Acute bronchitis

What is acute bronchitis?

Acute bronchitis is an infection of the the large airways (the bronchi). It is common and is usually due to a viral infection. A bacterial Infection is less common and causes around 1% to 10% of cases of bronchitis.

Respiratory tract

The diagram above shows the sites of a range of respiratory infections. This leaflet just deals with acute bronchitis. See the separate leaflets called Acute Sinusitis, Tonsillitis, Sore Throat, Laryngitis, Pleurisy, Bronchiolitis, and Pneumonia for the other types of infection shown in the diagram.

Note: chronic bronchitis is a separate illness and is not dealt with here. See the separate leaflet called Chronic Obstructive Pulmonary Disease (COPD) for more details.

Acute bronchitis symptoms

The main symptom of acute bronchitis is a cough. You may also develop a high temperature (fever), headache, cold symptoms and aches and pains. Symptoms typically peak after 2-3 days and then gradually clear. However,

It commonly takes 2-3 weeks for the cough to go completely after the other symptoms have gone. This is because inflammation in the airways caused by the bronchitis infection may take some time to settle.

Emergency symptoms

Consult a doctor if any of the following occur:

• If high temperature (fever), wheezing or headaches become worse or severe.

• If you develop fast breathing, shortness of breath, or chest pains.

• If you cough up blood or if your phlegm (sputum) becomes dark or rusty coloured.

• If you become drowsy or confused.

• If a cough persists for longer than 3-4 weeks.

• If you have repeated (recurring) bouts of acute bronchitis.

• If any other symptom develops that you are concerned about.

Diagnosing acute bronchitis

Your doctor will listen to the history and examine you - this is usually enough to make a diagnosis and tests are rarely needed. If further tests are needed, they could include blood tests, a chest X-ray or sending a sample of sputum to the laboratory for analysis.

Acute bronchitis treatment

A main aim of treatment is to ease symptoms whilst your immune system clears the infection. The most useful treatments are:

• Taking pain relievers such as paracetamol, ibuprofen, or aspirin to reduce high temperature (fever) and to ease any aches, pains and headaches. (Children aged under 16 years should not take aspirin.)

• Having lots to drink if you have a fever, to prevent mild lack of fluid in the body (dehydration).

• If you smoke, trying to stop for good. Bronchitis, chest infections and serious lung diseases are more common in smokers.

• Taking plenty of rest.

What about cold and cough remedies?

You can buy many other 'cold and cough remedies' at pharmacies. There is little evidence of any impact on the infection but they may be useful for certain symptoms. For example, a decongestant nasal spray may help to clear a blocked nose.

Remember, cold and cough remedies often contain several ingredients. Some may make you drowsy. This may be welcome at bedtime if you have difficulty sleeping with a bronchitis. However, do not drive if you are drowsy. Some contain paracetamol, so be careful not to take more than the maximum safe dose of paracetamol if you are already taking paracetamol tablets. Always follow the advice of your pharmacist about which medicines can be used for children of different ages.

What about antibiotics?

The National Institute for Health and Care Excellence (NICE) has confirmed that otherwise healthy people who have acute bronchitis should not be prescribed antibiotics. Your immune system can usually clear the infection. Antibiotics do not kill viruses. Even if a germ (bacterium) is the cause, antibiotics usually do little to speed up recovery of an acute bronchitis. Antibiotics may even make symptoms worse, as some people develop side-effects such as loose or watery stools (diarrhoea), feeling sick (nausea) and rashes.

NICE recommends that your doctor should consider either an immediate prescription for antibiotics or a 'delayed prescription' (to be taken if symptoms do not improve or get worse) for the following people:

• Over-80s who have been in hospital in the preceding year, are taking steroids, have diabetes or have heart failure.

• Over-65s who have two of the risk factors in the line above.

• People with long-term kidney, liver, heart, lung or nervous system conditions.

• People with cystic fibrosis.

• People with conditions which can stop their immune system from working properly.

NICE does not recommend prescribing bronchodilators (to open up the airways) or steroids in either inhaled or tablet form.

It recommends that you should consult your doctor if your symptoms have not settled within 3-4 weeks, or if your symptoms get rapidly worse or you become very unwell in yourself.

Antibiotics may also be prescribed if a complication develops such as pneumonia - but this is unlikely to occur if you are otherwise healthy.

Acute bronchitis in children

Children are more likely to get bronchiolitis (an infection of the smaller parts of the respiratory tree) than bronchitis.

Is bronchitis contagious?

As with any infection, bronchitis is contagious and so it is important to cough into a tissue and wash your hands regularly to reduce the risk of passing it to others.

How long does acute bronchitis last?

Acute bronchitis usually clears without complications within 3-4 weeks. Occasionally, the infection travels to the lung tissue to cause pneumonia.

Preventing acute bronchitis

Washing your hands regularly is important to reduce the risk of catching bronchitis or other respiratory tract infections from those around you who may have them. Smoking causes lung problems such as COPD which predispose to bronchitis and so stopping smoking may help to reduce the risk of catching bronchitis.