Bronchitis is a common respiratory condition characterized by inflammation of the bronchial tubes, the airways responsible for carrying air to and from the lungs. While bronchitis can present in both acute and chronic forms, acute bronchitis is far more common and is frequently encountered in outpatient clinics, emergency departments, and hospital settings.
For respiratory therapists and other healthcare professionals, understanding acute bronchitis is essential because it often mimics more serious respiratory diseases, contributes to patient discomfort and impaired ventilation, and requires appropriate assessment and patient education rather than aggressive intervention.
This article focuses specifically on acute bronchitis, its pathophysiology, clinical presentation, management strategies, and its relevance to the field of respiratory care.
What Is Acute Bronchitis?
Acute bronchitis is a short-term inflammatory condition affecting the bronchial airways, usually caused by a viral infection. The inflammation leads to increased mucus production, airway irritation, and coughing. In most cases, acute bronchitis develops after an upper respiratory tract infection such as the common cold or influenza.
Unlike pneumonia, acute bronchitis does not involve infection of the alveoli, and unlike asthma or COPD, it does not typically cause long-term airway remodeling or persistent airflow obstruction. The condition is self-limiting in the majority of patients and usually resolves within one to three weeks, although coughing may persist longer.
Acute bronchitis is one of the most common reasons patients seek medical care for respiratory symptoms, particularly during cold and flu season.
Causes of Acute Bronchitis
The vast majority of acute bronchitis cases are viral in origin. Common pathogens include:
- Influenza viruses
- Rhinovirus
- Coronavirus (non-COVID strains and COVID-19)
- Respiratory syncytial virus (RSV)
- Parainfluenza virus
Bacterial causes are uncommon and account for a small percentage of cases. When present, they may involve organisms such as Mycoplasma pneumoniae, Chlamydophila pneumoniae, or Bordetella pertussis.
Noninfectious irritants can also contribute to acute bronchitis, including exposure to tobacco smoke, air pollution, chemical fumes, and dust. These factors can exacerbate airway inflammation and prolong recovery.
Pathophysiology
In acute bronchitis, infectious or irritant exposure triggers inflammation of the bronchial mucosa. This inflammatory response leads to:
- Hyperemia and edema of the airway lining
- Increased mucus secretion from goblet cells
- Impaired ciliary function
- Narrowing of the airways due to swelling and secretions
These changes disrupt normal airflow and mucus clearance, resulting in coughing as the body attempts to clear secretions from the airways. Although airflow limitation may occur, it is usually mild and reversible.
From a respiratory therapy standpoint, this process highlights why patients may experience wheezing, chest tightness, and dyspnea despite having otherwise healthy lungs.
Clinical Signs and Symptoms
The hallmark symptom of acute bronchitis is cough. Other common features include:
- Productive or nonproductive cough
- Thick or discolored sputum
- Chest discomfort or burning sensation
- Wheezing or rhonchi on auscultation
- Mild shortness of breath
- Low-grade fever
- Fatigue and malaise
Importantly, sputum color alone does not reliably indicate bacterial infection. Green or yellow sputum is often seen in viral illnesses and should not automatically prompt antibiotic therapy.
Vital signs are usually stable, and oxygenation is typically preserved. Significant hypoxemia, high fever, or focal lung findings should raise suspicion for pneumonia or another more serious condition.
Diagnosis and Assessment
Acute bronchitis is primarily a clinical diagnosis based on patient history and physical examination. Diagnostic testing is often unnecessary unless red flags are present.
From a respiratory therapist’s perspective, assessment should include:
- Respiratory rate and pattern
- Oxygen saturation via pulse oximetry
- Breath sounds, noting wheezes, rhonchi, or diminished airflow
- Cough characteristics and sputum production
- Signs of respiratory distress or accessory muscle use
Note: Chest X-rays are generally not indicated unless pneumonia is suspected. Pulmonary function testing is rarely needed but may reveal transient airflow limitation in some patients.
Management and Treatment
Treatment of acute bronchitis is largely supportive and focused on symptom relief. Since most cases are viral, antibiotics are not recommended and offer no clinical benefit.
Common management strategies include:
- Adequate hydration to thin secretions
- Antipyretics and analgesics for fever and discomfort
- Cough suppressants for severe or disruptive cough
- Short-acting bronchodilators for patients with wheezing or bronchospasm
Respiratory therapists may be involved in administering aerosolized bronchodilators, particularly in patients with underlying reactive airway disease or significant wheezing. However, routine bronchodilator therapy is not necessary for all patients.
