Acute bronchitis
- Fysiobasen
- Sep 8
- 5 min read
Acute bronchitis is an acute inflammation of the large airways (bronchi) in the lungs. The condition typically causes cough, often with mucus, and frequently presents in primary care and emergency settings. Acute bronchitis is one of the ten most common reasons for doctor visits among adults¹. Approximately 5% of all adults experience an episode of acute bronchitis annually. The disease is most prevalent in children, especially under the age of three, and is most often seen in connection with colds, pharyngitis, or influenza³.
Causes and Pathophysiology
Acute bronchitis is most often caused by viral infection. The most common viruses include rhinovirus, influenza virus, coronavirus, parainfluenza virus, respiratory syncytial virus, and metapneumovirus². Bacterial infection is rare but may occur, particularly with Bordetella pertussis (whooping cough), Mycoplasma pneumoniae, or Chlamydophila pneumoniae. Other triggers include allergens and irritants such as smoke, dust, and air pollution¹.
During infection, an acute inflammatory process develops in the bronchi, leading to swelling, increased mucus production, and shedding of epithelial cells. This results in cough, which often persists for several weeks. In some cases, an upper respiratory tract infection spreads to the lower airways, causing acute bronchitis.
Epidemiology and Risk Factors
Acute bronchitis affects all age groups, but children are particularly vulnerable. The disease is often seasonal, occurring most frequently in the winter months³. Children with asthma, cystic fibrosis, or other chronic respiratory conditions are at increased risk. Additional risk factors include exposure to smoke, air pollution, underlying heart or lung disease, and weakened immune function.
Symptoms and Clinical Presentation
The predominant symptom is cough, which may be dry or productive. The sputum is usually clear or yellow, but rarely green as seen in bacterial pneumonia. Other symptoms include:
Sore throat, runny nose, and common cold symptoms
Mild fever, headache, muscle aches
Wheezing on exhalation (expiratory wheeze)
Shortness of breath and mild chest discomfort
In some cases, difficulty breathing, particularly in children or individuals with asthma
Symptoms typically last from a few days up to three weeks. If the cough persists longer, or is accompanied by high fever and reduced general condition, other diagnoses such as pneumonia should be considered.
Diagnosis
Acute bronchitis is primarily a clinical diagnosis based on patient history, physical examination, and the absence of signs of pneumonia or other severe illness. Important assessments may include:
Auscultation of the lungs to rule out crackles or other signs of pneumonia
Measurement of oxygen saturation, temperature, and pulse
Chest X-ray (only if pneumonia is suspected)
Sputum or blood tests performed only in special cases (severe illness, elderly patients, or immunocompromised individuals)
In elderly or severely ill patients, further investigations may be necessary to rule out other causes of cough, such as heart failure or pulmonary embolism.
Differential Diagnoses
In cases of persistent or unusual cough, other diagnoses should be considered, particularly:
Asthma (may be misdiagnosed as bronchitis)
Pneumonia
Acute or chronic sinusitis
Bronchiolitis (in young children)
COPD
Gastroesophageal reflux disease (GERD)
Viral pharyngitis
Heart failure
Pulmonary embolism⁴
Treatment and Medical Management
The management of acute bronchitis is primarily supportive:
Patient education: Explain that the illness usually resolves spontaneously within three weeks and that antibiotics rarely have an effect. Overuse of antibiotics increases the risk of resistance and side effects⁵.
Pain relief: Paracetamol or ibuprofen can be used for fever, sore throat, and pain.
Hydration: Adequate fluid intake is important to keep mucus thin and easier to clear.
Cough suppressants: Generally not recommended, but may be used short-term for troublesome dry cough.
Bronchodilators: Can be considered for patients with significant wheezing or dyspnea but should be used cautiously and only if effective.
Avoid irritants: Smoking and exposure to dust or pollution should be avoided as they worsen symptoms.
Hospital admission: Indicated only in cases of severe illness, high-risk patients, or complications.
Antibiotics are reserved for exceptional cases, such as confirmed pertussis, immunosuppressed patients, or suspected bacterial complications.
