BRONCHITIS OVERVIEW

Bronchitis develops when there is swelling and irritation of the bronchi, the large tubes that carry air to the lungs (figure 1). There are two types of bronchitis: acute (sudden onset) and chronic (long-standing).

Acute bronchitis often occurs with a viral infection, such as the common cold, and is sometimes called a "chest cold". The most common symptom of acute bronchitis is a nagging cough. Treatment of acute bronchitis usually involves treating the symptoms, such as sore throat and congestion. Antibiotics do not help to eliminate acute bronchitis caused by a virus.

This article will review the causes, symptoms, diagnosis, and treatment of acute bronchitis. Articles that discuss the common cold and sore throat are also available. (See "Patient information: The common cold in adults" and "Patient information: Sore throat in adults".)

Chronic bronchitis is discussed separately. (See "Patient information: Chronic obstructive pulmonary disease (COPD, including emphysema)".) More detailed information about acute bronchitis is available by subscription. (See "Acute bronchitis in adults".)

BRONCHITIS CAUSES

Most cases of bronchitis are caused by a viral infection of the upper airways, such as the common cold or the flu. Less commonly, a bacterium such as pertussis (whooping cough) is the cause. (See 'Whooping cough' below.)

BRONCHITIS SYMPTOMS

The most common symptoms of acute bronchitis include:

• A persistent cough; this may last 10 to 20 days
• Some people cough up mucus, which may be clear, yellow, or green in color

Fever is not common in people with acute bronchitis. However, having a fever can be a sign of another condition, such as the flu or pneumonia. (See "Patient information: Influenza symptoms and treatment" and "Patient information: Pneumonia in adults".)

Conditions with similar features — There are other conditions that have symptoms similar to those of acute bronchitis.

• Chronic cough — A persistent cough that lasts more than eight weeks is considered a chronic cough, which is discussed in detail elsewhere. (See "Patient information: Chronic cough in adults".)
• Chronic bronchitis — Chronic bronchitis is defined as a cough that occurs on most days of the month for at least three months of the year during two consecutive years. This condition is discussed separately. (See "Patient information: Chronic obstructive pulmonary disease (COPD, including emphysema)".)
• Pneumonia — Signs of pneumonia include fever and a fast heart and breathing rate. (See "Patient information: Pneumonia in adults".)
• Postnasal drip — Postnasal drip occurs when secretions drain from the sinuses into the throat. This can cause the throat to feel irritated, which causes you to feel like you need to clear your throat frequently. Postnasal drip can be caused by the common cold, allergies, sinusitis, or environmental irritants. (See "Patient information: Allergic rhinitis (seasonal allergies)".)

BRONCHITIS DIAGNOSIS

Most people who have a persistent cough after an upper respiratory infection (cold) do not need to see a healthcare provider. Diagnostic testing, such as x-rays, cultures, and blood tests, are not usually needed for people with acute bronchitis. However, testing may be recommended if your diagnosis is not clear based upon your examination or if another condition, such as pneumonia, is suspected.

When to seek help — You should call your healthcare provider if you have any of the following:

• Fever (temperature greater than 100.4º F or 38º C)
• A cough that lasts longer than 10 days
• Chest pain with coughing, difficulty breathing, or coughing up blood

People who are older than 75 do not always have a fever or other concerning symptoms. If you are over 75 years and you have a persistent cough, you should call your clinician to determine if and when an office visit is recommended.

BRONCHITIS TREATMENT

Relief of symptoms — There is no specific treatment for bronchitis, but there are a few treatments available for the common cold. (See "Patient information: The common cold in adults".)

• A nonsteroidal antiinflammatory drug (ibuprofen, naproxen), aspirin, or acetaminophen (Tylenol®) can help to relieve the pain of a sore throat or headache (table 1).
• Pseudoephedrine is a decongestant that can improve nasal congestion. Most drugstores in the United States carry pseudoephedrine behind the counter, so you must ask for it from the pharmacist (a prescription is not required).

Other decongestants, such as phenylephrine, are not as effective as pseudoephedrine.