Patient education is a critical component of care. RTs play an important role in explaining the expected course of the illness, proper inhaler technique if prescribed, and the limited role of antibiotics.
Relevance to Respiratory Therapists and Respiratory Care
Acute bronchitis is highly relevant to respiratory therapists because it is frequently misinterpreted as asthma exacerbation, pneumonia, or COPD flare. RTs are often called upon to assess breath sounds, evaluate oxygenation, and determine whether aerosol therapy or oxygen is truly indicated.
In emergency departments and clinics, RTs help differentiate acute bronchitis from more serious lower respiratory conditions. This prevents unnecessary treatments, reduces antibiotic overuse, and supports evidence-based care.
Additionally, respiratory therapists play a key role in:
- Patient education regarding smoking cessation
- Teaching effective coughing and airway clearance techniques
- Monitoring patients with comorbid respiratory disease
- Preventing progression to more severe illness through early recognition
Note: Understanding acute bronchitis also reinforces the importance of infection prevention, vaccination, and proper respiratory hygiene.
Acute vs. Chronic Bronchitis
Although they share a name, acute and chronic bronchitis are distinct conditions with different causes, clinical courses, and implications for respiratory care.
Acute Bronchitis
Acute bronchitis is a short-term inflammatory condition, usually caused by viral infection. It occurs suddenly, lasts a few weeks, and resolves completely without permanent lung damage. Patients are often otherwise healthy, and lung function typically returns to normal.
Chronic Bronchitis
Chronic bronchitis, on the other hand, is a form of chronic obstructive pulmonary disease (COPD). It is defined by a productive cough lasting at least three months in two consecutive years. Chronic bronchitis is most commonly caused by long-term smoking or environmental exposure and leads to permanent airway changes, mucus hypersecretion, and airflow limitation.
Note: For respiratory therapists, distinguishing between these two conditions is critical. Acute bronchitis requires reassurance and supportive care, while chronic bronchitis demands long-term disease management, airway clearance strategies, and ongoing respiratory monitoring.
Prognosis and Prevention
The prognosis for acute bronchitis is excellent. Most patients recover fully without complications. However, cough may persist for several weeks due to residual airway inflammation.
Prevention strategies include:
- Hand hygiene and respiratory etiquette
- Annual influenza vaccination
- Avoidance of tobacco smoke and irritants
- Use of masks during high-risk exposures
Note: RTs are well-positioned to educate patients on preventive measures, especially those at higher risk for respiratory complications.
Bronchitis Practice Questions
1. What is acute bronchitis?
A short-term inflammatory condition of the bronchial airways that is most often caused by a viral infection.
2. Which part of the respiratory system is primarily affected in acute bronchitis?
The bronchial tubes.
3. How does acute bronchitis differ from pneumonia?
Acute bronchitis does not involve infection or consolidation of the alveoli.
4. How does acute bronchitis differ from asthma or COPD?
It does not cause chronic airway remodeling or persistent airflow obstruction.
5. What is the most common cause of acute bronchitis?
Viral respiratory infections.
6. Which viruses are commonly associated with acute bronchitis?
Influenza, rhinovirus, coronavirus, RSV, and parainfluenza viruses.
7. Are bacterial infections a common cause of acute bronchitis?
No, bacterial causes account for only a small percentage of cases.
8. Which bacteria are occasionally associated with acute bronchitis?
Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Bordetella pertussis.
9. What noninfectious factors can contribute to acute bronchitis?
Exposure to tobacco smoke, air pollution, chemical fumes, and dust.
10. What pathophysiologic changes occur in the airways during acute bronchitis?
Inflammation, edema, increased mucus production, and impaired ciliary function.
11. Why do patients with acute bronchitis develop cough?
Cough occurs as the body attempts to clear excess secretions from inflamed airways.
12. What is the hallmark symptom of acute bronchitis?
Cough
13. What type of cough may be present in acute bronchitis?
Productive or nonproductive
14. What adventitious lung sounds are commonly heard in acute bronchitis?
Wheezes and rhonchi
15. Does discolored sputum indicate a bacterial infection in acute bronchitis?
No, sputum color alone does not reliably indicate bacterial infection.
16. What vital sign findings are typically seen in uncomplicated acute bronchitis?
Vital signs are usually stable with preserved oxygenation.
17. What findings should raise concern for a more serious condition such as pneumonia?
Significant hypoxemia, high fever, or focal lung findings.
18. How is acute bronchitis usually diagnosed?
Through clinical history and physical examination.
19. When is a chest x-ray indicated in suspected acute bronchitis?
Only when pneumonia or another serious condition is suspected.
