From the Guidelines
Bronchitis can progress to pneumonia in some cases, particularly in individuals with weakened immune systems, the elderly, young children, smokers, or those with underlying health conditions. Bronchitis is inflammation of the bronchial tubes (airways) while pneumonia is infection of the lung tissue itself. The progression typically happens when the infection spreads deeper into the lungs. According to the American College of Physicians, acute uncomplicated bronchitis is typically a self-limited infection of the large airways, usually caused by a virus 1. However, if bacterial pneumonia develops, antibiotic treatment would be necessary, with specific medications determined by your healthcare provider based on the type of bacteria and your medical history.
Signs that bronchitis might be developing into pneumonia include:
- Worsening cough with increased mucus production
- Higher fever
- Chest pain
- Difficulty breathing
- Fatigue If you have bronchitis and notice these symptoms worsening rather than improving after 7-10 days, seek medical attention. Most cases of acute bronchitis resolve on their own with rest, increased fluid intake, and over-the-counter medications for symptom relief. The evaluation of adults with an acute cough illness or a presumptive diagnosis of uncomplicated acute bronchitis should focus on clinically ruling out serious illness, particularly pneumonia 1.
It is essential to note that routine antibiotic treatment of uncomplicated acute bronchitis is not recommended, regardless of the duration of cough, as most of the time, acute bronchitis is the result of a viral illness that is self-limited, and will improve on its own 1. However, if bacterial pneumonia is suspected, antibiotic treatment should be initiated promptly to prevent further complications. Patients can benefit from analgesics, antipyretics, beta-agonist inhalers, antitussives, or vaporizers to relieve symptoms.
From the Research
Bronchitis Progression to Pneumonia
- Bronchitis can potentially progress to pneumonia, especially in certain patient populations 2, 3, 4, 5.
- The use of inhaled corticosteroids in patients with chronic obstructive pulmonary disease (COPD) and chronic bronchial infection may increase the risk of pneumonia 2.
- Patients with severe or very severe COPD, frequent or severe exacerbations, and those with underlying chronic bronchitis are at a higher risk of developing pneumonia 2, 3, 4.
- Antibiotics may be indicated in patients with acute bronchitis who are at increased risk of developing pneumonia, such as those 65 years or older 4, 5.
- The presence of certain symptoms, such as tachypnea, tachycardia, dyspnea, or lung findings suggestive of pneumonia, can indicate the need for further evaluation and potential treatment for pneumonia 5.
Risk Factors and Prevention
- Viruses are responsible for more than 90 percent of acute bronchitis infections, and antibiotics are generally not indicated for bronchitis 4, 5.
- The use of long-term or intermittent antibiotic treatment can help prevent COPD exacerbations and hospitalizations, but may also increase the risk of adverse events and bacterial resistance 2.
- Strategies to reduce inappropriate antibiotic use, such as delayed prescriptions, patient education, and calling the infection a chest cold, can help prevent unnecessary antibiotic use and potential complications 5.