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Acute Bronchitis

Clinical Subject Page

Acute Bronchitis

Acute bronchitis is a short-term inflammation of the bronchi, usually caused by a viral infection, with acute cough as the main symptom.

Also called

Acute bronchial infection

ICD-10

J20.9

Specialty

Pulmonology

Onset

Acute

Reviewed

July 2026

On This Page

Overview

commonly develops after an upper respiratory viral infection.

The infection causes:

Bronchial inflammation → Increased mucus production → Cough

The cough may be dry or productive and often lasts longer than the other symptoms.

Etiology & Risk Factors

Common Causes

Viruses — Most Common

  • Influenza virus
  • Rhinovirus
  • Respiratory syncytial virus (RSV)
  • Coronaviruses
  • Parainfluenza virus
  • Human metapneumovirus

Bacterial Causes — Uncommon

May include:

  • Bordetella pertussis
  • Mycoplasma pneumoniae
  • Chlamydia pneumoniae

Risk Factors

  • Recent viral respiratory infection
  • Close contact with infected people
  • Smoking
  • Air pollution
  • Exposure to respiratory irritants
  • Crowded environments

Pathophysiology

Viral infection or airway irritant
⬇
Injury to bronchial epithelium
⬇
Acute bronchial inflammation
⬇
Mucosal edema + Increased mucus production
⬇
Temporary airway hyperresponsiveness
⬇
Cough ± Sputum ± Wheezing

Key Concept

The cough may persist after the infection resolves because bronchial inflammation and airway hyperresponsiveness take time to recover.

Clinical Presentation

  • Main Symptom

    • Acute cough

    The cough may be:

    • Dry
    • Productive
    • Persistent for several weeks

    Other Symptoms

    • Sputum production
    • Wheezing
    • Mild dyspnea
    • Chest discomfort or soreness from coughing
    • Sore throat
    • Rhinorrhea
    • Fatigue
    • Mild fever

    Signs

    • Wheezing
    • Rhonchi that may improve after coughing
    • Mild tachypnea

History Taking

  • Ask about:

    • Cough?
    • When did it start?
    • Dry or productive?
    • Sputum color?
    • Fever or chills?
    • Shortness of breath?
    • Wheezing?
    • Chest pain?
    • Cough lasting more than 3 weeks?
    • Recent cold or influenza?
    • Smoking history?

Physical Examination

Look for:

  • Fever
  • Tachypnea
  • Tachycardia
  • Reduced oxygen saturation
  • Respiratory distress

Chest Examination

May show:

  • Wheezing
  • Rhonchi
  • Coarse breath sounds

The examination may also be normal.

Investigations

  • Routine Testing

    Usually not required.

    Acute bronchitis is generally diagnosed clinically.

    Chest X-ray

    Not routinely required.

    Consider when:

    • Pneumonia is suspected
    • High fever is present
    • Significant tachypnea is present
    • Hypoxemia is present
    • Focal chest signs are present

    Viral Testing

    May be considered when:

    • Influenza is suspected
    • COVID-19 is suspected
    • The result would change treatment or infection-control decisions

    Pertussis Testing

    Consider when there is:

    • Prolonged cough
    • Paroxysmal coughing
    • Inspiratory whoop
    • Post-tussive vomiting
    • Known exposure

Diagnosis

  • Diagnosis is based on:

    1. Acute Cough

    Usually with or without:

    • Sputum
    • Wheezing
    • Mild respiratory symptoms

    2. Absence of Pneumonia

    3. No Better Alternative Diagnosis

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Related Topics

Management of Acute Bronchitis

  • Main Goals

    • Relieve symptoms
    • Maintain hydration
    • Identify serious alternative diagnoses
    • Avoid unnecessary antibiotics

    Supportive Management

    • Rest
    • Adequate fluids
    • Analgesics or antipyretics when needed
    • Symptomatic cough treatment when appropriate

    Bronchodilators

    May be considered in patients with:

    • Wheezing
    • Evidence of bronchospasm

    Antibiotics

    • Not routinely indicated
    • Most cases are viral
    • Antibiotics provide little or no benefit in uncomplicated acute bronchitis

Complications of Acute Bronchitis

  • Prolonged cough
  • Secondary bacterial infection
  • Pneumonia
  • Asthma exacerbation
  • COPD exacerbation

Prognosis of Acute Bronchitis

  • Prognosis is excellent.
  • It is usually self-limiting.
  • Most patients recover without specific treatment.
  • The cough often lasts longer than patients expect and may persist for several weeks.
  • Persistent or worsening symptoms should prompt reassessment for another diagnosis.

Key Points / Clinical Pearls of Acute Bronchitis

  • Acute cough is the main symptom.
  • Most cases are caused by viruses.
  • The main diagnostic task is to exclude pneumonia.
  • Routine investigations are usually unnecessary.
  • Colored or purulent sputum does not prove bacterial infection.
  • Antibiotics are not routinely indicated.
  • Wheezing may occur because of temporary airway hyperresponsiveness.
  • Cough may persist for several weeks.
  •  
  • Singh A, Avula A, Zahn E. National Center for Biotechnology Information (NIH). Acute Bronchitis, StatPearls.
  • MedlinePlus, National Library of Medicine (NIH). Acute Bronchitis: Medical Encyclopedia.
  • Smith MP, Lown M, Singh S, et al; CHEST Expert Cough Panel. Acute Cough Due to Acute Bronchitis in Immunocompetent Adult Outpatients: CHEST Expert Panel Report. Chest. 2020. PMID: 32017932.
  • Widysanto A, Goldin J, Mathew G. National Center for Biotechnology Information (NIH). Chronic Bronchitis, StatPearls.
  • Smith SM, Schroeder K, Fahey T. Over-the-Counter (OTC) Medications for Acute Cough in Children and Adults in Community Settings. Cochrane Database Syst Rev. 2014. PMID: 25420096.