20. What is the primary goal of treatment for acute bronchitis?
Symptom relief and supportive care.
21. Are antibiotics routinely recommended for acute bronchitis?
No, antibiotics are not recommended because most cases are viral.
22. What supportive treatments are commonly used for acute bronchitis?
Hydration, antipyretics, analgesics, and cough suppressants if needed.
23. When may bronchodilators be helpful in acute bronchitis?
When wheezing or bronchospasm is present.
24. Why is patient education important in acute bronchitis?
To explain the expected course of illness and reduce unnecessary antibiotic use.
25. How long does acute bronchitis typically last?
Symptoms usually resolve within one to three weeks, though cough may persist longer.
26. Why is acute bronchitis often mistaken for asthma or pneumonia?
Because symptoms such as cough, wheezing, and chest discomfort can overlap.
27. What role does airway inflammation play in acute bronchitis symptoms?
It narrows airways and increases mucus, contributing to wheezing and dyspnea.
28. How does acute bronchitis affect airflow?
Airflow limitation may occur but is usually mild and reversible.
29. What is the prognosis for patients with acute bronchitis?
Excellent, with most patients recovering fully without complications.
30. What preventive measures can reduce the risk of acute bronchitis?
Hand hygiene, vaccination, avoidance of smoke and irritants, and respiratory etiquette.
31. During which season is acute bronchitis most commonly seen?
Fall and winter, coinciding with cold and flu season.
32. What underlying condition can make acute bronchitis symptoms more severe?
Preexisting reactive airway disease.
33. Why is cough often prolonged after acute bronchitis resolves?
Residual airway inflammation persists after infection clears.
34. What auscultation finding may improve after coughing in acute bronchitis?
Rhonchi caused by airway secretions.
35. Does acute bronchitis usually cause significant hypoxemia?
No, oxygenation is typically preserved.
36. What respiratory pattern may be observed due to airway irritation?
Mild tachypnea.
37. Why is routine sputum culture not recommended in acute bronchitis?
The condition is usually viral and self-limiting.
38. What chest discomfort is commonly described by patients with acute bronchitis?
A burning or tight sensation behind the sternum.
39. Can acute bronchitis cause transient wheezing in patients without asthma?
Yes, due to airway inflammation and mucus.
40. Why should smokers be counseled during an acute bronchitis episode?
Smoking worsens airway inflammation and delays recovery.
41. What airway clearance strategy may help relieve symptoms?
Effective coughing and adequate hydration.
42. What physical exam finding helps differentiate acute bronchitis from pneumonia?
Absence of focal crackles or consolidation signs.
43. What pulse oximetry finding is expected in uncomplicated acute bronchitis?
Normal oxygen saturation
44. Can acute bronchitis cause fever?
Yes, usually low-grade if present.
45. What is the primary mechanism behind wheezing in acute bronchitis?
Airflow through narrowed, inflamed airways.
46. Why are inhaled corticosteroids not routinely used in acute bronchitis?
Airway inflammation is transient and self-resolving.
47. What patient population is at increased risk for prolonged symptoms?
Older adults and those with chronic lung disease.
48. Why is rest encouraged during recovery from acute bronchitis?
It reduces metabolic demand and supports immune recovery.
49. What finding suggests that acute bronchitis has progressed to another condition?
Worsening dyspnea with declining oxygen saturation.
50. How does acute bronchitis affect mucus clearance?
Ciliary dysfunction reduces effective mucus transport.
51. Why should hydration be emphasized in treatment?
It helps thin secretions and improves cough effectiveness.
52. What type of cough suppressant may be used cautiously?
Short-term antitussives for severe, disruptive cough.
53. Can acute bronchitis cause chest pain with coughing?
Yes, due to airway irritation and muscle strain.
54. What is the expected lung exam finding after recovery?
Return to normal breath sounds.
55. Why is patient reassurance an important part of care?
Symptoms can be persistent but are usually benign.
56. What role does vaccination play in prevention?
It reduces viral infections that commonly trigger bronchitis.
57. Can acute bronchitis occur without sputum production?
Yes, especially early in the illness.
58. What airway sounds may be absent despite significant coughing?
Crackles, unless another pathology is present.
59. Why should unnecessary imaging be avoided?
It does not change management in uncomplicated cases.
60. What is the most important indicator of recovery from acute bronchitis?
Gradual resolution of cough and respiratory symptoms.
61. What type of lung sound is most commonly heard early in acute bronchitis?
Scattered rhonchi due to mucus in the larger airways.
