Acute bronchitis

Last updated: October 4, 2022

Summarytoggle arrow icon

Acute bronchitis is a lower respiratory tract infection (LRTI) characterized by inflammation of the bronchi. It often follows an upper respiratory tract infection (URTI) and, in more than 90% of cases, the cause is viral. Acute bronchitis may manifest with cough, runny nose, headache, and malaise. The cough may persist for 2–3 weeks and is usually self-limiting; it is often productive and associated with chest pain. The diagnosis is made on the basis of clinical symptoms and auscultation findings; further diagnostic testing is not routinely necessary. Important differential diagnoses to consider include asthma, acute exacerbation of COPD, and pneumonia. Management of acute bronchitis consists of adequate hydration and symptomatic relief. Treatment with antibiotics is not generally indicated. While chronic bronchitis also involves inflammation of the bronchi, its clinical picture and management are very different (see “COPD”).

Etiologytoggle arrow icon

The etiology of acute bronchitis is viral in > 90% of cases!


Clinical featurestoggle arrow icon

Diagnosticstoggle arrow icon


  • Acute bronchitis is a clinical diagnosis based on typical clinical features and auscultation findings
  • Diagnostic studies are usually only required to: [6]
    • Rule out alternative diagnoses: e.g., CBC, CXR, nasopharyngeal swab
    • Evaluate for complications (e.g., pneumonia, AECOPD) in patients with:
      • Atypical clinical findings
      • Increased risk of bacterial infection: e.g., smokers, patients > 75 years old, patients with lung disease

Routine laboratory and imaging studies [4]

Further diagnostic testing [4]

Consider targeted testing for alternate diagnoses or complications in patients with the following:

In otherwise healthy patients with typical clinical findings and normal vital signs, acute bronchitis does not require diagnostic testing. [6]

Differential diagnosestoggle arrow icon

The differential diagnoses listed here are not exhaustive.

Treatmenttoggle arrow icon

Acute bronchitis is generally self-limiting. Treatment is focused on the relief of symptoms. [4][6]

Treatment is focused on symptomatic management. Antibiotics, cough and cold medications, bronchodilators, and steroids have no proven efficacy in uncomplicated acute bronchitis.

Complicationstoggle arrow icon

  • Respiratory failure
  • Secondary bacterial infections (especially pneumonia)
  • Protracted bacterial bronchitis [19]
    • Chronic bacterial infection that causes a productive cough
    • Clinical diagnosis requires all of the following:
      • Daily cough for > 4 weeks
      • Resolution within 2–4 weeks of antibiotic treatment
      • Absence of alternate diagnosis

We list the most important complications. The selection is not exhaustive.

Prognosistoggle arrow icon

Referencestoggle arrow icon

  1. Diagnosis and treatment of acute bronchitis. Updated: December 1, 2010. Accessed: March 15, 2017.
  2. Jazeela F. Bronchitis. In: Mosenifar M, Bronchitis. New York, NY: WebMD. Updated: February 9, 2017. Accessed: March 15, 2017.
  3. File TM. Acute Bronchitis in Adults. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: March 25, 2016. Accessed: March 16, 2017.
  4. Kinkade S, Long NA. Acute Bronchitis.. Am Fam Physician. 2016; 94 (7): p.560-565.
  5. Koehler U, Hildebrandt O, Fischer P, et al. Time course of nocturnal cough and wheezing in children with acute bronchitis monitored by lung sound analysis. Eur J Pediatr. 2019; 178 (9): p.1385-1394.doi: 10.1007/s00431-019-03426-4 . | Open in Read by QxMD
  6. Smith MP, Lown M, Singh S, et al. Acute Cough Due to Acute Bronchitis in Immunocompetent Adult Outpatients: CHEST Expert Panel Report.. Chest. 2020; 157 (5): p.1256-1265.doi: 10.1016/j.chest.2020.01.044 . | Open in Read by QxMD
  7. Harris AM, Hicks LA, Qaseem A. Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2016; 164 (6): p.425-34.doi: 10.7326/m15-1840 . | Open in Read by QxMD
  8. Moore M, Stuart B, Little P, et al. Predictors of pneumonia in lower respiratory tract infections: 3C prospective cough complication cohort study.. Eur Respir J. 2017; 50 (5).doi: 10.1183/13993003.00434-2017 . | Open in Read by QxMD
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  12. Marini T, Hobbs SK, Chaturvedi A, Kaproth-Joslin K. Beyond bronchitis: a review of the congenital and acquired abnormalities of the bronchus. Insights Imaging. 2017; 8 (1): p.141-153.doi: 10.1007/s13244-016-0537-y . | Open in Read by QxMD
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  14. Zilong Zhang, Lixing Tan, Anke Huss, Cui Guo, Jeffrey R. Brook, Lap‐ah Tse, Xiang Q. Lao. Household incense burning and children's respiratory health: A cohort study in Hong Kong. Pediatr Pulmonol. 2019; 54 (4): p.399-404.doi: 10.1002/ppul.24251 . | Open in Read by QxMD
  15. Chest Cold (Acute Bronchitis). Updated: August 30, 2019. Accessed: December 23, 2020.
  16. Llor C, Moragas A, Bayona C, et al. Efficacy of anti-inflammatory or antibiotic treatment in patients with non-complicated acute bronchitis and discoloured sputum: randomised placebo controlled trial.. BMJ. 2013; 347: p.f5762.doi: 10.1136/bmj.f5762 . | Open in Read by QxMD
  17. 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: p.CD001831.doi: 10.1002/14651858.CD001831.pub5 . | Open in Read by QxMD
  18. Becker LA, Hom J, Villasis-Keever M, van der Wouden JC. Beta2-agonists for acute cough or a clinical diagnosis of acute bronchitis.. Cochrane Database Syst Rev. 2015: p.CD001726.doi: 10.1002/14651858.CD001726.pub5 . | Open in Read by QxMD
  19. Kasi AS, Kamerman-Kretzmer RJ. Cough. Pediatr Rev. 2019; 40 (4): p.157-167.doi: 10.1542/pir.2018-0116 . | Open in Read by QxMD
  20. Agabegi SS, Agabegi ED. Step-Up To Medicine. Wolters Kluwer Health ; 2015
  21. Cohen HA, Rozen J, Kristal H, et al. Effect of honey on nocturnal cough and sleep quality: a double-blind, randomized, placebo-controlled study.. Pediatrics. 2012; 130 (3): p.465-71.doi: 10.1542/peds.2011-3075 . | Open in Read by QxMD
  22. Paul IM, Beiler J, McMonagle A, Shaffer ML, Duda L, Berlin CM Jr. Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents.. Arch Pediatr Adolesc Med. 2007; 161 (12): p.1140-6.doi: 10.1001/archpedi.161.12.1140 . | Open in Read by QxMD
  23. Oduwole O, Udoh EE, Oyo-Ita A, Meremikwu MM. Honey for acute cough in children. Cochrane Database Syst Rev. 2018.doi: 10.1002/14651858.cd007094.pub5 . | Open in Read by QxMD

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