Jeffrey A Linder, MD, MPH, FACP
Jeffrey A. Linder, MD, MPH, FACP is the Michael A. Gertz Professor of Medicine and chief of general internal medicine and geriatrics at the Northwestern Medicine Feinberg School of Medicine, Chicago.
A cough that lasts for weeks can get in the way of work and social activities, disturb your sleep and, in the era of COVID-19, earn you some hostile glances at the grocery store. But if the malady causing your cough is a typical case of acute bronchitis, basically, a chest cold, then there’s good news: It will go away, usually within three weeks. And you won’t need an expensive medical workup or an antibiotic prescription to get better.
The problem is that too many people with acute bronchitis, a common illness, get over tested and overtreated. That’s costly for patients and the health-care system. More importantly, it exposes millions of people every year to treatment that does them no good and can cause them harm. It also contributes to a major public health problem: the rise of bacteria that are resistant to antibiotics.
Here’s what you need to know when you might have acute bronchitis, and how to feel better safely.
Bronchitis is an inflammation of the bronchial tubes, the passages that let air in and out of your lungs. When these airways are inflamed, your chest may feel full or tight and you may cough up mucus. After a while, your cough may become dry. Other symptoms can include shortness of breath, a low-grade fever, and wheezing.
Some people develop chronic bronchitis, long-term inflammation of the bronchial tubes, because of smoking or exposure to other airway irritants. Their symptoms can linger for months and return year after year.
Acute bronchitis is different. It’s usually caused by the same common viruses that cause colds and the flu. Less often, it’s caused by bacteria. The coughing of acute bronchitis may last longer than the initial cold and flu symptoms but typically subsides within three weeks without treatment.
If you visit your health-care provider with a cough that’s been bothering you for a few days or weeks, you should expect to answer a few questions and undergo a quick exam. These days, you should also expect a test for COVID-19. Your provider will also want to rule out some other possible causes, especially pneumonia, an infection of the air sacs of the lungs that can be more serious than bronchitis. A racing heart, rapid breathing, a temperature of at least 100.5 F, and the sound of fluid or other abnormalities in your lungs are possible signs of pneumonia. But if you don’t have any of those signs or another condition that would explain your symptoms (such as asthma or chronic obstructive pulmonary disease), acute bronchitis may be diagnosed.
Additional tests, including chest x-rays and tests of your blood, respiratory secretions, and sputum (the mucus you cough up), haven’t been shown to be helpful in people with healthy immune systems who appear to have acute bronchitis.
There’s a disconnect in the United States between how acute bronchitis is treated and how expert groups recommend it should be treated. Surveys consistently show that two-thirds or more of patients are prescribed an antibiotic. Antibiotics work only against bacterial infections. Most acute bronchitis cases are caused by viruses, not bacteria. That means that most people get medications that have no chance of improving their symptoms but a good chance of causing side effects such as yeast infections, diarrhea, and long-lasting disruptions in gut microbes. Some people suffer allergic reactions. Even people with bronchitis caused by bacteria are unlikely to benefit from antibiotics in any significant way, studies suggest. In addition, antibiotic overuse promotes the growth of drug-resistant bacteria.
The best treatments for acute bronchitis are the simplest: rest, plenty of fluids, and time. People who have a fever or body aches can feel better with some ibuprofen or acetaminophen. If you have wheezing or shortness of breath, you may benefit from an inhaled beta-
agonist, a medicine used for asthma. Home remedies, such as honey, warm drinks, humidifiers, and steamy showers, are safe and often helpful.
And while studies have not found clear benefits from cough medicines, over-the-counter medications that contain the ingredient guaifenesin are safe for adults and children over age 4. These medicines thin mucus and might reduce coughing.
If you cough for more than four weeks, cough up blood, develop a high fever, experience chest pain, or start to feel worse overall, contact your provider. You might then benefit from additional tests or treatments.
