Highlights & Basics
- Acute bronchitis is typically associated with a cough that is worse at night or with exercise; lasts >2 weeks in half of patients and 4 weeks in a quarter of patients; may be associated with bronchospasm and/or excessive mucus production.
- Diagnosis is primarily clinical. Other causes for acute cough such as pneumonia, asthma, or postnasal drip should be ruled out if suspected.
- Treatment is aimed at symptom reduction until infection is resolved and bronchial damage repaired. Antibiotics are not recommended in the majority of patients.
- Complications are rare; the primary complication is a postbronchitis syndrome, which can produce a cough lasting several months.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
Harris AM, Hicks LA, Qaseem A, et al. 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 Mar 15;164(6):425-34. [Abstract][Full Text]
Spurling GK, Del Mar CB, Dooley L, et al. Delayed antibiotic prescriptions for respiratory infections. Cochrane Database Syst Rev. 2017 Sep 7;(9):CD004417.[Abstract][Full Text]
Smith SM, Fahey T, Smucny J, et al. Antibiotics for acute bronchitis. Cochrane Database Syst Rev. 2017 Jun 19;(6):CD000245.[Abstract][Full Text]
1. MacFarlane J, Holmes W, Gard P, et al. Prospective study of the incidence, aetiology and outcome of adult lower respiratory tract illness in the community. Thorax. 2001;56:109-114.[Abstract]
2. Williamson HA Jr. Pulmonary function tests in acute bronchitis: evidence for reversible airway obstruction. J Fam Pract. 1987;25:251-256.[Abstract]
3. Harris AM, Hicks LA, Qaseem A, et al. 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 Mar 15;164(6):425-34. [Abstract][Full Text]
4. Gulliford MC, van Staa T, McDermott L, et al. Cluster randomised trial in the general practice research database: 1. electronic decision support to reduce antibiotic prescribing in primary care (eCRT study). Trials. 2011 May 10;12:115. [Abstract][Full Text]
5. King DE, Williams WC, Bishop L, et al. Effectiveness of erythromycin in the treatment of acute bronchitis. J Fam Pract. 1996 Jun;42(6):601-5.[Abstract]
6. Wernli D, Emonet S, Schrenzel J, et al. Evaluation of eight cases of confirmed Bordetella bronchiseptica infection and colonization over a 15-year period. Clin Microbiol Infect. 2011 Feb;17(2):201-3.[Abstract][Full Text]
7. Williamson HA Jr. Pulmonary function tests in acute bronchitis: evidence for reversible airway obstruction. J Fam Pract. 1987 Sep;25(3):251-6.[Abstract]
8. Jary H, Simpson H, Havens D, et al. Household air pollution and acute lower respiratory infections in adults: a systematic review. PLoS One. 2016 Dec 1;11(12):e0167656.[Abstract][Full Text]
9. Martineau AR, Jolliffe DA, Hooper RL, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 2017;356::i6583.[Abstract][Full Text]
10. Ginde AA, Blatchford P, Breese K, et al. High-dose monthly vitamin D for prevention of acute respiratory infection in older long-term care residents: a randomized clinical trial. J Am Geriatr Soc. 2017;65:496-503.[Abstract][Full Text]
11. MacFarlane J, Holmes W, Gard P, et al. Prospective study of the incidence, aetiology and outcome of adult lower respiratory tract illness in the community. Thorax. 2001 Feb;56(2):109-14.[Abstract][Full Text]
12. National Institute for Health and Care Excellence. Pneumonia in adults: diagnosis and management. September 2019 [internet publication]. [Full Text]
13. American College of Radiology. ACR appropriateness criteria: hemoptysis. 2019 [internet publication].[Full Text]
