Acute bronchitis

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.

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.”

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 is a good idea to see your doctor if the cough lasts longer than eight weeks. If the cough lasts for several months and you are coughing up phlegm, it could be chronic bronchitis. That is often caused by smoking and can develop into chronic obstructive pulmonary disease ( COPD). If no other cause is found for a long-lasting cough, experts refer to it as an “unexplained chronic cough.”

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).

If you go to your family doctor with a persistent cough, you will usually first be asked about the symptoms you have and your general health.

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 should see a doctor about any of the following warning signs:

• The cough lasts longer than eight weeks.
• You have a very high fever, or a fever that returns after going away for a while.
• You 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 repeatedly find it hard to breathe, and your breathing is accompanied by a strange wheezing sound.

If you have these kinds of symptoms, further diagnostic examinations or tests (for instance, a chest x-ray or blood tests) will be done to rule out any serious illnesses.

If you have a weakened immune system or a chronic disease affecting your heart or lungs, it may be a good idea to go to the doctor even if the symptoms are milder.

People who are taking 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,
• practice social distancing,
• avoid shaking hands and hugging or kissing people, and
• stay at home until you are no longer contagious.

A medical mask that covers your nose and mouth can also help prevent the viruses from spreading to yourself and other people.

A number of studies have looked into whether things like vitamin supplements, probiotics, herbal medicines, gurgling, getting enough sleep or regular exercise can prevent respiratory tract infections. It wasn’t possible to draw any clear conclusions, though.

Acute bronchitis gets better on its own without treatment. Often, you won’t even need to go to the doctor. 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.

When people are ill or need medical advice, they usually go to see their family doctor first. In our topic "Health care in Germany" you can read about how to find the right doctor – and our list of questions can help you to prepare for your appointment.