Acute Bronchitis

Acute bronchitis lasts less than three weeks and will generally improve on its own with no treatment.

Acute bronchitis, sometimes called a chest cold, is inflammation of the bronchial tubes (the airways that allow air to pass from the mouth to the lungs) that usually is caused by viruses or bacteria. Although other irritants, for example, smoke or pollution, also may cause the disease, they are far less frequent causes.

Acute bronchitis will usually get better on its own but can sometimes develop into pneumonia. Bronchitis affects the airways leading to the lungs, while pneumonia affects the air sacs in the lungs, called alveoli. Pneumonia is much worse than bronchitis and can be life-threatening in older or otherwise vulnerable people. Pneumonia symptoms are similar to bronchitis symptoms but generally are more severe.

Bronchitis can be acute or chronic:

• Acute bronchitis: It is a short-term condition. A viral infection usually causes it. Smoking may initiate or worsen the symptoms. Bacterial infection may occasionally cause acute bronchitis. Acute bronchitis usually goes away in a week or two. The symptoms may at times last for three weeks.
• Chronic bronchitis: It is less common compared with acute bronchitis. It is defined as a cough productive of sputum, lasting three months of the year for at least two consecutive years. It may block the airflow in the lungs and is classified as chronic obstructive pulmonary disease or COPD. Chronic bronchitis may begin as a cough and inflammation caused by a respiratory infection or illness, exposure to tobacco smoke, or other irritants in the air. It is more frequently seen in smokers and patients with underlying lung disease.

The most common cause of acute bronchitis is viral (short-term viral). There is no "bronchitis virus” as many different types of viruses can cause bronchitis.

The main genera of viruses that cause acute bronchitis include:

• Influenza (the same virus that causes colds)
• Parainfluenza
• RSV
• Rhinovirus
• Adenovirus
• Coronaviruses

Many people develop mild symptoms of acute bronchitis so often that the exact virus that caused the infection is never determined. In addition, the common cold may mimic an acute bronchitis flair-up.

Bacteria are less common causes of acute bronchitis. Bacterial causes of the disease (bacterial bronchitis) include:

• Mycoplasma
• Streptococcus
• Bordetella
• Moraxella
• Haemophilus
• Chlamydia pneumoniae

Other irritants (for example, tobacco smoke, chemicals, etc.) may irritate the bronchi and cause acute bronchitis. Consequently, bronchial or bronchitis infections are not the only cause of acute bronchitis.

Is acute bronchitis contagious?

The majority of people with acute bronchitis are contagious if the cause is an infectious agent such as a virus or bacterium. The contagious period for both bacteria and viruses is usually as long as the patient has symptoms; however, a few viruses may be contagious a few days before symptoms appear. Contagious viruses that may cause acute bronchitis are listed in the causes section. Tracheobronchitis (inflammation of both the bronchiole(s) and the trachea) may lead to lung infections (respiratory infections like pneumonia).

People usually are less likely to be contagious as the symptoms wane. However, acute bronchitis caused by the immune system, exposure to pollutants, tobacco smoke (including second-hand smoke), or other environmental chemicals or toxins that are bronchiole and/or lung irritants are not contagious.

Risk factors for acute bronchitis are the same as those for getting viral and bacterial infections and two include:

• Being in close contact with people who are coughing
• Sneezing
• Touching items that infected persons recently handled

People who are exposed to air pollution, tobacco smoke, and chemicals that are aerosolized are at higher risk for acute bronchitis. Unfortunately, many people worldwide are at risk of getting this type of bronchitis. About 4.6 out of 100 individuals may develop acute bronchitis each year (or about 12.5 million in the US). The highest risks for the disease are in the winter months.

Coughing is the most common symptom of acute bronchitis. The coughing begins early in the disease and usually lasts about 10 to 20 days as it gradually subsides. About 50% of individuals have a productive cough with either clear, yellow, greenish, or occasionally blood-tinged sputum.

Consequently, signs and symptoms of acute bronchitis may include:

• Coughing
• Productive cough
• Mild shortness of breath
• Sore throat
• Nasal congestion
• Headache
• Mild fever and chills
• Chest discomfort
• Muscle aches
• Fatigue
• Wheezing

Children may also have:

• Runny nose
• Mild fever
• May gag or vomit mucus

If a person develops a fever, shortness of breath, cyanosis, or chest pain, they likely have another problem but not acute bronchitis. Blood-tinged sputum should always be evaluated by a healthcare provider.

A cough lasting five or more days suggests acute bronchitis as a cause. Acute bronchitis usually lasts about 10 to 20 days. People with recurrent acute bronchitis may develop chronic bronchitis.