Antihistamines such as diphenhydramine (Benadryl®) may also help, but can cause side effects such as drowsiness and drying of the eyes, nose, and mouth.

• Heated, humidified, air can improve symptoms of nasal congestion and runny nose, and has few to no side effects.
• Cough suppressants are not effective in treating coughing due to colds.

Antibiotics — Antibiotics are NOT helpful for most people with bronchitis since the illness is typically caused by a virus. Antibiotics treat bacterial, not viral infections. For example, pneumonia is usually caused by bacteria and is treated with antibiotics.

Many people request antibiotics in the hopes that it will get rid of the cough, and some people even think that antibiotics have helped on previous occasions. However, there is no benefit of antibiotics for most cases of bronchitis. Thus, if a clinician determines that antibiotics are not required, it is best to accept this advice.

Whooping cough — Whooping cough is caused by a bacterium, Bordetella pertussis. A vaccine is routinely given during childhood, and again during adolescence or adulthood, to reduce the risk of becoming infected with pertussis. However, the illness can still develop in those who were vaccinated. (See "Clinical features and diagnosis of Bordetella pertussis infection in adolescents and adults".)

Signs of whooping cough in adults include repeated "spasms" of severe coughing, sometimes followed by vomiting. If whooping cough is suspected, your healthcare provider may prescribe an antibiotic. Antibiotics will not help the cough, but can reduce the risk of spreading the infection to others. (See "Treatment and prevention of Bordetella pertussis infection in adolescents and adults".)

PREVENTING THE SPREAD OF ILLNESS

Hand washing is an essential and highly effective way to prevent the spread of infection. Wet your hands with water and plain soap and rub them together for 15 to 30 seconds. Pay special attention to the fingernails, between the fingers, and the wrists. Rinse your hands thoroughly, and dry with a single use towel.

Alcohol-based hand rubs are a good alternative for disinfecting hands if a sink is not available. Spread the hand rub over the entire surface of your hands, fingers, and wrists until dry. You can use hand rubs repeatedly without irritating the skin or losing effectiveness. Hand rubs are available as a liquid or wipe in small, portable sizes that are easy to carry in a pocket or handbag. When a sink is available, you should wash visibly soiled hands with soap and water.

Wash your hands before preparing food and eating, and after going to the bathroom, and after coughing, blowing the nose, or sneezing. While it is not always possible to limit contact with people who are ill, avoid touching your eyes, nose, or mouth after direct contact, when possible.

In addition, use a tissue to cover your mouth when sneezing or coughing. Throw away used tissues promptly and then wash your hands. Sneezing/coughing into the sleeve of your clothing (at the inner elbow) is another way of containing sprays of saliva and secretions and does not contaminate your hands. Sneezing and coughing without covering your mouth can spread infection to anyone within 6 feet.

WHERE TO GET MORE INFORMATION

Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed every four months on our web site (www.uptodate.com/patients).

Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.

Patient level information

Patient information: The common cold in adults
Patient information: Sore throat in adults
Patient information: Chronic obstructive pulmonary disease (COPD, including emphysema)
Patient information: Influenza symptoms and treatment
Patient information: Pneumonia in adults
Patient information: Chronic cough in adults
Patient information: Allergic rhinitis (seasonal allergies)

Professional level information

Acute bronchitis in adults
Clinical features and diagnosis of Bordetella pertussis infection in adolescents and adults
Diagnosis and treatment of infection in acute exacerbations of chronic obstructive pulmonary disease
Etiology and evaluation of hemoptysis in adults
Fluoroquinolones
Respiratory syncytial virus infection: Clinical features and diagnosis
The common cold in adults: Treatment and prevention
Treatment and prevention of Bordetella pertussis infection in adolescents and adults

The following organizations also provide reliable health information.

• National Library of Medicine

      (www.nlm.nih.gov/medlineplus/bronchitis.html)

• Centers for Disease Control and Prevention (CDC)

      (www.cdc.gov/getsmart/antibiotic-use/URI/bronchitis.html)

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