Physiotherapy
Physiotherapy in acute bronchitis mainly aims to maintain airway patency, promote effective mucus clearance, and improve oxygenation and ventilation. The physiotherapist adapts interventions according to the patient’s age, symptoms, and functional level, always considering contraindications before initiation¹.
Interventions and Methods
1. Postural Drainage
This involves positioning the patient in different postures so that gravity assists in draining mucus from the various lung segments. For example, side-lying or prone positioning at approximately a 45-degree angle can be used, provided there are no contraindications (e.g., head injury or unstable condition). Institutional guidelines should always be followed when selecting drainage positions.
2. Manual Techniques
The physiotherapist may use gentle clapping (percussion), shaking, and vibration over the chest to loosen and mobilize mucus in the airways. These techniques must be applied with caution, particularly in young children, elderly patients, or individuals with reduced general health.
3. Breathing Exercises and Coughing Techniques
Active Cycle of Breathing Technique (ACBT): A structured method where the patient alternates between deep breathing, relaxed breathing, and huffing/coughing to mobilize and clear mucus.
Deep and diaphragmatic breathing: Enhances oxygen uptake, improves lung expansion, and prevents shallow breathing.
Coughing technique: Training in effective coughing, including the use of support holds if needed. Patients should be encouraged to cough voluntarily throughout the day, while avoiding overexertion and fatigue.
Thoracic expansion exercises: Aimed at improving chest wall movement and overall lung ventilation.
4. Secretion Mobilization
Patients are encouraged to move as much as tolerated and to use breathing exercises actively to help loosen and clear mucus. In some cases, devices such as a PEP (positive expiratory pressure) valve may be considered.
5. Education and Self-Care
Instruction in effective nose blowing (into tissue, not swallowing secretions, and disposing of tissues immediately).
Advice on good hand hygiene to prevent transmission of infection.
Education for family/caregivers that cough may persist even after the acute infection resolves, and that this is normal.
The use of a humidifier in the bedroom may help reduce airway irritation associated with post-bronchitis dry cough.
6. Home Exercises and Follow-Up
Treatment can be performed 3–4 times daily, depending on severity. In cases of worsening symptoms or new respiratory infections, therapy should be initiated promptly to prevent progression to more serious conditions.
Special Considerations for Children
Children with acute bronchitis and their families should be taught to recognize warning signs of deterioration and know when to seek medical attention. It is particularly important to avoid exposure to smoke and pollution, and to ensure a balanced diet to strengthen the immune system.
Prevention
Preventive measures include good hand hygiene, avoidance of smoking in the home, and reduced exposure to air pollution. For children with recurrent infections, minimizing contact with others who have respiratory infections is especially important.
References:
Singh A, Avula A, Zahn E. Acute Bronchitis. [Updated Nov 20, 2020]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448067/ [accessed 05.07.2025]
Kinkade S, Long NA. Acute bronchitis. American Family Physician. 2016;94(7):560–5.
Radiopaedia. Bronchitis. Available from: https://radiopaedia.org/articles/acute-bronchitis [accessed 05.07.2025]
Singh A, Avula A, Zahn E. Acute Bronchitis. In: StatPearls [Internet]. StatPearls Publishing; 2019.
UpToDate. Acute Bronchitis in Adults. Available from: https://www.uptodate.com/contents/acute-bronchitis-in-adults/print [accessed 05.07.2025]
Sutton PP, Pavia D, Bateman JR, Clarke SW. Chest physiotherapy: a review. Eur J Respir Dis. 1982;63(3):188–201.
Lord of Physiotherapy. Postural Drainage. Available from: http://www.youtube.com/watch?v=TPZsP1ujg0U [accessed 05.07.2025]
enmurrcp. RT Chest Physiotherapy Demonstration. Available from: http://www.youtube.com/watch?v=ErMTXJLE5es [accessed 05.07.2025]
pbg03. Active Cycle of Breathing Technique. Available from: http://www.youtube.com/watch?v=hq32_LThDE4 [accessed 05.07.2025]
Fleming DM, Elliot AJ. The management of acute bronchitis in children. Expert Opin Pharmacother. 2007;8(4):415–26.
