Bronchitis: Acute vs. Chronic – Symptoms, Causes, and Management

Bronchitis is inflammation of the bronchial tubes. Acute and chronic forms differ in etiology, duration, and management.

Acute Bronchitis

• Cause: Viral (>90%: rhinovirus, influenza, RSV, coronavirus); bacterial rare (<10%).
• Course: Self-limited, 1–3 weeks; cough may linger 3–4 weeks (post-viral bronchial hyperresponsiveness).
• Symptoms: Cough (dry → productive), low-grade fever, malaise, wheeze.
• Management: Supportive (hydration, honey, humidifier, NSAIDs). Antibiotics not indicated unless pertussis suspected or high-risk for pneumonia (COPD, immunocompromised).

Chronic Bronchitis

• Definition: Productive cough ≥3 months/year for 2 consecutive years (COPD phenotype).
• Cause: Cigarette smoke (primary), air pollution, occupational dusts.
• Pathology: Mucous gland hyperplasia (Reid index >0.4), goblet cell metaplasia, airway fibrosis.
• Management: Smoking cessation (only intervention slowing decline), bronchodilators (LAMA/LABA), pulmonary rehab, vaccinations, treat exacerbations (antibiotics if purulent sputum + dyspnea).

Red Flags for Referral

• Hemoptysis, weight loss, persistent fever, dyspnea at rest, known malignancy, immunosuppression.