What doctors wish patients knew about bronchitis

Bronchitis is a respiratory condition that affects millions of people every year, often bringing with it a persistent cough, chest discomfort and fatigue. The illness occurs when the lining of the bronchial tubes—which carry air to and from the lungs—becomes inflamed, usually as a result of a viral infection, but sometimes due to bacteria or irritants such as smoke and air pollution. 

While acute bronchitis typically resolves within a few weeks, chronic bronchitis can last much longer and may signal a more serious underlying health issue. Recognizing the symptoms, understanding the causes, and knowing when to seek medical help are all important steps in managing and preventing bronchitis.

The AMA’s What Doctors Wish Patients Knew™ series gives physicians a platform to share what they want patients to understand about today’s health care headlines.

In this installment, Jonathan Stoever, MD, a pulmonologist with Confluence Health in Wenatchee, Washington, discusses bronchitis and what patients should know.

Confluence Health is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.

Bronchitis is an inflammation of the bronchial tubes, which are the airways that carry air to and from the lungs. 

“Acute bronchitis is usually defined as a self-limited lower respiratory tract infection lasting no more than three weeks,” said Dr. Stoever, “with symptoms including a cough with or without phlegm, with no other alternative explanation based on clinical or radiographic information.”

Jonathan Stoever, MD

“There are other forms of bronchitis including chronic bronchitis, nonasthmatic eosinophilic bronchitis and asthmatic bronchitis to name a few,” he said. “Chronic bronchitis is a long-term airway inflammation with a persistent, productive cough that lasts for at least three months per year for two consecutive years. 

“This can be caused by a variety of conditions including smoking-related lung disease, vaping, cannabis use, asthma and other diseases,” said Dr. Stoever.

“Pneumonia is infection or inflammation of the alveoli all the way in the deep part of the lung,” said Dr. Stoever, noting it “is not just limited to the bronchi and airways.

“Respiratory viruses including the common cold are frequent causes for bronchitis, but the common cold does not always cause bronchitis,” he added.

“Acute bronchitis is incredibly common with up to 5% of the population affected each year leading to around 10 ambulatory visits per 1,000 people,” said Dr. Stoever, noting it “is most common during the respiratory viral season, since viral respiratory infections are the primary cause for acute bronchitis.”

“The timing and peak of respiratory viral season can vary year over year but usually peaks during the holidays and starts declining around early spring,” he said. “Acute bronchitis can also be seen during pollen season and with exposure to particulate air pollution such as wildfire smoke.” 

“Usually, the symptoms start in the upper respiratory tract with nasal congestion or stuffiness, a runny nose, snot dripping down the back of your throat, and occasionally fever and malaise,” said Dr. Stoever, which refers to a feeling of discomfort, illness or lack of well-being.

“Then the symptoms progress to include the lower respiratory tract causing a cough with or without phlegm but limited to the larger and medium sized airway tubes in bronchitis,” he said.

“Cough and mucus are your body’s primary defense against pneumonia,” said Dr. Stoever. “A cough, even with purulent phlegm, does not necessarily mean bacterial infection.”

“If you have symptoms of a viral infection, prepare to stick it out for a week or two or three with chicken soup, a good show or book, guaifenesin or dextromethorphan to help with the cough, nasal irrigation with hypertonic saline,” he said, “along with some hot and humid showers where you cough up some nasty phlegm and make noises like your grandpa did when he would hock up a big loogie.”

“Acute bronchitis very rarely becomes a problem without antibiotics,” said Dr. Stoever, “but recurrent episodes of bronchitis can be a symptom of underlying asthma or another lung diseases.”

“If there is a true bacterial infection such as bacterial pneumonia or other resurgent vaccine preventable diseases like whooping cough, it can lead to chronic airway changes and a persistent cough,” he said. “And in rare cases, permanent lung damage.”

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For acute bronchitis, “the most effective treatment is a tincture of time and letting your body take care of itself,” said Dr. Stoever, noting that “bacterial infections account for 10% or less of acute bronchitis cases.”

“Home remedy care can include honey, warm tea, humidifiers, cough drops, expectorants—which are medications that help loosen mucus in the respiratory tract—and hypertonic saline nasal rinses,” he said. “Hypertonic saline nasal rinses have been shown to reduce the time of cold symptoms by several days and can help you get rid of that ‘ick’ feeling from the thick snot stuck in the back part of your upper throat.”

“Antibiotics are rarely necessary for bronchitis,” said Dr. Stoever. “There is an old saying that if you take an antibiotic for your bronchitis, you’ll feel better in seven days, but if you don’t take an antibiotic, you’ll feel better in a week.”

“Overuse of antibiotics leading to side effects and antibiotic resistance, overprescription of bronchodilators and inhaled steroids, antihistamines, oral steroids, and nasal steroids can lead to significant risk to patients and cost to the health care system without any clear evidence of benefit,” he said.

Bronchitis itself is not contagious, but the viruses and bacteria that cause it are, especially “in the early phase of the illness,” said Dr. Stoever. “Precautions include hand hygiene, wearing a mask to protect you from droplets and avoiding touching your face.”

“You should also avoid contact with people showing active signs of a respiratory illness and be very vigilant if you have a close household contact who is sick,” he said.

“Staying up to date on vaccines for respiratory illnesses including pneumococcal pneumonia, RSV, influenza and COVID-19 is very important,” said Dr. Stoever. “Strict hand hygiene and avoiding touching your mouth are excellent ways to reduce your risk of developing bronchitis.” 

“No supplements, including zinc, vitamin D, vitamin C or other natural remedies, have been shown to prevent or reduce acute respiratory tract infections,” he added.

If you have bronchitis symptoms, said Dr. Stoever, it is important to seek medical attention if you “have a fast heart rate of more than 100 beats per minute at rest, fast breathing rate of over 24 breaths per minute and a fever of 100.4 ºF or higher.” 

“If your cough does not improve or lingers for more than six to eight weeks after initial symptoms, you should seek medical attention,” he said.