Most bouts of acute bronchitis are caused by viral infections and they usually soon go. This leaflet gives some tips on what to do and what symptoms to look out for which may indicate a more serious illness.
What is acute bronchitis?
Acute bronchitis is an infection of the the bronchi - the large airways. Acute bronchitis is common and is usually due to infection with a virus. Infection with a germ (a bacterial infection) is a less common cause.
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 for more details.
Acute bronchitis symptoms
The main symptom is 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 infection may take some time to settle.
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 paracetamol, ibuprofen, or aspirin to reduce high temperature (fever) and to ease any aches, pains and headaches. (Children aged under 16 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.
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.
In March 2009 an important statement was issued by the Medicines and Healthcare products Regulatory Agency (MHRA) which says:
"The new advice is that parents and carers should no longer use over-the-counter (OTC) cough and cold medicines in children under 6. There is no evidence that they work and they can cause side effects, such as allergic reactions, effects on sleep or hallucinations. For 6 to 12 year olds these medicines will continue to be available but will only be sold in pharmacies, with clearer advice on the packaging and from the pharmacist. This is because the risk of side effects is reduced in older children because they weigh more, get fewer colds and can say if the medicine is doing any good. More research is being done by industry on how well these medicines work in children aged 6-12 years."
Note: paracetamol and ibuprofen are not classed as cough and cold medicines and can still be given to children.
What about antibiotic medicines?
Dr Sarah Jarvis, February 2019.
The National Institute for Health and Care Excellence (NICE) has confirmed that otherwise healthy people who have acute bronchitis should not be prescribed antibiotics. They recommend 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 last 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.
- Young children who were born prematurely.
They do not recommend prescribing bronchodilators (to open up the airways) or steroids in either inhaled or tablet form.
They recommend that you should go back and see 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 are not usually advised if you are normally in good health. 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. Antibiotics may be prescribed if you become more unwell, or if you already have an ongoing (chronic) lung disease. They may also be prescribed if a complication develops such as pneumonia - but this is unlikely to occur if you are otherwise healthy.
How long does acute bronchitis last?
Acute bronchitis usually clears without complications. Occasionally, the infection travels to the lung tissue to cause pneumonia. 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.
Further reading and references
Respiratory tract infections (self-limiting): prescribing antibiotics; NICE Clinical Guideline (July 2008)
Over-the-counter cough and cold medicines for children; Medicines and Healthcare products Regulatory Agency (MHRA), 2009
Worrall G; Acute bronchitis. Can Fam Physician. 2008 Feb54(2):238-9.
Chest infections - adult; NICE CKS, July 2015 (UK access only)
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