Bronchitis
Bronchitis is inflammation of the lining of the bronchi, the tubes carrying air from the windpipe into the lungs.
On this page
- What it looks like and how long it lasts
- Why an antibiotic is usually not needed
- Signs that mean calling an ambulance
- When the cough is no longer just bronchitis
- What genuinely eases things
- Chronic bronchitis and COPD are a different story
- Who has the harder time
- How not to pass it on and not to catch it again
- Online consultation
Medicines commonly prescribed for Bronchitis
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 500 mgActive substance: paracetamolManufacturer: Galenicum Health S.L.U.Prescription requiredDosage form: EFFERVESCENT TABLET, 1000 mgActive substance: paracetamolManufacturer: Industria Quimica Y Farmaceutica Vir S.A.Prescription requiredDosage form: TABLET, 1 gActive substance: paracetamolManufacturer: Industria Quimica Y Farmaceutica Vir S.A.Prescription not required
Bronchitis is inflammation of the lining of the bronchi, the tubes carrying air from the windpipe into the lungs. Almost always it is set off by a virus, the same sort that causes a cold: it travels down from the nose and throat, the lining swells, produces more mucus, and a cough begins. It feels unpleasant — the cough scrapes at the chest, wrecks sleep and drags on for weeks — but in a healthy adult it clears on its own. The two questions people actually have are when to start worrying and why no antibiotic is being offered.
What it looks like and how long it lasts
It nearly always begins like a cold: a scratchy throat, a blocked nose, a mild temperature, aching limbs. A day or two later the cough arrives, and it is what remains once everything else has gone.
At first the cough is dry and raw; later phlegm comes up. It may be clear, white, yellow or greenish. The colour of phlegm says nothing about whether an antibiotic is needed. Yellow and green come from the cells that arrive at the inflammation and break down, not from bacteria; the widespread belief that green phlegm calls for an antibiotic has not held up.
Alongside it there may be a burning soreness behind the breastbone when coughing, breathlessness on exertion, wheeze, a hoarse voice and general flatness. Any fever is usually modest and lasts two or three days.
The cough lasts about three weeks on average. In some people it stretches to four or six, and that alone does not mean something has gone wrong: the lining takes time to rebuild. What should prompt attention is not the length but the direction. A cough that is slowly easing is running its normal course; getting worse again after a period of improvement is not.
Why an antibiotic is usually not needed
The great majority of acute bronchitis is viral. Antibiotics have no effect on viruses at all, so there is no relief to be had from them.
This has been tested many times, comparing an antibiotic against a dummy tablet. The gain came to roughly half a day less coughing, while upset stools, rashes and other side effects turned up noticeably more often. There is a separate price too: bacterial resistance, which builds up both in the person and around them.
There are situations where an antibiotic genuinely belongs: suspected pneumonia, whooping cough, a flare of long-term lung disease, weakened immunity or serious underlying illness. That is a decision made by a doctor after examining, and it rests on what can be heard in the chest, on temperature, breathing and overall condition — never on the colour of phlegm.
Signs that mean calling an ambulance
- breathing is hard even at rest: you are short of air and cannot finish a sentence;
- lips, tongue or skin turn blue, grey or blotchy;
- sudden confusion: not knowing where you are, losing the thread of simple things;
- severe chest pain, especially if it is unrelated to coughing and spreads to the arm or jaw;
- coughing up a lot of blood — not streaks, but blood;
- a child who cannot be woken or who is unusually floppy.
Do not drive yourself in that state. Call for help and, while you wait, put together the list of medicines you take.
When the cough is no longer just bronchitis
This is the most useful part of any conversation about bronchitis. The word is convenient because it explains the cough — and that is exactly why something else can hide behind it for months.
- Pneumonia. A high temperature lasting beyond three or four days, or returning after an improvement, pain on one side of the chest when breathing in, and faster breathing and pulse. That calls for examination, not for waiting.
