Bronchitis: Symptoms, Types, Causes and Treatment

Bronchitis is a common respiratory condition that affects millions of people worldwide each year. It can range from a short-term illness that resolves on its own to a chronic, ongoing respiratory challenge that significantly impacts quality of life. Whether you’ve experienced a nagging cough after a cold or know someone managing chronic symptoms, understanding bronchitis is key to effective management and better health outcomes.

In this comprehensive guide, we’ll explore the hallmark symptoms, different types, causes, and current evidence-based treatments for bronchitis. Let’s dive in to demystify this frequently misunderstood condition.

Symptoms of Bronchitis

Many people first suspect bronchitis when a cough just won’t go away. But bronchitis involves more than just a persistent cough. Understanding the full range of symptoms is crucial for timely recognition and management.

Symptom	Description	Duration	Source(s)
Cough	Persistent, with/without phlegm	Days to weeks	4 11 14 17
Sputum	Clear, yellow, or green mucus	Variable	14 17
Dyspnea	Shortness of breath	Acute or chronic	2 3 14
Fatigue	Feeling unusually tired	Common	2 17
Chest Discomfort	Pain or tightness	Especially with cough	19
Wheezing	Whistling sound when breathing	Some cases	4 11 14
Sleep Disturbance	Trouble sleeping	Due to cough	2

Table 1: Key Symptoms

The Major Symptoms Explained

Cough: The Defining Symptom

• Acute bronchitis starts with a cough that can last up to 3 weeks, often following a cold or respiratory infection. The cough may be dry or productive (bringing up mucus) 4 11 17.
• Chronic bronchitis is defined by a productive cough present most days for at least three months, over two consecutive years, excluding other causes 14.

Sputum Production

• Mucus may be clear, yellow, or green. The color does not reliably indicate bacterial infection 4.
• Sputum volume and character are especially important in chronic bronchitis, where persistent mucus hypersecretion is a core feature 14.

Other Common Symptoms

• Shortness of breath (dyspnea): More common in chronic forms, especially when there is airflow obstruction 2 3 14.
• Fatigue and malaise: These symptoms often accompany the respiratory complaints, reflecting systemic effects of infection and inflammation 2 17.
• Chest discomfort and wheezing: Chest pain or tightness can occur, especially during coughing fits, and wheezing may be present in some cases 4 11 14 19.
• Sleep disturbance: Nighttime coughing and breathlessness can interfere with sleep quality 2.

Atypical and Associated Symptoms

• Irritability, anxiety, and helplessness: More commonly reported in certain groups, such as women and younger patients, especially with chronic bronchitis 2.
• Extrapulmonary symptoms: Chronic bronchitis, especially when associated with COPD, may be aggravated by conditions like gastroesophageal reflux disease (GERD) or post-nasal drip, which can worsen cough and sputum production 5.

Types of Bronchitis

Bronchitis isn’t a one-size-fits-all diagnosis. It encompasses several forms, each with distinct features, causes, and implications.

Type	Description	Duration / Course	Source(s)
Acute Bronchitis	Sudden onset, often after a cold; self-limited	<3 weeks	4 11 15 17
Chronic Bronchitis	Persistent cough/sputum >3 months/year, 2 years	Long-term	3 7 8 14
Simple Chronic Bronchitis	Mucus hypersecretion, minimal obstruction	Chronic	7 8
Mucopurulent Chronic Bronchitis	Recurrent/persistent infection, purulent sputum	Chronic	7 8
Chronic Obstructive Bronchitis	With airflow obstruction (often in COPD)	Chronic	7 8 13
Protracted Bacterial Bronchitis	Cough >4 weeks, responds to antibiotics	Subacute	10

Table 2: Bronchitis Types

Acute Bronchitis

• Onset: Follows a viral upper respiratory infection (“chest cold”).
• Course: Cough (with or without sputum) lasting up to 3 weeks, often resolving without intervention.
• Key distinction: Must be differentiated from pneumonia and asthma; pneumonia generally presents with systemic signs and abnormal chest examination 4 11 15 17.

Chronic Bronchitis

• Definition: Cough and sputum most days for at least 3 months per year, for two consecutive years, not attributable to other diseases 14.
• Subtypes:
  • Simple chronic bronchitis: Persistent mucus production, little to no airflow obstruction 7 8.
  • Mucopurulent chronic bronchitis: Frequent or persistent infections, purulent (pus-like) sputum 7 8.
  • Chronic obstructive bronchitis: Airflow limitation is present, often as part of COPD 7 8 13.
• Clinical significance: Chronic bronchitis can lead to progressive lung function decline and increased risk of exacerbations, especially in smokers 13.

Protracted Bacterial Bronchitis (in Children)

• Features: Cough lasting more than 4 weeks, typically improves with antibiotics.
• Differential diagnosis: Must be distinguished from bronchiectasis and chronic suppurative lung disease if persistent 10.

Causes of Bronchitis

The triggers behind bronchitis vary depending on the type and patient risk factors. Both infectious and non-infectious causes play a role.

Cause Type	Examples / Details	Prevalence / Importance	Source(s)
Viral	Influenza, parainfluenza, RSV, rhinovirus	Most common (acute)	4 11 15 17
Bacterial	Mycoplasma, Chlamydia, Bordetella (rare); S. pneumoniae, H. influenzae (in AECB)	Less common; more in exacerbations	4 11 12 15 17
Environmental	Smoking, air pollution, workplace exposure	Major risk for chronic	3 13 14
Host Factors	Age, genetics, asthma, lung cancer, family history	Increases susceptibility	3 14
Extrapulmonary	GERD, post-nasal drip	Worsen symptoms	5

Table 3: Bronchitis Causes

Infectious Causes

Viral Infections

• Acute bronchitis: Over 90% of cases are due to viruses, including influenza A/B, parainfluenza, respiratory syncytial virus (RSV), rhinoviruses, coronaviruses, and adenoviruses 4 11 15 17.
• Transmission: Spread by respiratory droplets, especially in crowded or institutional settings 17.

