses, so it often occurs together with other symptoms of a cold.

Acute bronchitis causes a cough which might not go away for a while, even after the cold has gone away. Although the cough may be unpleasant and persistent, in otherwise healthy people it usually isn’t anything serious. The symptoms then go away on their own after a few weeks. Treatment with medication usually isn’t necessary. Some medications may help relieve the symptoms a bit.

Symptoms

The main symptom of acute bronchitis is a cough. The cough is usually dry at first. Later on, it may develop into a phlegmy cough, where you cough up mucus. Doctors sometimes call this kind of cough a “cough with sputum” or a “productive cough.” The color of the coughed-up sputum may change during the course of the illness – for instance, from whitish to a greenish yellow.

People often cough at night, which disturbs their sleep. If acute bronchitis occurs together with a cold, many of those affected have other symptoms such as a mild fever, a stuffy nose, a sore throat and a hoarse voice. Severe coughs can lead to pain behind the breastbone and sometimes make it harder to breathe.

If a sore throat or runny nose develops into a stubborn cough, many people go to their family doctor for advice. Most of them will leave the doctor’s practice without a prescription. People who work may be given a medical certificate so they can stay at home and get the rest they need to get better again.

When children have a high temperature and a cough, parents often wonder whether to take them to the doctor or not. The answer is the same for both adults and children: Acute bronchitis usually doesn’t have to be treated with medicine. So there’s nothing wrong with staying at home and waiting to see if it gets better first. But it’s a good idea to see a doctor if any of the following happen:

  • The cough lasts longer than eight weeks.
  • The cough is accompanied by a very high fever, or a fever returns after going away for a while.
  • You or the child feel very ill, have chills, or sweat at night while you have the cough.
  • The mucus that is coughed up has blood in it.
  • You or the child repeatedly find it hard to breathe, and breathing is accompanied by a strange wheezing sound.

People who have a weakened immune system or a chronic heart or lung condition may be advised to already seek medical advice if they have milder symptoms.

Causes

Bronchitis is usually caused by a viral infection (viruses). There are many different viruses that can cause respiratory infections like colds, the flu or sinusitis. In rarer cases, acute bronchitis can also be caused by bacteria or harmful substances that have been breathed in (such as fine dust with sulphur or heavy metals in it). Fungal infections may cause acute bronchitis too, but that is very rare.

Viruses and bacteria are able to enter the bronchi in your lungs when you breathe in. There they can settle in the mucous membranes and start multiplying (grow in number). In order to fight them, your body reacts with an inflammation: The blood supply to the infected membranes is increased, and the membranes become swollen. Cells of the immune system enter the inflamed area to fight the germs. The membranes produce more fluid and mucus to “flush out” the viruses, bacteria and dead cells, which are coughed up as phlegm.

When you cough, droplets of fluid containing the germs are released into the air. If other people come into contact with these droplets, they may become infected too. When germs spread in this way it is sometimes referred to as a “droplet infection.”

Prevalence and outlook

Coughs are one of the main illnesses that people seek medical advice for in Germany and similar countries. Every year, about 5 out of 100 people go to their family doctor because of acute bronchitis. Most of them get it in the autumn or winter.

In most cases acute bronchitis goes away without treatment and doesn’t have any lasting effects – unless the lungs were already damaged beforehand. Common cold symptoms such as a stuffy nose or fever usually get a lot better within a few days. But it might take several weeks for the cough to go away if you have acute bronchitis.

It’s a good idea to see your doctor if the cough lasts longer than eight weeks. Other illnesses – such as chronic obstructive pulmonary disease (COPD) – may cause the same symptoms.

Effects

In people who have a weakened immune system or a chronic heart or lung condition, acute bronchitis may develop into pneumonia in rare cases. The inflammation then spreads from the mucous membranes lining the lungs to the lung tissue itself. If someone has COPD, acute bronchitis can trigger a COPD flare-up (exacerbation).

Diagnosis

People who go to their family doctor with a cough will usually first be asked the following questions:

  • How long have you had the cough?
  • Has the cough changed?
  • Is it a dry cough or do you cough up phlegm? What does the phlegm look like?
  • Have you had – or do you have – other symptoms such as a fever or feeling faint?
  • How ill do you feel?
  • Do you have any other, possibly chronic, medical conditions?

The answers to these questions are often enough for the doctor to determine whether it’s acute bronchitis or more likely to be something else.

In the physical examination that follows, the doctor will usually feel the lymph nodes in your neck, look into your throat and ears, gently tap your sinuses, and listen to your lungs and heart with a stethoscope. He or she may also measure your temperature, pulse or blood pressure.

You will be diagnosed with “acute bronchitis” if the chat with the doctor and physical examination confirm that you have the typical symptoms, and if there is no reason to believe that the symptoms are being caused by a different medical problem.

Further diagnostic examinations or tests (for instance, a chest x-ray or blood tests) are only needed if it is thought that you may have a different medical condition, such as pneumonia.

Prevention

People who take steps to prevent common colds will also be less likely to get acute bronchitis. As with all respiratory infections, hygiene plays an important role here: Washing your hands regularly, and trying not to touch your face with your fingers, lowers the risk of getting a common cold.

In order to stop colds from spreading to other people, you can

  • cough or sneeze into your elbow, not into your hand,
  • throw away used tissues immediately,
  • avoid shaking hands and hugging or kissing people, and
  • stay at home until you are no longer contagious.

A number of studies have looked into whether things like vitamin supplements, probiotics, herbal medicines or regular exercise can prevent respiratory tract infections. It wasn’t possible to draw any clear conclusions, though. So it still isn’t known for sure whether these measures can lower the risk of acute bronchitis.

Treatment

Acute bronchitis gets better on its own without treatment. If you feel weak and ill, it’s best to take it easy for a few days. This also means not doing any sports or other strenuous physical activities. Hot tea or broth is usually considered to have a soothing effect. But there is no scientific proof that drinking a lot more fluids than usual helps, or doesn’t help.

Acute bronchitis doesn’t need to be treated with medication. Drugs such as paracetamol (acetaminophen) or ibuprofen are sometimes a good idea, though, for the relief of cold symptoms such as fever and pain.

There hasn’t been enough research on the effectiveness of cough medicines that are designed to make you cough less (cough suppressants) or make it easier to cough up phlegm (expectorants). Because coughing has the important function of getting rid of mucus and foreign objects, cough suppressants should only be used for a limited amount of time, and only for really unpleasant, dry coughs that disrupt your sleep. Herbal medicines might relieve coughs somewhat.

Because the symptoms are usually caused by viruses, antibiotics don’t help much in the treatment of acute bronchitis. But they can have side effects and contribute to bacteria becoming resistant. So antibiotics aren’t recommended as a treatment for acute bronchitis.

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