- Whooping cough. Bouts of coughing that are hard to break out of, a whooping breath in, vomiting at the end of a bout, and looking well in between. It runs for months. Adults get through it fairly easily but pass it to babies, for whom it is genuinely dangerous.
- Tuberculosis. A cough of more than three weeks together with night sweats, an evening temperature and weight loss.
- Lung tumour. In a smoker, or anyone past forty, a cough that has not cleared in over three weeks, has changed in character, or comes with streaks of blood needs a chest X-ray rather than another course of syrup.
- Asthma. A cough with no preceding cold, at night and towards morning, after exertion, in cold air or with dust, often with a wheeze on breathing out.
- Heart failure. The cough is worse lying down, a second pillow appears, and the ankles swell by evening.
- Reflux and medicines. Heartburn with coughing after meals; and some blood pressure medicines cause a dry cough in their own right, starting weeks after they are begun.
It is worth being seen even without any of this if the cough passes three weeks, or if you are pregnant, over sixty-five, taking medicines that suppress immunity, or living with long-term lung, heart, kidney or liver disease or with diabetes.
What genuinely eases things
There is nothing to treat the virus with, and nothing needed, but the illness can be made considerably easier to sit through.
- rest and sleep: the body is spending energy on the inflammation and should not have it taken away;
- plenty of fluids, which thin the phlegm so it comes up more easily;
- paracetamol or ibuprofen for aching and fever;
- a spoonful of honey in a warm drink soothes the throat and quietens the cough; honey is not given under the age of one;
- moist air and a room free of dust and strong smells;
- stopping smoking at least for the duration: smoke adds weeks to the cough.
Cough syrups do little, and in adults their benefit is on a par with a warm drink. There is no sense in taking a cough suppressant and an expectorant together: they work against each other. Children under six should not be given cough medicines without a doctor's instruction.
Chronic bronchitis and COPD are a different story
Chronic bronchitis is the name for a cough with phlegm present on most days over three months of the year, repeated in two consecutive years. It is a description, not a separate infection: in someone who has smoked for years or breathed dust at work, the lining remodels itself and produces mucus continuously.
If on top of that air leaves the lungs less well than it should and does not recover, the term is chronic obstructive pulmonary disease. The two cannot be equated: chronic bronchitis exists without obstruction, and lung disease exists without heavy phlegm. What separates them is spirometry, a straightforward breathing test done at a local clinic.
The difference is a practical one. A smoker's long-running cough often gets filed under "chronic bronchitis" and lived with, while what is being missed is either reversible asthma or a disease that can be slowed but not undone.
Who has the harder time
- people who smoke, and those who have lived alongside smokers for years;
- people with asthma, long-term lung disease or heart failure;
- those working with dust, solvents, welding fumes, flour or grain;
- older people and those with weakened immunity;
- children in their first years: in the very young, similar symptoms more often mean bronchiolitis.
How not to pass it on and not to catch it again
What is catching is not the bronchitis itself but the virus behind it, and it spreads exactly as a cold does.
- cover your mouth and nose with a tissue when coughing or sneezing and bin it straight away; with no tissue, cough into your elbow;
- wash your hands with soap after coughing, after sneezing and on getting home;
- stay at home while you have a temperature, and keep away from babies and older relatives;
- air the rooms: viruses linger longer in still air;
- consider the seasonal flu vaccination, particularly if you are over sixty-five, pregnant or living with a long-term condition;
- stop smoking: it is the one thing that really changes how often bronchitis comes and how long it stays.
Online consultation
In an online appointment a doctor can go through how the cough started and how it has changed, what you have already tried, whether there is breathlessness, fever or blood in the phlegm, and take account of your age, your smoking history and your other conditions. That is often enough to show whether an in-person examination and a chest X-ray are needed, whether there is any case for an antibiotic, and what should worry you over the coming days.
This material is for information only and does not replace medical advice.
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