Treating acute bronchitis

Photo of a man coughing
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Acute usually goes away on its own again. Until that happens, several things can help to relieve the cough and cold symptoms somewhat. Antibiotics generally don’t help in the treatment of acute so they aren’t recommended for this purpose.

A lot of people will know what it’s like to have acute , particularly in the autumn and winter months: Typical cold symptoms like a stuffy nose, headache and sore throat are followed by a stubborn cough that lasts for several weeks. Then it’s time to “sit back and wait” for the acute to go away on its own. You do not have to take any medication. Antibiotics generally don’t help in the treatment of acute because it is usually caused by viruses.

Various medications can be used to treat the cough and cold symptoms – but only a few of them can noticeably influence the course of the illness. The costs of most of the medications aren’t covered by health insurers.

Is it worth using medicine to loosen and cough up phlegm (expectorants)?

“Expectorants” is the medical term used to describe medications that

  • increase the production of mucus in the bronchi of the lungs or
  • loosen thick, sticky mucus in the .

This is meant to make it easier to cough up the phlegm and relieve the cough. Based on the research in this area so far, it isn’t clear whether these medications actually help in the treatment of acute . If used at all, expectorants should only be used if the mucus that is produced can be coughed up.

What do cough suppressants (antitussives) do?

Cough suppressants (antitussives) don’t act upon the inflamed mucous membranes in the . Instead, they aim to suppress the urge to cough, so they are rarely used in the treatment of acute . Typical examples of suppressants include codeine and dextromethorphan.

Cough suppressants should only be used in the treatment of severe dry coughs, for a maximum period of two weeks. They shouldn’t be used in the treatment of productive (“wet”) coughs: If the urge to cough is suppressed, the phlegm won’t be coughed up and out of the .

Besides, there haven't been any studies on the benefits and drawbacks of cough suppressants in the treatment of acute . The few studies done so far have only looked into their effectiveness in the treatment of simple common colds, throat inflammations and sinusitis. They found the following:

  • Codeine doesn’t help in the treatment of acute coughs in adults, nor in children and teenagers, who have a cold. Children under the age of twelve generally shouldn’t be prescribed codeine or codeine-containing medications. The same is true for breastfeeding mothers.
  • Dextromethorphan can somewhat soothe coughs associated with upper respiratory tract infections in adults, at least for a short while after taking it. People who have lung conditions such as asthma or COPD shouldn’t take dextromethorphan. The possible side effects include dizziness and gastrointestinal (stomach and bowel) problems.

Codeine has to be prescribed by a doctor, whereas medications containing dextromethorphan are also available from pharmacies without a prescription.

How effective are herbal products?

Various herbal products are available for the treatment of acute , some of them based on combinations of different active ingredients. Examples include Pelargonium, primrose, thyme, eucalyptus and ivy extracts. Studies on these products suggest that they can somewhat soothe acute coughs and make it easier to cough up phlegm. The possible side effects include stomach and bowel problems. Statutory health insurers in Germany generally don’t cover the costs of these products.

Other herbal products – such as those used in traditional Chinese medicine (TCM) – have hardly been tested in high-quality studies. So it isn’t known whether they can help. But they, too, can have side effects.

Do bronchodilators work?

Bronchodilators (medications to widen the airways) are normally used in the form of an inhaler for the treatment of lung conditions that cause the airways to narrow, such as and . They shouldn’t be used to treat acute in which the airways aren’t narrowed, particularly because they wouldn’t help.

Which medications can help relieve other symptoms?

Especially at the start of acute , an accompanying cold or flu can cause symptoms such as a headache, sore throat, earache or joint pain. Medication that relieves pain and reduces fever can lead to an improvement in these symptoms. Examples include paracetamol (acetaminophen) and non-steroidal (NSAIDs), e.g. ibuprofen and acetylsalicylic acid – the drug in medications like Aspirin.

These drugs are available from pharmacies without a prescription. They come in the form of tablets, suppositories and syrups. Acetylsalicylic acid isn’t suitable for children under the age of twelve who have a viral with a fever. This is because it can lead to severe brain and liver damage (Reye's syndrome), although that is rare.

What else can you do?

Particularly in the first few days of the illness, it is important to take the time to rest, and avoid strenuous physical activity and sports. People are often advised to drink a lot of fluids to help loosen the mucus in their (lungs). But there are no suitable studies on whether “drinking a lot of fluids” is better than “drinking normal amounts,” or may even be harmful.

Honey can soothe coughs – either eaten on its own or stirred into a warm drink. Studies in children suggest that honey can soothe coughs associated with upper respiratory tract infections. But children under the age of one shouldn’t eat honey because they sometimes react sensitively to certain in it.

Smokers who have acute can go easy on their lungs by trying not to smoke, or by smoking a lot less.

Why aren’t antibiotics recommended?

Antibiotics are drugs that kill or prevent the growth of bacteria. Acute is usually caused by viruses, though, so won’t help.

Many studies have shown that hardly affect the course of the illness. In the studies, reduced the duration of the cough by half a day on average. But they also caused side effects such as diarrhea, nausea or a skin rash in about 3 out of 100 people.

Also, the more often are prescribed, the more likely it is that will become resistant to them. As a result, antibiotics may no longer be effective against certain bacteria. So aren’t recommended for the treatment of acute .

Some people have a higher risk of acute leading to more serious complications (e.g. ), for instance due to a weak , a severe lung or heart condition, or old age. Treatment with may then be a good idea, in order to prevent complications.

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IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Created on September 7, 2017
Next planned update: 2021

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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