62. Why does coughing tend to worsen at night with acute bronchitis?
Supine positioning promotes mucus pooling in the airways.
63. Can acute bronchitis cause temporary airflow obstruction?
Yes, due to airway inflammation and mucus narrowing the bronchi.
64. What symptom often prompts patients to seek medical care?
Persistent cough lasting several days.
65. Why is deep breathing sometimes uncomfortable in acute bronchitis?
Inflamed airways increase chest wall and airway sensitivity.
66. What finding would argue against uncomplicated acute bronchitis?
Localized dullness to percussion.
67. Why are antivirals not routinely prescribed for acute bronchitis?
Most cases resolve without specific antiviral therapy.
68. What environmental exposure can prolong symptoms?
Continued exposure to smoke or air pollutants.
69. What happens to ciliary function during acute bronchitis?
It becomes impaired, reducing mucus clearance.
70. Why may breath sounds sound harsher during auscultation?
Inflammation increases airflow turbulence.
71. Can acute bronchitis occur without fever?
Yes, fever is absent in many cases.
72. What cough characteristic helps differentiate acute bronchitis from asthma?
Cough is usually the dominant symptom without chronic reversibility.
73. Why should patients be advised to avoid cold air?
Cold air can trigger coughing and bronchospasm.
74. What is a common misinterpretation of wheezing in acute bronchitis?
That it always indicates asthma.
75. Why is reassurance about illness duration important?
Cough may persist for weeks despite recovery.
76. What respiratory finding often normalizes first during recovery?
Respiratory rate
77. What physical activity recommendation is appropriate during illness?
Light activity as tolerated, avoiding overexertion.
78. Why should dehydration be avoided?
Thickened secretions are harder to clear.
79. What breath sound change may signal improvement?
Decreased rhonchi after coughing.
80. Can acute bronchitis increase work of breathing?
Mildly, especially during coughing episodes.
81. What role does airway irritation play in symptom persistence?
It maintains cough reflex sensitivity.
82. Why is acute bronchitis considered a diagnosis of exclusion?
Serious causes of cough must be ruled out first.
83. What auscultation finding suggests secretions are mobilizing?
Coarse sounds that shift with coughing.
84. Why is bed rest not always recommended?
Prolonged inactivity may impair secretion clearance.
85. What clinical sign suggests airway inflammation is resolving?
Reduced cough frequency.
86. Can acute bronchitis exacerbate underlying lung disease?
Yes, especially in patients with asthma or COPD.
87. What patient behavior can delay healing?
Continued smoking during illness.
88. Why should antibiotics be avoided unless clearly indicated?
They provide no benefit in viral illness.
89. What is the expected trend of sputum over time?
It becomes thinner and less frequent.
90. What overall outcome is expected with proper supportive care?
Full recovery without lasting lung damage.
91. Why does acute bronchitis often follow an upper respiratory infection?
Viral spread from the upper to lower airways triggers bronchial inflammation.
92. What airway change directly stimulates the cough reflex in acute bronchitis?
Irritation of bronchial mucosal receptors.
93. Why are breath sounds often variable during the illness?
Mucus movement and airway inflammation change airflow patterns.
94. What clinical feature helps distinguish acute bronchitis from pneumonia?
Normal oxygenation and absence of focal lung consolidation.
95. Why may patients report chest tightness despite normal lung imaging?
Bronchial inflammation increases airway sensitivity.
96. What role does rest play in recovery from acute bronchitis?
It reduces metabolic demand and limits symptom exacerbation.
97. Why can laughter or talking provoke coughing fits?
They increase airflow and irritate inflamed bronchi.
98. What physiologic process explains prolonged cough after infection resolves?
Persistent airway hyperresponsiveness.
99. Why is patient reassurance about cough duration important?
Lingering cough does not indicate ongoing infection.
100. What long-term complication is uncommon in otherwise healthy individuals?
Permanent airflow limitation.
Final Thoughts
Acute bronchitis is a common, self-limiting respiratory condition characterized by temporary inflammation of the bronchial airways. Although it is often uncomfortable and disruptive, it rarely leads to serious complications in otherwise healthy individuals.
For respiratory therapists, acute bronchitis represents an important opportunity to apply clinical assessment skills, avoid unnecessary interventions, and provide patient-centered education.
Understanding how acute bronchitis differs from chronic bronchitis and other lower respiratory conditions ensures accurate diagnosis, appropriate care, and improved outcomes across the spectrum of respiratory care.
Written by:
John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.
References
- Singh A, Avula A, Zahn E. Acute Bronchitis. [Updated 2024 Mar 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.