What are the signs and symptoms of bronchitis?

Signs and Symptoms of Bronchitis

Acute Bronchitis

Acute bronchitis presents primarily as a cough lasting 1-3 weeks, often accompanied by upper respiratory symptoms such as sore throat or rhinorrhea. 1

Primary Clinical Features

• Cough is the hallmark symptom, typically lasting up to 3 weeks (mean resolution 8-15 days in children), though it may persist up to 6 weeks in adults 1, 2
• The cough may be dry or productive with sputum that can be clear, white, yellow, or green 1, 3
• Purulent (green or yellow) sputum does NOT indicate bacterial infection—purulence results from inflammatory cells or sloughed epithelial cells and occurs with both viral and bacterial causes 1

Associated Symptoms

• Mild constitutional symptoms including malaise and low-grade fever 1
• Upper respiratory symptoms such as rhinorrhea, nasal congestion, and sore throat typically precede the cough 1
• Wheezing or chest tightness may occur due to transient bronchial hyperresponsiveness 1

Critical Distinction from Pneumonia

Pneumonia is unlikely if ALL of the following are absent: 1

• Tachycardia (heart rate >100 beats/min)
• Tachypnea (respiratory rate >24 breaths/min)
• Fever (oral temperature >38°C)
• Abnormal chest examination findings (rales, egophony, tactile fremitus, or focal consolidation)

Chronic Bronchitis

Chronic bronchitis is defined by chronic cough and sputum production occurring on most days for at least 3 months in each of 2 consecutive years, after excluding other causes of chronic productive cough. 1

Defining Characteristics

• Persistent productive cough with regular sputum expectoration 1
• Chronic mucus hypersecretion due to goblet cell hyperplasia and submucosal gland hypertrophy 1
• Symptoms typically associated with chronic exposure to respiratory irritants, particularly cigarette smoke 1

Acute Exacerbation of Chronic Bronchitis

An acute exacerbation presents as sudden deterioration in a stable patient with increased cough, increased sputum volume, sputum purulence, and/or worsening shortness of breath, often preceded by upper respiratory infection symptoms. 1

Key features of exacerbation include: 1

• Increased sputum production and purulence
• Worsening dyspnea
• Increased cough frequency and severity
• Often preceded by viral upper respiratory symptoms

Important Caveats

• Other conditions must be excluded during exacerbations, including pneumonia, pulmonary embolism, pneumothorax, congestive heart failure, and exacerbation of bronchiectasis 1
• Persistent or newly developed chronic bronchitis is associated with continued smoking, worse lung function, greater exacerbation frequency, and worse quality of life 4

Bronchiolitis (Infants and Young Children)

Bronchiolitis in children under 2 years presents with tachypnea, wheeze and/or crackles following an upper respiratory illness. 1

Clinical Presentation

• Rhinitis and cough typically begin first 1
• Progression to tachypnea, wheezing, rales, use of accessory muscles, and/or nasal flaring 1
• Most children (90%) are cough-free by day 21 1
• Chronic cough persisting beyond 4 weeks post-bronchiolitis may represent a different clinical problem requiring evaluation per pediatric chronic cough guidelines 1