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Acute bronchitis

What's new

The American Academy of Family Physicians (AAFP) has published an updated evidence review on acute bronchitis. A chest X-ray is suggested only for patients with severe symptoms, a combination of typical pneumonia symptoms, or older patients with high clinical suspicion for pneumonia. Routine laboratory tests, including viral and sputum testing, CBC, and inflammatory markers, are not recommended. Patient education and symptom relief are the mainstay of management, as acute bronchitis is self-limiting. OTC cough medications are not recommended. Rest, hydration, humidified air, mist, steam, and nasal saline irrigation may help with symptom relief. Antibiotic prescription should be avoided, as it does not contribute to overall improvement. Patients should be counseled that acute bronchitis lasts an average of 2-3 weeks to set appropriate expectations and reduce unnecessary antibiotic requests. Further evaluation for alternative diagnoses is suggested if symptoms persist beyond or worsen over 3-4 weeks. .

Background

Overview

Definition
Acute bronchitis is a transient inflammation of the tracheobronchial tree in response to infection without a history of chronic pulmonary disease or evidence of pneumonia or sinusitis.
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Pathophysiology
The most common cause of acute bronchitis are viruses (90%) including adenovirus, influenza, measles, respiratory syncytial, parainfluenza, and HSV. Nonvirus (10%) causes include bacteria (Mycoplasma pneumoniae, Bordetella pertussis, and Chlamydia pneumoniae) and inhaled lung irritants.
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Disease course
Inflammation of the tracheobronchial tree results in acute bronchitis, which causes clinical manifestations of cough (dry or productive), chest tightness, burning with or without wheezing, headache, low-grade fever, rhinorrhea, sore throat, malaise, and myalgia.
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Prognosis and risk of recurrence
Acute bronchitis is not associated with an increase in mortality.
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Guidelines

Key sources

The following summarized guidelines for the evaluation and management of acute bronchitis are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2025), the American College of Physicians (ACP 2021), the American College of Chest Physicians (ACCP 2020,2006), the American College of Physicians (ACP/CDC 2016), and the Infectious Diseases Society of America (IDSA ...
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Screening and diagnosis

Diagnostic criteria: as per ACCP 2006 guidelines, diagnose acute bronchitis in patients with an acute respiratory infection manifested predominantly by cough, with or without sputum production, lasting ≤ 3 weeks, if there is no clinical or radiographic evidence of pneumonia, common cold, acute asthma, and COPD exacerbation.
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Diagnostic criteria for acute bronchitis
Symptoms of an acute respiratory infection (predominantly cough, with or without sputum production)
Symptoms lasting < 3 weeks
Pneumonia ruled out clinically and radiographically as the cause of cough
Common cold, acute asthma or an exacerbation of COPD ruled out as the cause of cough
Acute bronchitis is unlikely
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Diagnostic investigations

CXR
As per AAFP 2025 guidelines:
Consider reassuring otherwise healthy patients aged < 70 years with acute cough, normal vital signs, and a normal chest examination (no rales, egophony, or tactile fremitus) that community-acquired pneumonia is highly unlikely.
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Consider obtaining a CXR in patients with severe symptoms, a combination of typical symptoms (such as absence of coryza, presence of dyspnea, rales, or abnormal vital signs), or in older patients when clinical suspicion for community-acquired pneumonia is high.
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More topics in this section

  • Laboratory tests

  • Spirometry

  • Further evaluation

Medical management

Antibiotic therapy: as per AAFP 2025 guidelines, avoid prescribing antibiotics for acute bronchitis, as antibiotics do not contribute to the overall improvement of acute bronchitis.
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More topics in this section

  • Antiviral therapy

  • Symptomatic therapy

Nonpharmacologic interventions

Supportive care
As per AAFP 2025 guidelines:
Recognize that patient education and symptom relief are the mainstays of acute bronchitis management, as it is a self-limiting disease.
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Consider offering rest, hydration, humidified air, mist, steam, and nasal saline irrigation for symptom relief.
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Specific circumstances

Patients with Aspergillus bronchitis
As per IDSA 2016 guidelines:
Obtain both PCR and galactomannan on respiratory secretions, usually sputum, for the detection of Aspergillus species to confirm the diagnosis of Aspergillus bronchitis in non-transplant patients.
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Consider initiating oral itraconazole or voriconazole with therapeutic drug monitoring in non-transplant patients with Aspergillus bronchitis.
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