14. Schuetz P, Wirz Y, Sager R, et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database Syst Rev. 2017 Oct 12;(10):CD007498.[Abstract][Full Text]
15. Williamson HA Jr. Pulmonary function tests in acute bronchitis: evidence for reversible airway obstruction. J Fam Pract. 1987 Sep;25(3):251-6.[Abstract]
16. Smith MP, Lown M, Singh S, et al. Acute cough due to acute bronchitis in immunocompetent adult outpatients: CHEST expert panel report. Chest. 2020 May;157(5):1256-65.[Abstract][Full Text]
17. Irwin RS, French CL, Chang AB, et al. Classification of cough as a symptom in adults and management algorithms: CHEST guideline and expert panel report. Chest. 2018 Jan;153(1):196-209.[Abstract][Full Text]
18. Gonzales R, Bartlett JG, Besser RE, et al. Principles of appropriate antibiotic use for treatment of uncomplicated acute bronchitis: background. Ann Intern Med. 2001 Mar 20;134(6):521-9.[Abstract]
19. Melbye H, Kongerud J, Vorland L. Reversible airflow limitation in adults with respiratory infection. Eur Resp J. 1994 Jul;7(7):1239-45.[Abstract][Full Text]
20. Becker LA, Hom J, Villasis-Keever M, et al. Beta2-agonists for acute cough or a clinical diagnosis of acute bronchitis. Cochrane Database Syst Rev. 2015 Sep 3;(9):CD001726.[Abstract][Full Text]
21. National Institute for Health and Care Excellence. Cough (acute): antimicrobial prescribing. February 2019 [internet publication].[Full Text]
22. Prabhu Shankar S, Chandrashekharan S, Bolmall CS, et al. Efficacy, safety and tolerability of salbutamol + guaiphenesin + bromhexine (Ascoril) expectorant versus expectorants containing salbutamol and either guaiphenesin or bromhexine in productive cough: a randomised controlled comparative study. J Indian Med Assoc. 2010 May;108(5):313-4;316-8;320.[Abstract]
23. Food and Drug Administration. FDA drug safety communication: FDA requires labeling changes for prescription opioid cough and cold medicines to limit their use to adults 18 years and older. January 2018 [internet publication].[Full Text]
24. Lee RA, Centor RM, Humphrey LL, et al. Appropriate use of short-course antibiotics in common infections: best practice advice from the American College of Physicians. Ann Intern Med. 2021 Jun;174(6):822-7.[Abstract][Full Text]
25. Tonkin-Crine SK, Tan PS, van Hecke O, et al. Clinician-targeted interventions to influence antibiotic prescribing behaviour for acute respiratory infections in primary care: an overview of systematic reviews. Cochrane Database Syst Rev. 2017 Sep 7;(9):CD012252.[Abstract][Full Text]
26. Huang DT, Yealy DM, Filbin MR, et al. Procalcitonin-guided use of antibiotics for lower respiratory tract infection. N Engl J Med. 2018 Jul 19;379(3):236-49.[Abstract][Full Text]
27. Little P, Stuart B, Smith S, et al. Antibiotic prescription strategies and adverse outcome for uncomplicated lower respiratory tract infections: prospective cough complication cohort (3C) study. BMJ. 2017 May 22;357:j2148.[Abstract][Full Text]
28. de la Poza Abad M, Mas Dalmau G, Moreno Bakedano M, et al; Delayed Antibiotic Prescription Group. Prescription strategies in acute uncomplicated respiratory infections: a randomized clinical trial. JAMA Intern Med. 2016 Jan;176(1):21-9.[Abstract][Full Text]
29. Llor C, Bjerrum L. Antibiotic prescribing for acute bronchitis. Expert Rev Anti Infect Ther. 2016 Jul;14(7):633-42.[Abstract][Full Text]
30. Spurling GK, Del Mar CB, Dooley L, et al. Delayed antibiotic prescriptions for respiratory infections. Cochrane Database Syst Rev. 2017 Sep 7;(9):CD004417.[Abstract][Full Text]
