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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

-General 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.