Bacterial Infections

• Acute bronchitis: Bacteria cause less than 10% of cases. Notable exceptions include:
  • Bordetella pertussis: Especially in unvaccinated or incompletely immunized adults/children 11 15.
  • Mycoplasma pneumoniae, Chlamydia pneumoniae: Can cause acute episodes or outbreaks 11 15.
• Chronic bronchitis exacerbations: Bacterial superinfection is more common, particularly with Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis 12.

Environmental and Lifestyle Factors

• Smoking: The most significant risk factor for developing chronic bronchitis. Tobacco smoke damages airway linings, leading to chronic inflammation and mucus overproduction 3 13 14.
• Air pollution and occupational exposures: Dust, fumes, and chemicals in the environment or workplace can trigger or worsen bronchitis, especially in susceptible individuals 3 13.

Host and Comorbid Factors

• Age and genetics: Older adults and those with a family history of lung disease are at higher risk 3.
• Pre-existing lung conditions: Asthma, COPD, and lung cancer increase susceptibility and severity 3 14.
• Extrapulmonary contributors: GERD and post-nasal drip can aggravate bronchitis symptoms, particularly cough and sputum production 5.

Treatment of Bronchitis

Treatment depends on the type and severity of bronchitis, as well as underlying risk factors and comorbidities. Evidence-based strategies focus on symptom relief, risk reduction, and, in some cases, targeted therapy.

Approach	Application / Details	Effectiveness / Risks	Source(s)
Supportive Care	Rest, fluids, humidified air	Foundation for acute cases; effective	4 11 15 17
Symptom Relief	Cough suppressants, pain relievers	May help some; limited evidence	4 11 19
Antibiotics	Only for suspected/confirmed bacterial causes or high-risk patients	Minimal benefit in most; risk of resistance	4 11 15 16 17 20
Inhaled Bronchodilators	For wheeze or underlying airway disease	May help select chronic cases	14
Smoking Cessation	All chronic cases	Key for long-term improvement	13 14
Airway Clearance	Chest physiotherapy, positive expiratory pressure (PEP)	May help chronic cases	18
Herbal Remedies	Pelargonium sidoides extract (EPs 7630)	Some benefit in acute bronchitis	19

Table 4: Bronchitis Treatment Options

Supportive and Symptomatic Care

• Rest and hydration: Mainstay for both acute and chronic bronchitis. Staying well-hydrated thins mucus, making it easier to clear 4 11 15 17.
• Humidified air: Can soothe irritated airways and help loosen secretions.
• Cough suppressants and pain relievers: May provide short-term relief, especially for severe cough interfering with sleep, but evidence is limited 4 11.

Antibiotics: Use With Caution

• Acute bronchitis: Routine antibiotics are NOT recommended due to the viral nature of most cases and minimal benefit shown in trials 4 11 15 16 17 20.
  • Modest reductions in cough duration (less than one day) do not outweigh risks like side effects or resistance 16 20.
  • Exceptions: Suspected pertussis, high-risk elderly or immunocompromised patients, or when pneumonia is not fully excluded 11 15 16.
• Chronic bronchitis exacerbations: Antibiotics may be necessary if there is evidence of bacterial infection (e.g., increased sputum purulence, volume, or breathlessness) 12 14.

Inhaled Bronchodilators and Other Medications

• For chronic or obstructive bronchitis: Inhaled beta-agonists, anticholinergics, or corticosteroids may improve symptoms, especially in patients with wheezing or underlying COPD 14.
• Expectorants and mucolytics: Limited evidence for benefit; not routinely recommended 14.

Lifestyle and Non-Pharmacologic Interventions

• Smoking cessation: The most effective step for halting disease progression in chronic bronchitis 13 14.
• Airway clearance techniques: Chest physiotherapy and devices like positive expiratory pressure (PEP) masks may reduce cough and exacerbations in chronic cases 18.
• Herbal treatments: Preparations like Pelargonium sidoides extract (EPs 7630) may provide symptom relief in acute bronchitis, with low risk of adverse effects 19.

Special Considerations

• Children: Avoid cough and cold preparations in children under six due to safety concerns 4.
• Prevention: Annual influenza vaccination and avoidance of respiratory irritants are important preventive steps.

Conclusion

Bronchitis is a diverse and common respiratory condition, spanning short-lived viral infections to chronic illnesses linked to smoking and environmental exposures. Recognizing the symptoms, types, causes, and current treatment recommendations is vital for effective care and prevention of complications.

Key Takeaways:

• Cough is the hallmark symptom, often with sputum, and can last from days (acute) to months or years (chronic) 4 11 14 17.
• Acute bronchitis is usually viral and self-limited; antibiotics are rarely needed 4 11 15 17 20.
• Chronic bronchitis is defined by prolonged cough and sputum, most often linked to smoking or environmental exposures 3 13 14.
• Treatment focuses on supportive care, symptom relief, and risk factor modification; antibiotics are reserved for specific scenarios 4 11 15 16 17 20.
• Smoking cessation is the most important intervention for chronic bronchitis 13 14.
• Novel therapies and non-pharmacologic measures (like airway clearance) may benefit selected patients 18 19.
• Careful diagnosis and patient education help prevent unnecessary medication use and foster better outcomes.

By understanding bronchitis in all its forms, patients and healthcare providers can work together to achieve better respiratory health and quality of life.