31. Smith SM, Fahey T, Smucny J, et al. Antibiotics for acute bronchitis. Cochrane Database Syst Rev. 2017 Jun 19;(6):CD000245.[Abstract][Full Text]
32. Kraus EM, Pelzl S, Szecsenyi J, et al. Antibiotic prescribing for acute lower respiratory tract infections (LRTI) - guideline adherence in the German primary care setting: an analysis of routine data. PLoS One. 2017 Mar 28;12(3):e0174584.[Abstract][Full Text]
33. McCullough AR, Pollack AJ, Plejdrup Hansen M, et al. Antibiotics for acute respiratory infections in general practice: comparison of prescribing rates with guideline recommendations. Med J Aust. 2017 Jul 17;207(2):65-9.[Abstract]
34. Morice AH, Millqvist E, Bieksiene K, et al. ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. Eur Respir J. 2020 Jan;55(1):1901136.[Abstract][Full Text]
35. Hay AD, Little P, Harnden A, et al. Effect of oral prednisolone on symptom duration and severity in nonasthmatic adults with acute lower respiratory tract infection: a randomized clinical trial. JAMA. 2017 Aug 22;318(8):721-30. [Abstract]
36. Hueston WJ. Albuterol delivered by metered-dose inhaler to treat acute bronchitis. J Fam Pract. 1994 Nov;39(5);437-40.[Abstract]
37. Hueston WJ. A comparison of albuterol and erythromycin for the treatment of acute bronchitis. J Fam Pract. 1991 Nov;33(5):476-80.[Abstract]
38. Timmer A, Günther J, Motschall E, et al. Pelargonium sidoides extract for acute respiratory tract infections. Cochrane Database Syst Rev. 2013;(10):CD006323.[Abstract][Full Text]
39. Agbabiaka T, Guo R, Ernst E. Pelargonium sidoides for acute bronchitis: A systematic review and meta-analysis. Phytomedicine. 2008;15:378-385. [Abstract]
40. Kamin W, Maydannik VG, Malek FA, et al. Efficacy and tolerability of EPs 7630 in patients (aged 6-18 years old) with acute bronchitis. Acta Paediatr. 2010;99:537-543.[Abstract][Full Text]
41. Matthys H, Lizogub VG, Malek FA, et al. Efficacy and tolerability of EPs 7630 tablets in patients with acute bronchitis: a randomised, double-blind, placebo-controlled dose-finding study with a herbal drug preparation from Pelargonium sidoides. Curr Med Res Opin. 2010;26:1413-1422.[Abstract]
42. Sierocinski E, Holzinger F, Chenot JF. Ivy leaf (Hedera helix) for acute upper respiratory tract infections: an updated systematic review. Eur J Clin Pharmacol. 2021 Aug;77(8):1113-22.[Abstract][Full Text]
43. Fischer J, Dethlefsen U. Efficacy of cineole in patients suffering from acute bronchitis: a placebo-controlled double-blind trial. Cough. 2013;9:25.[Abstract][Full Text]
44. Gillissen A, Wittig T, Ehmen M, et al. A multi-centre, randomised, double-blind, placebo-controlled clinical trial on the efficacy and tolerability of GeloMyrtol® forte in acute bronchitis. Drug Res (Stuttg). 2013;63:19-27.[Abstract]
45. Kähler C, Derezinski T, Bocian-Sobkowska J, et al. Spicae aetheroleum in uncomplicated acute bronchitis: a double-blind, randomised clinical trial. Wien Med Wochenschr. 2019 Apr;169(5-6):137-148.[Abstract][Full Text]
46. Li J, Chen Y, Yu X, et al. Diagnosis and treatment guideline for Chinese medicine on acute trachea-bronchitis. J Evid Based Med. 2021 Dec;14(4):333-45.[Abstract][Full Text]
47. Xia R, Wang D, Wang Y, et al. Evidence base of randomized controlled trials and guideline recommendations of patent Traditional Chinese Medicines for uncomplicated acute lower respiratory tract infections in adults. J Tradit Chin Med. 2018 Aug;38(4):490-503.[Abstract]
Key Articles
Other Online Resources
Referenced Articles
Sign in to access our clinical decision support tools