After bronchitis, a cough often takes two to three weeks to settle: that is normal, and it is not a reason for antibiotics. Some signs, though, change the picture completely. Here is how to tell them apart.
What is acute bronchitis?
Acute bronchitis is inflammation of the airways in the chest, and it usually follows a viral infection of the upper airways — a cold or a flu that has “gone down to the chest”. It begins with a dry cough, which then turns chesty and productive, sometimes with a tight or sore feeling behind the breastbone and a mild fever in the first few days.
In more than nine cases out of ten it is caused by a virus. That is why antibiotics change neither how long it lasts nor how it turns out: the large trials and the international guidelines all agree on this point.
How long does the cough last?
This is the question I am asked most often, and the reason for most unnecessary appointments. After acute bronchitis a cough lasts around three weeks on average, so a cough that is still there after ten days is not abnormal at all.
Most people expect to be better within a week. That gap between expectation and reality explains a large share of the antibiotic prescriptions that achieve nothing. Knowing what to expect saves you the worry — and the pointless treatment.
Coloured phlegm: should you worry?
No. Yellow or green phlegm is not a sign of a bacterial infection: the colour comes from the white blood cells that have moved in to clean the airways, and it is just as common in viral bronchitis. On its own, it is never a reason for antibiotics.
When should you see a doctor?
- if you are short of breath, breathing fast, or have chest pain when you breathe in;
- if a fever lasts more than three or four days, or comes back after you had started to improve;
- if there is blood in the phlegm;
- if the cough lasts more than three weeks, or comes with weight loss or night sweats;
- in someone with asthma, a smoker, an older person, a baby, or anyone living with a long-term condition;
- in a child who is breathing fast, whose ribs pull in with every breath, or who refuses to drink.
What these situations point to above all is pneumonia, which does need an antibiotic — and that is exactly why listening to the chest matters.
How to feel better
Rest, plenty of fluids and humid air are usually all that is needed. In adults and in children over one year old, honey has been shown to work at least as well as over-the-counter cough syrups for a night-time cough — it must never be given before the first birthday.
Cough suppressants work poorly and are not advised when the cough is chesty and productive: that cough is doing a job, clearing the airways. Stopping smoking, even for a few days, makes a clear difference to how fast you recover. If you have asthma and your chest feels tight, inhaled treatment may be needed, and that is worth discussing with a doctor.
Seeing Dr Nathalie Gozlan
Dr Nathalie Gozlan, a general practitioner, can see you for a lingering cough or for bronchitis — as a home visit in the Sharon region (Netanya, Kfar Saba, Raanana, Kadima-Tzoran and the moshavim and kibbutzim nearby), or by video consultation anywhere in Israel; she works in French, Hebrew and English.
Listening to your chest is the key examination here: it is what tells an ordinary bronchitis apart from pneumonia and spares you a pointless antibiotic — or, the other way round, allows one to be prescribed in time.
Frequently asked questions
Does bronchitis need antibiotics?
In the vast majority of cases, no: it is viral, and antibiotics shorten neither the cough nor the illness. They are kept for pneumonia and for a few particular situations, after a medical examination.
My cough has lasted two weeks — should I be worried?
Not in itself: the average cough after bronchitis lasts about three weeks. What matters is the direction it is going — a cough that is slowly easing is reassuring, while one that is getting worse, or comes with fever or breathlessness, needs to be checked.
Does green phlegm mean I need an antibiotic?
No. The colour of phlegm cannot tell a viral infection from a bacterial one. It is not a reason to prescribe.
Can bronchitis be handled by video consultation?
Yes, for a recent cough with no warning signs: advice, treatment for the symptoms and a sick note. As soon as there is breathlessness, a fever that drags on, or any doubt about pneumonia, the chest has to be listened to and a home visit is offered.
This article is for information only and does not replace a medical consultation. If in doubt or in an emergency, see a doctor.