Chronic bronchitis is defined as a cough that occurs every day with sputum production that lasts for at least 3 months, 2 years in a row. However, acute bronchitis may develop into chronic bronchitis in some individuals and even lead to COPD (chronic obstructive pulmonary disease).

Most people do not need to contact their doctor since acute bronchitis is usually limited to about 10 to 20 days and then resolves. However, call your doctor or another healthcare professional if your symptoms become severe or if you develop a fever that does not go down. Moreover, if other symptoms develop (shortness of breath, night sweats) if the symptoms persist past about 20 days, or if you have repeated bouts of acute bronchitis during the year, you should contact your doctor.

If you think your child has acute bronchitis (especially those aged two and under), call your pediatrician to have your child seen.

Primary care physicians and pediatricians often treat acute bronchitis.

If acute bronchitis reoccurs (recurring bronchitis), other specialties may include:

• Allergists
• Infectious disease
• ENT specialists
• Pulmonologist

If you are pregnant, consult your OB/GYN or Midwife.

Because acute bronchitis has many causes and is often self-limiting within 10 to 20 days and its main symptom is coughing, most doctors consider the diagnosis after a history and physical without additional tests.

If the diagnosis is not clear or the specific cause needs to be identified, such tests as sputum cytology, throat cultures, influenza tests, chest X-rays, blood gas, procalcitonin levels, and even bronchoscopy have been used to identify specific viral, bacterial, and other sources or causes or rule out more severe illnesses (such as pneumonia).

Usually, the symptoms of acute bronchitis are mild to moderate, and symptoms like cough are treated for a few days before a more extensive workup is begun.

Bed rest and supportive care such as reducing coughing are the main treatments for acute bronchitis. Usually, antibiotics are not needed, especially if bronchitis has viral or environmental causes.

For some people who have wheezing with their cough, bronchodilators (beta2 agonists) may be helpful.

The most useful treatments are directed at reducing cough symptoms with over-the-counter preparations containing guaifenesin (an expectorant) and a mucolytic. Nonsteroidal anti-inflammatory drugs (NSAIDs) often are added to reduce inflammation and help relieve discomfort.

However, the American Academy of Pediatrics does not recommend giving OTC (over-the-counter; non-prescription) cough and cold medications to children under two years of age. These medicines may cause harmful side effects that can be life-threatening to young children. Side effects include:

• Organ toxicity (kidneys, for example)
• Death

The following medication(s) may be helpful for people with acute bronchitis.

Cough suppressants

• Robitussin and Delsym: Use this medicine sparingly because coughing helps remove irritants from the air passages, and you want to cough these irritants out of these passages in the lungs.
• Mucolytics (Mucinex, Mucomyst): These medicines help remove sticky mucus from the airways.
• Acetaminophen and NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) and/or acetaminophen (Tylenol and others) may reduce inflammation and/or discomfort.
• Inhaler bronchodilators: This medicine opens airways, which makes it easier to breathe.
• Antibiotics: Acute bronchitis is treated with antibiotics only if the cause is bacterial (suspected or diagnosed). Reports indicate that about 65%-80% of people with acute bronchitis receive an antibiotic despite evidence that antibiotics are not effective in treating acute bronchitis (with a few exceptions). Antibiotics are not recommended for routine acute bronchitis treatment.

Do not give drugs like NSAIDs and aspirin to young children and young adults with fever due to the risk of Reye's syndrome. Check with a pediatrician before giving over-the-counter medicine to your child.

Home remedies may help reduce acute bronchitis symptoms, such as:

• Stay well hydrated by drinking fluids
• Use a humidifier to moisten the air
• Avoid dairy products because they thicken mucous secretions
• Avoid alcohol and caffeine because of potential drug interactions
• Avoid exposure to environmental smoke and other air pollutants
• Over-the-counter (OTC) cough suppressants and cough drops can help reduce coughing symptoms.

If symptoms worsen, see your doctor. For children under age 2 (and some doctors recommend under age 6), the doctor should be consulted before OTC medicines are used.

For most adults acute bronchitis is self-limiting and has a good prognosis. If you suffer from other underlying medical conditions especially any that suppress your immune system you should consult with your doctor to make sure bronchitis does not turn into pneumonia.

Complications of acute bronchitis are infrequent but include:

• A respiratory infection like pneumonia (viral and/or bacterial)
• Chronic bronchitis
• Asthma
• Sinusitis

In addition, depending on the pathogen, complications include tuberculosis, whooping cough (pertussis), and other infectious lung diseases. It may eventually lead to the development of COPD.

Avoiding contact with people who have respiratory symptoms (coughing) and hand washing can help prevent bronchitis as well as wearing a face mask.