Acute bronchitis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 2 Jun 2025

Last updated: 10 Dec 2024

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.

Definition

Acute bronchitis is defined as a self-limiting lower respiratory tract infection, to distinguish this condition from common colds and other upper respiratory ailments. Bronchitis refers specifically to infections causing inflammation in the bronchial airways, whereas pneumonia denotes infection in the lung parenchyma resulting in consolidation of the affected segment or lobe.

Although there is no universally accepted definition for acute bronchitis, the criteria proposed by MacFarlane offer a practical approach: (a) an acute illness of <21 days; (b) cough as the predominant symptom; (c) at least 1 other lower respiratory tract symptom, such as sputum production, wheezing, chest pain; (d) no alternative explanation for the symptoms.[1] While the MacFarlane criteria state that the symptoms usually last <3 weeks, other studies have shown that cough may linger for >30 days in about a quarter of patients with acute bronchitis.[2] Consequently, acute bronchitis can still be present in patients with coughs lasting >1 month.

This topic focuses on acute bronchitis in adults.

History and exam

Key diagnostic factors

duration of cough <30 days
productive cough
no history of chronic respiratory illness
exclusion of other respiratory and cardiac illness as cause for symptoms

Full details

Other diagnostic factors

fever
wheezes
rhonchi

Full details

Risk factors

viral or atypical bacterial infection exposure
cigarette smoking
household pollution exposure

Full details

Diagnostic tests

1st tests to order

clinical diagnosis

Full details

Tests to consider

pulmonary function test
chest x-ray
C-reactive protein

Full details

Emerging tests

procalcitonin

Treatment algorithm

ACUTE

cough ≤4 weeks

ONGOING

cough >4 weeks

Contributors

Authors

William J. Hueston, MD

Senior Associate Dean for Academic Affairs

Professor of Family and Community Medicine

Medical College of Wisconsin

Milwaukee

Disclosures

WJH receives compensation from the American Physicians' Institute for the development and presentation of continuing physician education material related to primary care respiratory diseases, including acute bronchitis. WJH has received compensation from the Hong Kong Food and Health Bureau’s Research Fund Secretariat to review research grants for respiratory conditions such as acute bronchitis. He is also the author of a number of references cited in this topic.

Acknowledgements

Dr William J. Hueston would like to gratefully acknowledge Dr Ann M. Rodden, a previous contributor to this topic.

Disclosures

AMR declares that she has no competing interests.

Peer reviewers

David L. Hahn, MD

Clinical Professor

School of Medicine and Public Health

University of Wisconsin-Madison

Disclosures

DLH declares that he has no competing interests.

Cristine Radojicic, MD

Staff Physician

Cleveland Clinic

Cleveland

Disclosures

CR declares that she has no competing interests.

Philip W. Ind, BA (Cantab), MB BChir, MA (Cantab), FRCP

Consultant Physician

Honorary Senior Lecturer

Imperial College Healthcare Trust

Hammersmith Hospital

London

Disclosures

PWI declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

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.Full text Abstract

Spurling GK, Del Mar CB, Dooley L, et al. Delayed antibiotic prescriptions for respiratory infections. Cochrane Database Syst Rev. 2017 Sep 7;(9):CD004417.Full text Abstract

Smith SM, Fahey T, Smucny J, et al. Antibiotics for acute bronchitis. Cochrane Database Syst Rev. 2017 Jun 19;(6):CD000245.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Coronavirus disease 2019 (COVID-19)
- Pneumonia
- Allergic rhinitis
More Differentials
Guidelines
- Acute cough due to acute bronchitis in immunocompetent adult outpatients: CHEST expert panel report
- Cough (acute): antimicrobial prescribing
More Guidelines
Patient information
Bronchitis
More Patient information
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Acute bronchitis

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Emerging tests

Treatment algorithm

cough ≤4 weeks

cough >4 weeks

Contributors

Authors

William J. Hueston, MD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

David L. Hahn, MD

Disclosures

Cristine Radojicic, MD

Disclosures

Philip W. Ind, BA (Cantab), MB BChir, MA (Cantab), FRCP

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice